Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

Thomas Jewell; Moritz Herle; Lucy Serpell; Alison Eivors; Mima Simic; Peter Fonagy; Ivan Eisler

doi:10.1007/s00787-021-01930-3

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

Thomas Jewell, Moritz Herle, Lucy Serpell, Alison Eivors, Mima Simic, Peter Fonagy, Ivan Eisler

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Abstract

Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

Original language	English
Journal	European Child and Adolescent Psychiatry
Early online date	30 Dec 2021
DOIs	https://doi.org/10.1007/s00787-021-01930-3
Publication status	Published - 30 Dec 2021

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Attachment and mentalization as predictors_ECAP_Author accepted manuscriptAccepted author manuscript, 335 KBLicence: CC BY
Jewell 2021 Attachment and Mentalization as Predictors in FT-AN_ Published version in ECAPFinal published version, 636 KBLicence: CC BY

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title = "Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa",

abstract = "Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.",

author = "Thomas Jewell and Moritz Herle and Lucy Serpell and Alison Eivors and Mima Simic and Peter Fonagy and Ivan Eisler",

note = "Funding Information: This study was supported by National Institute of Health Research (NIHR) Clinical Doctoral Research Fellowship, Tom Jewell, CDRF-2014-05-024. Dr Moritz Herle is funded by a fellowship from the Medical Research Council UK (MR/T027843/1). Publisher Copyright: {\textcopyright} 2021, The Author(s).",

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T1 - Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

AU - Jewell, Thomas

AU - Herle, Moritz

AU - Serpell, Lucy

AU - Eivors, Alison

AU - Simic, Mima

AU - Fonagy, Peter

AU - Eisler, Ivan

N1 - Funding Information: This study was supported by National Institute of Health Research (NIHR) Clinical Doctoral Research Fellowship, Tom Jewell, CDRF-2014-05-024. Dr Moritz Herle is funded by a fellowship from the Medical Research Council UK (MR/T027843/1). Publisher Copyright: © 2021, The Author(s).

PY - 2021/12/30

Y1 - 2021/12/30

N2 - Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

AB - Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

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DO - 10.1007/s00787-021-01930-3

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SN - 1018-8827

JO - European Child and Adolescent Psychiatry

JF - European Child and Adolescent Psychiatry

ER -

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

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