# Emotion coaching skills as an augmentation to family based therapy for adolescents with anorexia nervosa: A pilot study

> **NIH NIH R34** · CINCINNATI CHILDRENS HOSP MED CTR · 2020 · $239,059

## Abstract

Project Summary
Pediatric anorexia nervosa (AN) affects 400,000 adolescents in the US with devastating consequences
including growth delay, bone density loss, bradycardia, and the highest mortality rate of any psychiatric
condition (11.5%), with half of all deaths due to suicide. Early intervention in adolescents is life-saving, making
pediatric AN treatment an important public health concern. The goal of pediatric AN treatment is to restore the
adolescent back to a healthy weight and reverse the dangerous effects of malnutrition. Family based therapy
(FBT) is the gold standard of treatment for pediatric AN; however, 50% of patients do not respond. The
consequences of treatment non-response are dire, underscoring the importance of improving treatment via
augmentations to address non-response. One barrier to treatment response in pediatric AN is expressed
emotion (EE), which is defined as a family's response to an ill patient that is characterized by hostility, critical
comments, and emotional overinvolvement. Several studies have highlighted that families with high EE
undergoing treatment for their adolescent with AN have poorer outcomes, including higher drop-out rates, lack
of weight restoration, and less improvement in eating disorder symptoms. Conversely, parental warmth, a facet
of EE, is associated with good outcomes in FBT. Recent parenting interventions focused on emotion coaching
(EC) to address high EE have demonstrated success as adjuncts to evidence-based treatments in other
pediatric populations (e.g., PTSD, ADHD) but have not been applied to pediatric AN. Given the detrimental
effects that high EE has on the re-feeding process and the benefits of parental warmth, emotion coaching has
the potential to reduce high EE, increase parental warmth, and improve weight restoration in adolescents with
AN. The aim of this R34 pilot effectiveness trial is to conduct a two-stage study to evaluate the effectiveness of
a FBT + EC parent group intervention within a clinical setting. In Stage 1 (Feasibility Stage; Year 1), we will
conduct preliminary feasibility and acceptability testing of an EC parent group intervention in 6 patients with
pediatric AN and their families who exhibit elevated EE. The data from the Feasibility Stage will be used to
modify session content to improve treatment delivery and the uptake of EC skills. Once our manual is refined
and finalized, we will conduct a randomized controlled clinical trial (Stage 2) of 50 adolescents and their
parents to compare FBT+EC parent group (n=25) versus FBT+support (n=25). The FBT+support condition is a
general parent support group that is offered as part of standard care in our clinical Eating Disorders Program.
FBT will be identical in both the treatment and control conditions, with the EC parent group sessions and
parent support group sessions occurring separately from the FBT sessions. If the aims of the project are
achieved, this study would have a large impact on pediatric AN with the...

## Key facts

- **NIH application ID:** 9843166
- **Project number:** 5R34MH115897-02
- **Recipient organization:** CINCINNATI CHILDRENS HOSP MED CTR
- **Principal Investigator:** Claire Marie Aarnio-Peterson
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $239,059
- **Award type:** 5
- **Project period:** 2019-05-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9843166

## Citation

> US National Institutes of Health, RePORTER application 9843166, Emotion coaching skills as an augmentation to family based therapy for adolescents with anorexia nervosa: A pilot study (5R34MH115897-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9843166. Licensed CC0.

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