Multifamily Therapy: A Promising Boost for Anorexia Treatment in Teens
"New research suggests that multifamily therapy, when added to single-family therapy, can significantly improve outcomes for adolescents battling anorexia nervosa."
Anorexia nervosa (AN) is a serious and complex eating disorder, particularly affecting adolescents. Family therapy for anorexia nervosa (FT-AN) has emerged as a leading treatment approach, but not all adolescents respond positively. This has spurred research into supplementary therapies to enhance the effectiveness of FT-AN.
Multifamily therapy for anorexia nervosa (MFT-AN) is one such promising approach. In MFT-AN, several families participate in day treatment sessions together, creating a supportive and collaborative environment. While open trials have indicated the potential of MFT-AN, a rigorous randomized controlled trial was needed to confirm its benefits.
A recent study published in BMC Psychiatry has provided valuable insights into the efficacy of MFT-AN. This randomized trial compared the outcomes of adolescents receiving MFT-AN in addition to single-family therapy with those receiving single-family therapy alone. The results offer compelling evidence for the potential of MFT to improve outcomes for adolescents with AN.
Documented Benefits Across the Lifespan
A systematic review reports that multi-family therapy for eating disorders is associated with significant benefits in weight gain and eating-disorder symptoms. It also reports improvements in patients' and parents' depression symptoms and reductions in parents' negative caregiving experiences. A May 6, 2024 narrative review states that recent systematic, scoping, and meta-analytic reviews have expanded the evidence base for multi-family therapy across the lifespan.
Family-Based Care and Emerging Adjuncts
A review of therapeutic approaches to anorexia nervosa reports that adolescents generally respond well to treatment, with family-based therapy consistently associated with improvements in weight and psychological symptoms. Family-based therapy for anorexia nervosa remains a central framework, while multi-family therapy draws on the Maudsley Family Therapy for Anorexia Nervosa model and incorporates psychological and group frameworks. MFT aims to create change through experiential, activity-based content and purposeful use of group processes, but its development reflects efforts to extend or adapt established treatment approaches.
Origins in the 1960s
The concept of multi-family therapy for eating disorders was first reported in the 1960s. The approach involves treating more than one family at the same time and in the same setting. According to the cited historical account, the intervention is increasingly used by eating-disorder services worldwide.
How Multifamily Therapy Enhances Anorexia Treatment
The study, conducted across six specialist eating disorder services in the UK, involved adolescents aged 13-20 diagnosed with AN or other specified eating disorders. Participants were required to be medically stable and have a body mass index (BMI) above a certain threshold. The trial randomly assigned participants to either the FT-AN arm or the MFT-AN arm.
- Improved Outcomes: Adolescents in the MFT group showed significantly higher rates of good or intermediate outcomes at the end of treatment compared to those in the FT-AN group (76% vs 58%).
- Increased BMI: The MFT group also exhibited a higher percentage of median BMI at follow-up.
- High Satisfaction: Despite the greater demands of MFT, families reported high levels of acceptability and satisfaction with the treatment.
Growing Evidence for MFT
Recent reviews describe multi-family therapy as an intervention whose development includes historical work, reported benefits, treatment objectives, and the therapist's role. Research indicates that both family therapy for anorexia nervosa and multi-family therapy are effective treatments for adolescents experiencing anorexia nervosa. A recent study is also described as suggesting that MFT may serve as an adjunct to traditional single-family therapy, with potential benefits for recovery rates and overall well-being.
Added Contact and Incomplete Response
Family therapy for anorexia nervosa currently has the strongest evidence base for medically stable adolescents, but many adolescents treated with FT-AN do not respond. This limitation has prompted efforts to improve FT-AN through adjuncts and adaptations such as MFT. In one comparison, participants received a similar number of single-family therapy sessions, 18.5 versus 19.0, despite the expectation that the MFT group would require fewer sessions. The reported result may reflect the additional therapeutic contact provided by MFT sessions.
The Established Benchmark
International guidelines recommend single-family treatment for adolescents with anorexia nervosa. The cited multicenter trial describes a global consensus that early and efficacious intervention is important because it may reduce the risk of chronic illness and limit comorbidities. Comparative evidence is more limited for other family-therapy approaches: the cited review reports that none included more than 16% of the total adolescents with anorexia nervosa studied.
The Future of Anorexia Treatment: Integrating Multifamily Therapy
The study's findings suggest that MFT holds considerable promise as an adjunct to single-family therapy for adolescents with anorexia nervosa. However, further research is needed to identify the active components of MFT that contribute to improved outcomes. Future studies should focus on testing the effectiveness of individual and combined components to inform well-informed components analysis. This will help determine whether complex treatments like MFT can be simplified and made less resource-intensive, ultimately benefiting more adolescents and families affected by anorexia nervosa.
A Promising but Developing Evidence Base
A systematic review examined quantitative and qualitative evidence on multi-family therapy for eating disorders, including changes in physical and psychological symptoms and broader outcomes. Reviews also describe recent growth in theoretical, quantitative, and qualitative reports on MFT. Together, these sources support viewing MFT as a promising intervention whose evidence base is continuing to develop rather than as a replacement for established care.