Sunday 18 December 2016

Why FBT is being adopted in some NHS authorities as first line treatment for young people with anorexia

A couple of years ago when I went to Glasgow to hear James Lock (of Standford University) speak about the evidence for FBT (Family Based Treatment) as an effective treatment model for adolescent eating disorders, I found myself wanting to jump up and down with agreement. But at the same time I also felt immense sadness and fury at the fact that back in the day we, along with numerous other adolescents and their families, were not offered FBT. Back then many UK treatment teams were still adopting the more traditional Adolescent-Focused Individual therapy (AFT) for adolescents with anorexia nervosa. Thankfully times are slowly changing and these days more and more local health authorities are rolling out FBT as first line treatment for young people with anorexia - our home city included. Indeed the evidence for FBT goes back to 2010 (and even further; Maudsley family therapy was initially devised at the Maudsley Hospital in London two decades ago) when, according to Prof Lock, "[researchers found that] family therapy for anorexia more effective than individual therapy".

My son's treatment for anorexia began in 2010, so in a way it's not surprising that we were never offered FBT as a treatment model. It was still being researched and - as far as I am aware - only really adopted by some clinicians in the States (despite the fact that it was first pioneered at London's Maudsley Hospital here in the UK). My problem was that I was discovering more and more about the evidence for FBT (mainly via my US-based contacts along with clinicians from the Maudsley itself) which is why my views clashed with those of CAMHS during my son's eating disorder treatment. Their approach (AFT) and mine (FBT) were diametrically opposed which led to serious triangulation and discord.

I am not saying that FBT is a 'magic bullet', nor that it suits everyone. But there appears to be more evidence for FBT than AFT. And, when faced with an illness that could kill your child, I'd bet my back teeth that any parent would want to try the treatment method for anorexia with the most evidence of success!

Below is a reply to some questions I sent to NHS Greater Glasgow & Clyde about why, in 2013/14, Glasgow & Clyde decided to roll out FBT as first line treatment (from my blog post of 21st March 2014). I'm doing this because it helps to demonstrate that research has found that "a family-based approach was twice as effective as individual therapy for treating adolescent anorexia patients" (from a James Lock article about the evidence for FBT).

The other day I emailed Charlotte Oakley, Clinical Lead, Connect-Eating Disorders, Glasgow & Clyde, Scotland, for more information on Family Based Treatment for eating disorders being rolled out across Scotland. I am immensely grateful to her for taking the time and trouble to reply at length, for allowing me to post the following info and for clarifying the situation which will hopefully help my blog followers to understand what is being done in Scotland - and why. Or at least in Greater Glasgow & Clyde - because, as Charlotte says, she "cannot speak for all of Scotland" although she suspects that other areas are "likely to be the same".

Charlotte says: "The position is Scotland is, briefly, that in NHS Greater Glasgow and Clyde we decided to implement FBT (Family Based Treatment) as first line treatment for young people with anorexia / atypical, and to that end we first had Professor James Lock over to train in 2010.

"Since then we have been monitoring our progress to enable us to be as proficient as we can in the treatment. In 2011 the East of Scotland had Professor Lock to train (Lothian, Borders, Fife health boards). Last week he trained the rest to the health boards from the West and North of Scotland.

"Therefore, in theory, all children and young people in Scotland should have access to a person trained in FBT (Family Based Treatment). (He may becoming back to do more training in September with the eastern health boards.)

"We had a fantastic week at the Scottish Parliament [Scottish Eating Disorder Research Network Meeting - 25th February 2014, Scottish Parliament, Edinburgh] as part of Eating Disorders Awareness Week, and from that I think we will progress with sharing of practice and learning across CAHMS in Scotland, some thing that we have already started with FBT"

I asked her whether alternative eating disorders treatment models would still be available in Scotland for families who, for whatever reason, prefer not to go down the FBT route. She said that, yes, this will be the case and that "families are given the treatment options, including the evidence base for each, to decide what is the best fit for them."

Finally I asked her: "What convinced you that FBT is the way forward for adolescent treatment, especially with an illness that is notoriously difficult to treat and where 'one size may not fit all'?"

She said: "FBT has the best evidence base and the manualised approach enables implementation, as a way of training clinicians, in what we hoped was an effective way and which I think turns out to be the case. I agree that one size may not fit all but there are fundamental elements of the eating disorder that are the same which makes FBT a perfect fit for example a lack of motivation to change by the sufferer and the need for re-nourishment before someone is cognitively able to do any individual therapeutic work. Studies show that FBT is a very acceptable therapy to families, for example we have only a 7% drop-out rate."

Thank you so much, Charlotte, for clarifying the situation (from the viewpoint of NHS Greater Glasgow and Clyde).

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