[Parents as Co-Therapists in Home Treatment for Adolescents with Anorexia Nervosa - Factors and Mechanisms]. / Eltern als Ko-Therapeuten im home treatment bei adoleszenter Anorexia nervosa ­Wirkfaktoren und Mechanismen.

Caring for a child with anorexia nervosa (AN) puts a strain on many parents. At the same time, actively involving the parents in treatment to increase their skills tomanage the disorder is important, as it seems to improve the child's prognosis. Home treatment requires the parents to be particularly involved. The aim of this study was to assess parental burden and caregiving skills and the association of these factors with the child's AN pathology in the course of a multidisciplinary home treatment (HoT). After 4 to 8 weeks of inpatient treatment, 22 adolescent patients with AN received home treatment with intensive involvement of their parents as co-therapists. Caregiving burden and caregiving behavior and the symptom severity of the child's AN were assessed using standardized questionnaires on admission to the hospital, at discharge from the HoT, and 1 year after admission (Eating Disorder Inventory-2 (EDI-II), Beck Depression Inventory-2 (BDI-II), Accommodation and Enabling Scale for Eating Disorders (AESED), Eating Disorders Symptom Impact Scale (EDSIS)). Parental burden was reduced and the parents' ability to manage their child's AN improved after the step-down treatment frominpatient treatment to home treatment and was also associated with lower eating disorder-specific psychopathology of the patients. HoT as a treatment setting does not seem to burden the parents as co-therapists and is associated with an improvement in skills in dealing with the child's AN.

Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome.

Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period. Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated. Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: -0.53 to -0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account. Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising.

'Therapists in action'-Home treatment in adolescent anorexia nervosa: A stepped care approach to shorten inpatient treatment.

OBJECTIVE: It was the aim of this pilot study to apply a novel eating disorder (ED)-specific home treatment (HoT) to adolescents with anorexia nervosa (AN) and to investigate its feasibility, effects and safety. METHOD: Twenty-two patients consecutively admitted to the hospital and fulfilling DSM-5 criteria for typical or atypical AN received HoT after 4-8 weeks of inpatient treatment. During the first two months of HoT, the patient and her family were visited on average three to four times per week, during the third and fourth months of HoT once or twice a week by a multi-professional team. Body mass index, ED and general psychopathology, quality of life and treatment satisfaction were assessed in the patients at admission, start and end of HoT and the 1-year follow-up as well as carers' skills and burden. RESULTS: The majority of patients successfully achieved target weight within HoT and maintained it successfully at the 1-year follow-up. ED and general psychopathology in the patients and carers' skills improved significantly associated with a high treatment satisfaction. CONCLUSIONS: HoT seems to be a promising new tool to improve outcome in adolescent AN and to reduce time of hospitalisation. Larger randomised controlled trials are needed to generalise these results.