# Confirming the Effectiveness and Efficiency of Online Guided Self-Help Family-Based Treatment for Adolescent Anorexia Nervosa

> **NIH NIH R01** · STANFORD UNIVERSITY · 2024 · $653,246

## Abstract

The application responds to PAR-21-130: Clinical Trials to Test the Effectiveness of Treatment, Prevention,
and Services Interventions. With an incidence rate of about 1%, Anorexia Nervosa (AN) is a serious mental
disorder associated with high mortality, morbidity and cost but becomes highly resistant once it has taken an
enduring course. The first-line treatment for adolescents with AN is Family Based Treatment (FBT), but is not
available to many patients. An effective strategy used with other eating disorders to address impediments to
scaling effective treatments is guided self-help (GSH) versions of efficacious treatments. We developed,
refined, and tested GSH-FBT in case series and pilot studies. Results of a multisite randomized feasibility
study comparing GSH-FBT to FBT-V found that both treatments were similarly acceptable to families with good
recruitment rates, low attrition rates, high completion rates of assessments, and were safe to deliver while
achieving similar improvements in eating related cognitions and weight. However, GSH-FBT achieved these
outcomes with greater efficiency (e.g., larger ratio of improvement in weight and cognitions to therapist
treatment time) by utilizing approximately 75% less therapist time than FBT-V. The main aim of this proposed
comparative effectiveness study is to confirm that clinical improvements in GSH-FBT are achieved with greater
efficiency than FBT-V in generalizable clinical settings. If this outcome is confirmed, it will lead to an increased
opportunity to utilize and scale an effective treatment for adolescent AN, promote increased access and
improve outcomes for these patients. We will also explore therapist attitudes toward GSH-FBT. To conduct this
study 200 adolescents with DSM-5 AN and their families will be randomized to either GSH-FBT or FBT-V in
two treatment sites (Stanford Children’s Hospital Eating Disorder Clinic and the Ontario Provincial Network of
Ministry-funded Specialized Treatment Services for Eating Disorders). The main outcome will be clinical
efficiency (the ratio of change in weight and eating related distorted cognitions to therapist time). Parental self-
efficacy will be assessed as a potential mediator of treatment effect. Family structure and severity of eating
related obsessions will be examined as moderators. Weights will be collected from session 1-4 to assess early
weight gain as a predictor of weight remission at the end of treatment (EOT). Data on therapists’ views of
GSH-FBT implementation will be collected by quantitative measures at BL and EOT, as well as by individual
semi-structured qualitative interviews. Both primary and secondary outcomes will be analyzed in line with the
intention to treat principle.

## Key facts

- **NIH application ID:** 10899747
- **Project number:** 5R01MH130388-03
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** JAMES D LOCK
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $653,246
- **Award type:** 5
- **Project period:** 2022-09-20 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10899747

## Citation

> US National Institutes of Health, RePORTER application 10899747, Confirming the Effectiveness and Efficiency of Online Guided Self-Help Family-Based Treatment for Adolescent Anorexia Nervosa (5R01MH130388-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10899747. Licensed CC0.

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