The death of Robin Williams serves as a harsh reminder of the dangers caused by psychiatric disorders. Yet, while the effects of diseases such as major depressive disorder are devastating, anorexia nervosa – an eating disorder characterized by body image issues that can lead to self-starvation – actually has the highest mortality rate among mental illnesses.
Due to an overwhelming fear of gaining weight, even when of normal or below-normal weight, anorexics suffer from behaviors that can damage both mind and body. Eating too little, purging, over-exercising or other weight-reduction strategies all can lead to severe malnutrition and emaciation, which in turn lead to muscle atrophy, bone density loss, arrhythmias and organ failure. Other illnesses such as depression, anxiety and substance abuse frequently accompany anorexia, as well as increased risk of suicide.
Anorexia is treatable, however. The disease typically appears in early to mid-adolescence, and a 2010 Chicago/Stanford clinical trial found that more than 50 percent of patients who received Family-Based Treatment (FBT) – a strategy that promotes paternal involvement in restoring an adolescent to healthy weight and eating habits – were in full remission after a year-long treatment period.
FBT encourages families to play an active role in restoring their anorexic child to healthy weight, developing healthy eating habits at home and establishing a healthy adolescent identity The trial, which was co-led by Daniel Le Grange, PhD, professor of Psychiatry and Behavioral Neuroscience and director of the Eating Disorders Program at The University of Chicago Medicine, showed that FBT was a stark improvement over other therapy methods, including significantly lowered rates of remission.
In remote, rural or underserved parts of the United States, however, access to a FBT-trained therapist can be difficult. To address the needs of families in these areas, Le Grange, together with Kristen Anderson, LCSW, are co-leading a study to test the efficacy of conducting FBT through telemedicine. The six-month study will provide participating families 20 FBT sessions through a secure video-conferencing system.
Science Life asked Anderson and Le Grange a few questions about the study:
Family-Based Treatment Without Borders F.A.Q.
How does online FBT differ from FBT in person?
We’ve found that there are only slight modifications needed to the treatment manual to deliver FBT through telemedicine. This includes parents weighing their child at home prior to session and sending information to the therapist. Patients are also using the secure messaging system provided by the software to communicate with therapists instead of communicating via email and telephone.
What will sessions be like?
Each therapy session lasts for one hour, and we typically do one session per week. In the beginning phases when weight gain is the first priority, the therapist may see the family for two sessions in one week (i.e., one session on a Monday and one session on a Thursday, for example). Typically as treatment progresses therapy occurs every other week, and then every third week as treatment is completed.
How is success measured?
We want to determine if it is feasible to deliver Family-Based Treatment utilizing a secure internet-based video conferencing system. Treatment outcome relies on a series of measures, including self-report and clinician-administered interviews. These assessments evaluate eating disorder symptoms, self-esteem and other common psychiatric diagnoses including depression and anxiety. Within treatment, weight is a marker for progress. Parents are responsible for weighing patients, and are instructed on how to most accurately weight their adolescent. To understand participants overall experience in treatment, patients, their parents and the study therapist are asked to complete surveys on this topic.
What happens after the 20 sessions are over?
After the 20 sessions are over, if the patient is still symptomatic, we will aid in finding follow-up care for the patient. This may be a therapist near the patient’s hometown, follow up with a psychiatrist, etc. Additionally, the patient may choose to continue care at the University of Chicago.
Will these sessions be secure?
As telemedicine is a growing platform for delivering clinical care, the research team worked with both members of the security and legal teams within University of Chicago medicine to ensure privacy and security are maintained throughout this study.
What are you most excited for regarding the study?
We are excited to understand if delivering this treatment via telemedicine is feasible as it will allow many underrepresented areas of the country receive evidence based treatment. Additionally, we believe that this study has implications for the delivery of other mental health treatment, and could improve both access to care, as well as early-intervention for families facing an eating disorder diagnosis
What’s most important for the lay public to know about the study?
The most important thing the lay public should know about the study is that we are working to make the treatment that is currently most efficacious for adolescent anorexia nervosa available outside of well-known medical centers in urban areas. In other words, we are working on making the treatment available to the public, and to assist families that do not have access to the limited places that currently provide this type of treatment.
Interested participants should contact the research coordinator, Ali Goodyear, at 773-702-0789, or email firstname.lastname@example.org. For more visit, http://psychiatry.uchicago.edu/page/family-based-treatment-without-borders.