Online Family-Based Treatment

Online Family-Based Treatment (FBT) is an excellent option for busy families. Even prior to the COVID-19 pandemic, our therapists were delivering FBT by telehealth. We continue to do so. Read on to learn why this is such an amazing potential treatment for your family.

What is Family-Based Treatment?

Family-Based Treatment (FBT) has emerged as a leading therapy with empirical support for the treatment of teens with anorexia nervosa who are medically stable. It also shows support for adolescents with bulimia nervosa and young adults with anorexia nervosa. FBT makes the role of parents central to challenging their adolescent’s eating disorder. The hallmark of the treatment is family meals which parents plan, prepare, serve, and supervise. If purging is an issue, they supervise after meals. They implement strategies to prevent purging, excessive exercise, and other eating disorder behaviors. I often say that FBT is like providing residential treatment in your house for only your child.

FBT is a manualized treatment and usually takes place in approximately 20 weekly sessions with an FBT therapist over a period of about 6 months. A teen should also be monitored by a medical doctor and a dietitian may be involved in helping the parents with meal planning. Fortunately, FBT sessions can be delivered via telehealth. Our practice owner, Dr. Muhlheim, wrote a leading book on FBT.

What is Telehealth or Video Therapy?

Telehealth is the delivery of medical or mental health treatment over live video. There are numerous HIPAA-compliant platforms that treatment professionals use such as Doxy, Zoom, and Vsee. Aside from a reliable internet connection and a private setting, there are no additional requirements for telehealth-delivered mental health care. Telehealth interventions have been used in various forms since 1972. In general, the research shows that therapy delivered via telehealth can be effective for a variety of problems. Telehealth has been successfully applied to both family therapy and the treatment of eating disorders.

The Switch to Telehealth During the Covid-19 Pandemic

One of the most significant impacts of social distancing was a change in the mode of delivery of psychological treatment. Most outpatient therapists, dietitians, and medical doctors moved entirely to telehealth sessions (over the computer). Even many intensive outpatient (IOP) and partial hospitalization (PHP) programs shifted to a telehealth delivery model. Admissions to residential treatment centers were reduced often limited to only the most severely medically compromised patients.

As a result of more stringent admission standards as well as travel restrictions and the transition to online sessions, it appears that a larger number of eating disorder patients will be in the home. Fortunately, Family-Based Treatment (FBT) is a treatment naturally poised to fill the gap created by the Coronavirus.

Research on Online Family-Based Treatment

Kristen Anderson, LCSW and colleagues did a study of FBT for adolescent anorexia utilizing telehealth. They utilized the same treatment manual used in outpatient studies of FBT with minor variations. For example, instead of weighing the patient in the therapist’s office prior to appointments, the parents weighed the patient at home prior to the session and shared the weight with the therapist. The structure of the sessions was the same, with all family members in attendance. The therapist initiated therapy sessions by video conference and met individually with the patient for a few minutes first, followed by a meeting with the entire family for the remainder of the therapy hour.

Anderson and colleagues found that it was feasible to deliver FBT via telehealth. There were no dropouts over the course of the study and the average number of treatment sessions attended was 18.4. Parents found the treatment to be extremely helpful and participants’ weight increased significantly. Meaningful improvements were also noted in eating disorder symptoms as well as depression and self-esteem. Anderson and colleagues concluded, “these findings suggest that this method of delivering FBT may be effective for meeting the treatment demands of adolescents living in areas of the country where there are inadequate treatment resources such as nonurban or rural settings.”

Little did they know that throughout the world, social distancing would create a need for FBT delivered by telehealth!

Online Family-Based Treatment May be Effective When Individual Teen Therapy Over Video Was Not

Many parents reach out to us after finding a teen’s eating disorder did not improve via individual therapy (often delivered over video). They believe the problem was the video platform and that their teen needs to see a therapist in person. Rather than blaming the platform, perhaps it was just that individual therapy for teens with eating disorders is not that effective. In most cases, teens with active eating disorders will not benefit from individual therapy (whether it is online or in person). Online FBT can be effective when individual therapy for a teen’s eating disorder was not helpful because FBT leverages the parents to change behaviors.

Get Help for a Teen’s Eating Disorder With Online FBT Now!

If you are looking for virtual FBT support, we can support families throughout the states of California, New York, Indiana, South Carolina, and Florida in the US. Occasionally we can also provide support for families in some other countries. We use a secure online platform. Please ensure you have a stable internet connection and try to position the video so that all members of the family are in view of the video screen. Learn more about our telehealth services. You can contact us here.

FBT Resources for States Other Than California, New York, Florida, Indiana, and South Carolina

If you are looking for FBT by telehealth in other states and countries, please check out the following websites:

The Training Institute for Child and Adolescent Eating Disorders

Eva Musby’s List of Therapists Providing Telehealth

Sources:

Anderson, K.E., Byrne, C., Goodyear, A. et al. Telemedicine of family-based treatment for adolescent anorexia nervosa: A protocol of a treatment development study. J Eat Disord 3, 25 (2015).

Anderson, KE, Byrne, CE, Crosby, RD, Le Grange, D. Utilizing Telehealth to deliver family‐based treatment for adolescent anorexia nervosa. Int J Eat Disord. 2017; 50: 1235– 1238.