Core Components

Family-Based Treatment (FBT), also known as Maudsley method or Maudsley approach, is a manualised intervention for the treatment of child/ adolescent eating disorders, including anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder (OSFED). FBT aims to restore adolescents to health by using parents as the agents for change, and as the best resource for recovery in the therapeutic process. Hence, it relies on the core capacity of parents to feed their child(ren) and assist in recovery from the eating disorder.

FBT adopts an agonistic view and makes no assumptions about the underlying causes of the eating disorder. For this reason, its primary focus is on weight restoration rather than on the psychological aspects that are associated with the disorder. FBT also recognises the eating disorder as an external illness that is separate from the adolescent. Hence, it recognises that the child’s behaviours, thoughts, and feelings (as it relates to food) are not within their control, but are driven by the eating disorder. This in turn helps parents to remain firm when faced with significant resistance, to stay compassionate, and to avoid criticism of their child/ adolescent. 

FBT is typically delivered in three phases, over a period of 6-12 months;

• Phase 1: This phase involves giving parents full control as it relates to re-feeding their child for the purpose of rapidly restoring them to physical health. To achieve this, the therapist equips patents with the knowledge, tools and skills they need to make decisions regarding the type, quantities, and frequency of feeding, and interrupt problematic eating disorder behaviours (e.g. over-exercising, binging and purging).
• Phase 2: This phase is initiated when steady weight gain is achieved, and the signs eating disorder are starting to recede (including control of eating disorder behaviours and easier feeding). In phase 2, the child is given gradual control of their eating in an age-developmentally appropriate manner. A gradual approach to handing over control is adopted in order to reduce chances of reverting to eating disorder behaviours. Parental oversight is in place, and parents are able to reassert control if required.
• Phase 3: As the child/adolescent establishes an age-appropriate level of independence as it relates to eating, the focus of treatment shifts. FBT now focuses on ensuring the family is back on track with normal family life. It also focuses on identifying the developmental challenges that the child will face, as well as the strategies that can be used to address these challenges without resorting to eating disorder behaviours as a coping mechanism.

FBT facilitates the child’s recovery in their own environment and with support from their parents, as opposed to in inpatient or residential treatment programmes.

Fidelity

Fidelity can be enhanced by practitioner training and practitioner adherence to FBT treatment manual. Recorded sessions can be rated for treatment fidelity using validated FBT fidelity measures (1). Regular external and peer supervision can enhance fidelity to treatment.

Modifiable Components

FBT is typically delivered as an outpatient intervention to children and adolescents who live at home with family. However, it can be delivered as part of residential or partial hospitalisation programmes. FBT is available for the treatment of Anorexia Nervosa (AN) and has been adapted for use in the treatment of Bulimia Nervosa (BN) (focused on disrupting patterns of binge eating and purging). FBT has also been adapted for use in the treatment of other eating and weight disorders, including prodromal presentations of AN, Paediatric Obesity (PO), and Avoidant/Restrictive Food-Intake Disorder (ARFID). FBT can be delivered face-to-face or remotely (e.g. via video-conferencing or guided self-help). FBT can be adapted for individuals with neurodevelopmental conditions such as autism. This involves retaining the core elements of FBT and incorporating adaptations based on a robust assessment and formulation of neurodevelopmental needs and preferences. The PEACE Pathway (2) offers structured guidance for adapting FBT for autistic people with eating disorders.

Multifamily Therapy (MFT): MFT shares a conceptual focus with FBT, because MFT also identifies family as the agent of change in recovery from the eating disorder. However, MFT is a more intensive intervention that is delivered in group format. This delivery format is intended to help reduce the isolation and stigma families may feel. Group delivery also enhances mutual support, solidarity, and stimulates new perspectives for the families. MFT consists of a four-day intensive multi-family workshop involving 5-7 families, 5-8 follow-up sessions delivered over 6–9 months, and with individual family sessions delivered between follow-up sessions if needed. The total length of treatment for MFT for each family is typically 12-months.