The aim of this study is to compare the effectiveness of Behavioral Family Systems Therapy (BFST) vs. Ego Oriented Individual Therapy (EOIT) for treating adolescent anorexia nervosa. BFST is predicted to produce better outcomes on weight, eating attitudes, and family relations, while EOIT is predicted to produce better outcomes on ego functioning and depression. Originally, 40 anorectics were to be randomly assigned to BFST or EOIT, treated for 12 months, and assessed at pre, mid-point, post, and at 1-year follow-up. In our first grant, 24 patients were recruited (22 retained), treated (16 mo.), and assessed. Twenty one have completed treatment and constitute the progress report data. Analyses confirm the superiority of BFST over EOIT on weight, and suggest superiority for EOIT on ego functioning. BFST and EOIT both improved significantly on eating attitudes, family relations, and depression. If current effect sizes are maintained when N=40, power analyses suggest we will confirm the differential predictions concerning weight, eating attitudes, ego functioning, and depression. Process analyses indicated that BFST and EOIT therapists carried out treatment with a high degree of fidelity. Analyses of the Vanderbilt Therapy Alliance Scale (VTAS) indicated that adolescents and fathers were more. resistant to BFST than EOIT; mothers reported the strongest therapeutic alliances; the initial impression of the alliance did not change; and that initial alliance ratings predicted outcome 16 months later. With the present continuation, we will faithfully finish the study as originally designed, recruiting, treating, and assessing 20 new anorectics. Recruitment difficulties have been addressed by: 1) allowing sufficient time (3 years); 2) as the IRG advised, hiring an eating-disorder program development expert to conduct the recruitment campaign.
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