Lei Zhang, Hanlai OuYang, Yin Ding, Sufang Peng, Han Chen, Hui Han, Rui Gao, Yue Liu, Li Mei, Yan Chen, Huiqin Han, Lian Gu, Jue Chen
The intervention was successfully delivered in an online format and demonstrated acceptable feasibility, with moderate retention across the intervention and follow-up periods. Exploratory clinical analyses suggested significant reductions in caregiver burden (ZBI; F(4, 31.61) = 12.96, p < 0.001) and eating-disorder-related family impact (EDSIS; F(4, 37.19) = 8.78, p < 0.001) over time. Significant improvements emerged by Week 8 and were maintained at follow-up. Patients' BMI also increased significantly across the study period (F(4, 33.95) = 32.65, p < 0.001). In contrast, caregivers' general psychological distress showed no significant improvements relative to baseline.
OBJECTIVE: This pilot study aimed to examine the feasibility and acceptability of a 12-week intensive, multidisciplinary, synchronous online intervention for caregivers of children and young adults with anorexia nervosa (patient age range: 10-24 years) that integrated Family-Based Therapy (FBT) principles with Dialectical Behavior Therapy (DBT) skills training. A secondary aim was to explore preliminary changes in caregiver and patient outcomes.
METHOD: Using a single-arm, pre-post design, 45 caregivers from 26 families (patients' mean age = 16.19 years, SD = 3.57, range = 10-24) completed assessments at baseline (T0), Week 4 (T1), Week 8 (T2), post-intervention (Week 12, T3), and 3-month follow-up (Week 24, T4). The 12-week program (approximately 57 contact hours) comprised weekly theory workshops, multidisciplinary clinical rounds, and skills practice sessions. The primary outcome was caregivers' subjective burden (Zarit Burden Interview, ZBI); secondary outcomes included eating-disorders-related family impact (Eating Disorders Symptom Impact Scale, EDSIS), caregivers' general psychological distress (Depression Anxiety and Stress Scale, DASS-21), and AN patients' Body Mass Index (BMI). Linear mixed models with unstructured covariance structures examined changes over time, with Bonferroni-adjusted pairwise comparisons and Hedges' g effect sizes.
RESULTS: The intervention was successfully delivered in an online format and demonstrated acceptable feasibility, with moderate retention across the intervention and follow-up periods. Exploratory clinical analyses suggested significant reductions in caregiver burden (ZBI; F(4, 31.61) = 12.96, p < 0.001) and eating-disorder-related family impact (EDSIS; F(4, 37.19) = 8.78, p < 0.001) over time. Significant improvements emerged by Week 8 and were maintained at follow-up. Patients' BMI also increased significantly across the study period (F(4, 33.95) = 32.65, p < 0.001). In contrast, caregivers' general psychological distress showed no significant improvements relative to baseline.
DISCUSSION: This pilot study provides preliminary evidence that an intensive online intervention integrating FBT and DBT can be feasibly delivered and is acceptable to Chinese caregivers of youth with AN. Exploratory findings suggested potential benefits for caregiver burden, eating-disorder-related family impact, and patient BMI; however, the single-arm design precludes conclusions regarding intervention effectiveness. These findings should therefore be considered hypothesis-generating and warrant evaluation in future randomized controlled trials.