Using a repeated-measures, pre-post therapy design, a pilot study was conducted to assess the effect of Multiple Family Therapy (MFT) on adolescents with Anorexia Nervosa (AN). Between 2007–2010, 32 patients (and their families) underwent MFT at an eating disorders service in Denmark. All were included in the study but12 were excluded from data analysis (primarily for providing incomplete data). The remaining 20 were female, with a mean age of 14.9. Using the Eating Disorder Examination (EDE), the researchers assessed that all met diagnostic criteria (eight for AN; 12 for Eating Disorder Not Otherwise Specified-AN).
Treatment comprised 12 days of MFT over the course of one year, in groups of six-seven patients (and their families).Acknowledged as a limitation by the study’s authors, patients also engaged in additional therapy during the study.
Outcomes of interest were changes in eating disorder symptomology (assessed using the EDE and the Eating Disorder Inventory; EDI); interpersonal issues (assessed primarily using the Inventory of Interpersonal Problems; IIP); and self-image and perceptions of interpersonal relationships (assessed using the Structural Analysis of Social Behaviour Interex; SASB-Intrex). Except for the EDE, all outcomes were self-reported by patients. Data analysis comprised paired sample t-tests of pre-post outcomes. Effect sizes were also reported. The researchers hypothesised reductions would be observed in patients’ eating disorder symptomology and interpersonal problems.
Results showed 13 patients no longer met criteria for an eating disorder diagnosis following treatment. Significant improvements (at the p ≤ 0.05 level) were also observed in BMI, weight concern, eating concern, exercise frequency, restriction, drive (desire) for thinness and interoceptive awareness (awareness of internal body processes such as hunger). Large effect sizes were observed for exercise frequency and restriction. There were not significant improvements in additional EDI/EDE- or IIP-dimensions. Self-affirmation was the only SASB-Intrex dimension that changed significantly.
A strength was that the study was conducted in routine clinical practice, thus minimising the burden of participation. Calculating clinically-significant change was another strength and the observed 65% reduction in the number of patients meeting diagnostic eating-disorder criteria suggests MFT is worthy of further study in this difficult to treat population (although there were significant confounds).
A limitation not discussed was that a large number of t – tests were performed without controlling for them. This inflated the risk that the significant results were the result of chance (a type I error).
There was also a noticeable lack of clarity in the authors’ report. Their hypotheses were vague and did not specify which dimensions of the measures their predictions applied to; unduly increasing the chance that evidence would be found in support of them. The psychometric properties of the measures were also not described (making it difficult to assess their reliability and validity). Finally, as this was a pilot study, it would have been useful to know whether outcomes differed between the different therapy groups and the composition of the families in each group (e.g. the number of single-parent families); in order to inform future research and clinical practice.