What's that: FBT?
FBT stands for "family based treatment".
This method of treating anorexia was developed at Maudsley Hospital in London in the 1970s and early 1980s. The method is therefore also known as the Maudsley Method (Maudsley Approach). In the US, the method is mainly used by Prof. Daniel Le Grange, and Dr. James Lock continues to develop and research it further. With the help of FBT, countless children around the world have recovered and families have escaped the trap of anorexia in the laste 30 years.
FBT has been well researched in many comparative studies. It is proven to be more effective than any other known anorexia treatment modality. It has become the standard treatment approach in the UK, USA, Canada, New Zealand and Australia. FBT has been developed as a treatment approach for young people up to the age of 18. But the method is also successfully used in a modified form with young adults in the age bracket up to 25 years.
FBT is about avoiding inpatient treatments, which are usually not very effective. Patients are treated at home. Parents are trained and empowered to be able to actively help their child to regain a healthy normal weight, to maintain it and to develop healthy eating habits over the long term.
In general, FBT treatment takes place in three phases, which extend over a period of one to two years: The first phase, the so-called refeeding phase, is primarily about recovering healthy weight. Parents are supported in promoting their child's weight gain.
When a healthy weight level is reached, the patient's mental state and the general mood within the family will have improved significantly, the second phase follows. Age-appropriate autonomy in all areas of life is given back to young people. When it comes to eating itself, the parents still have a monitoring and supportive function, which is scaled back over time.
Only in the third phase are therapeutic problems addressed, if they still exist. In many patients, all psychological abnormalities associated with the anorexic disease disappear.
FBT consists of the following basic principles:
- Parents and family are not the problem. You are the solution. Parents are the sick child's most powerful resource. Nobody in this world is in a position to deal with the child's current problem with more perseverance, intensity and love than their parents. FBT is not based on the assumption that a disrupted family structure or pathological parent-child relationship causes anorexia. Parents must therefore be supported in becoming experts on the disease.
- The most important factor when treatment begins is rapid weight recovery. A full recovery of the child's former healthy weight before the disease came into his or her life. Most young people experience a significant improvement in mental health and mood as their weight increases. Little by little the child that you know comes to the fore again.
- The best place for a sick young person is not a clinic, but their home. It is the best clinic in the world for your child's particular eating disorder. It also has the best, most loving and most indefatigable care team there is: their parents. Excising young individuals from of center of their life and separating them from their families leads to trauma, blocks the recovery process and should therefore be avoided. It is also much easier for sick children and adolescents to regain healthy and normal eating habits in their home and the daily life they are used to.
- It is necessary that the parents take full control over critical areas of life such as eating and exercise for a limited time. The child does not eat – not because they do not want to, but because they cannot. They didn't choose this disease. The disease chose the child. They do not need any additional responsibility for their own eating behavior that they cannot cope with in their current state. There is no need for psychotherapeutic discussions about calories, nutritional values and metabolism. There is no need to search for causes, which in most cases do not exist. They need practical and tangible intensive help. Now.
- A sick child needs competent parents in their situation who know how to enable their child to be able to eat again. Eating and food, body weight, physical appearance: all of these are extremely frightening for anorectic young people. They experience panic attacks and anxiety attacks when sitting in front of a meal. As the disease progresses, more and more food types increasingly become a source of fear. We have to break this often lethal spiral of fear. Mastering so-called fear foods is an essential part of a treatment.
- FBT does focus on the individual genesis of the disease and does not assign blame. This is not relevant for a recovery process. Recent research shows that biological, genetic, and neurological factors play a much larger role in the disease than was previously imagined. Many, many children with anorexia come from completely normal and happy families who are affected by the disease like a force of nature.
- Parents need to learn to separate their child from the disease. The so-called externalizing of the disease is a central component of FBT: It means that the young person is not held responsible for the disease. Realizing and knowing that the child is not responsible for the illness, but that the illness controls the child, very quickly improves most parents' ability to deal with the situation.
- Parents must be enabled to get through this extremely stressful time. Maintaining parents' mental health and fitness is a cornerstone of treatment. Parents need to learn to work together against the disease. Anorexia has a tendency to destroy relationships - both through the extreme psychological stress on the family structure and through mutual (often very subliminal) assignments of blame. Anorexia createsdivides, also in relationships.
There is no question: FBT demands a lot from parents and the whole family. FBT is a treatment method that specifically does not require the patient's consent. Especially at the beginning of treatment, the young patients often oppose the new measures with a lot of aggression and rejection. This is very difficult for parents to endure.
Continuous supervision and care of the child is necessary. Harmful behavior such as an excessive urge to move, self-injuring and vomiting must be stopped. Therefore, one of the child's parents usually stays at home for a longer period of time in order to be able to fulfill this crucial task.
There is no such thing as "the" FBT treatment according to formula X. Every family and every child is different. Every family has to find its own individual way. But not everyone has to reinvent the wheel. There are many effective methods that have helped many families. You can learn from the experience of other parents and get inspiration for your own path.
A very extensive and detailed description of what FBT is and how FBT treatment works can be found here (german language only):