Family-Based Therapy for Eating Disorders (FBT)

What is Family-Based Therapy (FBT)?

Family-Based Therapy (FBT), also known as the Maudsley Approach, is an evidence-based treatment designed specifically for adolescents with eating disorders, such as anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder (ARFID). Unlike traditional therapies, FBT actively involves the family in the recovery process, positioning parents and caregivers as the primary agents of change. The primary goal of FBT is to help restore healthy eating behaviors, improve family dynamics, and empower parents to take control of their child’s recovery.

What to Expect from FBT Treatment?

Three Phases of Treatment: FBT is a structured treatment program that typically occurs in three phases over a span of six to twelve months, depending on the severity of the eating disorder and the pace of recovery.
1. Phase One: Parents take an active role in refeeding their child by assuming full control over meals and food choices, with the aim of restoring physical health and weight. During this phase, therapy focuses on empowering the family to support healthy eating without placing blame on the child.
2. Phase Two: After a stable weight is achieved, control of eating is gradually transferred back to the adolescent. The therapist works with the family to develop strategies for the adolescent to regain autonomy in their eating habits in a balanced and healthy manner.
3. Phase Three: This phase focuses on fostering the adolescent’s development of normal adolescent issues, improving family relationships, and maintaining the gains made during treatment. The goal is to ensure that the adolescent’s eating disorder behaviors no longer dominate family life, allowing for healthy development and independence.
Family Involvement: FBT uniquely centers around the family’s involvement, recognizing that parents are crucial in the recovery process. Siblings also play a supportive role in helping their family member recover, though they may not always be directly involved in sessions.
Focus on Weight Restoration and Health: The primary goal of the early stages of FBT is to restore the adolescent’s physical health by normalizing eating patterns and regaining a healthy weight. Emotional and psychological aspects are addressed once physical health is stabilized.

Key Components of FBT

Parental Empowerment: FBT empowers parents to take a leadership role in their child’s recovery. Parents are not blamed for the eating disorder, but instead, they are seen as crucial allies in helping their child overcome the illness.
Refeeding at Home: In the initial phase, parents are responsible for planning and supervising meals to ensure that their child is eating adequately. This helps restore physical health, which is critical for cognitive and emotional recovery.
Gradual Autonomy for the Child: As the child begins to recover, they are gradually given more autonomy over their eating. The process is slow and intentional, ensuring that the adolescent can handle the responsibility without slipping back into disordered eating behaviors.
Family Sessions: Family therapy sessions focus on addressing dynamics within the family that may be influenced by the eating disorder, improving communication, and reducing conflict around food and meals. The therapist helps the family develop a more cohesive and supportive environment.
No Focus on Blame: FBT emphasizes a non-blaming approach, reinforcing that eating disorders are serious mental health conditions, not a result of parenting failures. The goal is to focus on recovery and collaboration.

Common Conditions Treated with FBT

Anorexia Nervosa: FBT is the leading treatment for adolescents with anorexia, especially when the disorder has been present for a relatively short period. It focuses on restoring weight and preventing long-term complications.
Bulimia Nervosa: FBT has also been adapted to treat bulimia in adolescents, focusing on reducing bingeing and purging behaviors while improving the individual’s relationship with food and their body.
Avoidant/Restrictive Food Intake Disorder (ARFID): FBT can be effective in treating ARFID, helping children and adolescents overcome their restrictive eating patterns and expand their food variety.
Other Eating Disorders: FBT can be adapted for other forms of disordered eating where early intervention is critical to prevent chronic issues.

Duration of FBT Treatment

FBT typically lasts between 6 to 12 months, depending on the severity of the eating disorder and the adolescent’s progress. The three-phase approach ensures that treatment moves at a pace suitable for each family, with regular assessments of the adolescent’s physical and emotional recovery. The number of sessions may vary, but FBT is designed to be an intensive, short-term intervention aimed at long-term success.

Why is FBT Effective?

Family as a Key Resource: Unlike individual therapy, FBT leverages the strength and support of the family unit. By placing parents in the driver’s seat, it ensures that adolescents have 24/7 support in their recovery process, which is critical for treating life-threatening eating disorders like anorexia.
Focus on Weight and Health Restoration First: FBT prioritizes the restoration of physical health, recognizing that adequate nutrition and healthy weight are essential for cognitive and emotional healing.
Research-Backed: Numerous studies have demonstrated the effectiveness of FBT, particularly for anorexia nervosa. It is one of the most researched treatments for adolescent eating disorders and has a solid foundation of evidence supporting its use.
Early Intervention: FBT is most effective when implemented early in the course of an eating disorder, making it a critical treatment option for families seeking timely intervention for their adolescent.

FAQs about FBT

How does FBT involve the family?

FBT positions parents and caregivers as key agents in their child’s recovery. Parents take charge of meal preparation and supervision in the early stages, gradually transferring responsibility back to the adolescent as they regain physical and emotional health.

Is FBT only for adolescents?

FBT was originally developed for adolescents with eating disorders, but it has been adapted for younger children and, in some cases, for young adults. Early intervention in adolescents offers the best outcomes, but FBT principles can be applied to older age groups as well.

Do siblings participate in FBT?

Siblings can play a supportive role in the process, though they are not always directly involved in therapy sessions. When appropriate, family therapy may include discussions around sibling dynamics and how they can support their sibling’s recovery.

How is progress measured in FBT?

Progress in FBT is typically measured through the restoration of healthy weight, improved eating patterns, and the reduction of eating disorder behaviors. Emotional and psychological improvements, such as better family communication and reduced anxiety around meals, are also key indicators of success.

Can FBT be done virtually?

Yes, FBT can be conducted via telehealth, especially for families who cannot attend in-person sessions. Virtual FBT can still be effective, provided that the family is committed to the process and maintains regular contact with the therapist.

Stages of Treatment

1. Weight Restoration

Parents take control of the child’s eating to restore weight.

2. Returning Control to the Child

Gradually handing control over eating back to the child.

3. Healthy Independence

Establishing independence while maintaining healthy habits.

Length of Time to See Results

FBT typically lasts 6-12 months, with initial improvements in physical health often seen within a few weeks.