Parent Emotion Coaching for Anorexia Nervosa
Condition: Anorexia Nervosa; Atypical Anorexia Nervosa
MeSH terms: Anorexia; Anorexia Nervosa
Study type: Interventional

Summary: 
      Family based treatment (FBT) is the evidence based treatment for pediatric anorexia nervosa
      (AN), but 50% of adolescents do not respond and the consequences for non-response are dire
      (e.g., 11.5% mortality rate). Expressed emotion and parental warmth are significant
      mechanisms of treatment outcome in adolescents with AN, which are not explicitly targeted by
      FBT. The current proposal is a parent emotion coaching skills group designed to augment FBT
      in the treatment of pediatric AN by arming high expressed emotion families with the skills
      necessary to implement FBT and improve treatment outcomes (e.g., weight restoration).
    

Detailed description: 
      Pediatric anorexia nervosa (AN) affects 400,000 adolescents in the US with devastating
      consequences including growth delay, bone density loss, bradycardia, and the highest
      mortality rate of any psychiatric condition (11.5%), with half of all deaths due to suicide.
      Early intervention in adolescents is life-saving, making pediatric AN treatment an important
      public health concern. The goal of pediatric AN treatment is to restore the adolescent back
      to a healthy weight and reverse the dangerous effects of malnutrition. Family based treatment
      (FBT) is the gold standard of treatment for pediatric AN; however, 50% of patients do not
      respond. The consequences of treatment non-response are dire, underscoring the importance of
      improving treatment via augmentations to address non-response. One barrier to treatment
      response in pediatric AN is expressed emotion (EE), which is defined as a family's response
      to an ill patient that is characterized by hostility, critical comments, and emotional
      overinvolvement. Several studies have highlighted that families with high EE undergoing
      treatment for their adolescent with AN have poorer outcomes, including higher drop-out rates,
      lack of weight restoration, and less improvement in eating disorder symptoms. Conversely,
      parental warmth, a facet of EE, is associated with good outcomes in FBT. Recent parenting
      interventions focused on emotion coaching (EC) to address high EE have demonstrated success
      as adjuncts to evidence-based treatments in other pediatric populations (e.g., PTSD, ADHD)
      but have not been applied to pediatric AN. Given the detrimental effects that high EE has on
      the re-feeding process and the benefits of parental warmth, emotion coaching has the
      potential to reduce high EE, increase parental warmth, and improve weight restoration in
      adolescents with AN. The aim of this R34 pilot effectiveness trial is to evaluate the
      effectiveness of a FBT + EC parent group intervention in families with high EE. In Stage 1
      (Feasibility Stage; Year 1), the investigators will conduct preliminary feasibility and
      acceptability testing of an EC parent group intervention in 6 patients with pediatric AN and
      their families who exhibit elevated EE. The data from the Feasibility Stage will be used to
      modify session content to improve treatment delivery and the uptake of EC skills. Once our
      manual is refined and finalized, the investigators will conduct a randomized controlled
      clinical trial (Stage 2) of 50 adolescents and their parents to compare FBT+EC parent group
      (n=25) versus FBT+support (n=25). The FBT+support condition is a general parent support group
      that is offered as part of standard care in the CCHMC Eating Disorders Program. FBT will be
      identical in both the treatment and control conditions, with the EC parent group sessions and
      parent support group sessions occurring separately from the FBT sessions. If the aims of the
      project are achieved, this study would have a large impact on pediatric AN with the potential
      to improve weight restoration outcomes by augmenting FBT for families high in EE.
    

Intervention name(s): Emotion Coaching; Support Group
Intervention type(s): Behavioral; Other
Intervention description(s): Participants randomized to FBT + EC parent group condition will also receive FBT as part of their standard of care. In addition to FBT, they will receive 10 additional, weekly, parent group sessions (each session is 60 minutes, 6-8 group members), within a 3-month time frame to account for cancellations. The EC intervention is designed to reduce expressed emotion (e.g., critical comments) and increase parental warmth. The intervention includes emotional awareness and emotion regulation skills for parents, and emotion communication skills for parents to use with their teens undergoing FBT including active listening, emotion support, labeling emotions, and coping with emotions. The structure of EC parent group sessions will begin with review of homework as applicable, a didactic component to teach new skills, followed by role plays between parents in the group and interventionist, and live coaching and feedback from the interventionist.; Participants randomized to FBT + Support Group parent group condition will also receive FBT as part of their standard of care. In addition to FBT, they will receive 10 additional, weekly, parent group sessions (each session is 60 minutes, 6-8 group members), within a 3-month time frame to account for cancellations. The support group will have a facilitator introduce each topic weekly and parents will discuss. The facilitator's role is to ensure the group remains on topic and on time. Weekly discussion topics include: co-morbid medical diagnoses, understanding levels of care in treatment, taking time off from work, and medications.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: family based treatment; expressed emotion; parent coaching; adolescents