Clinician adherence to guidelines in the delivery of family-based therapy for eating disorders
Open accessAbstract
OBJECTIVE: Clinicians have been shown to drift away from protocol in their delivery of evidence-based treatments. This study explores this phenomenon in the delivery of family-based therapy (FBT) for eating disorders, and the clinician characteristics that might explain such therapist drift. METHOD: The participants were 117 clinicians who reported using FBT for eating disorders. They completed an online survey, which included questions relating to clinician characteristics, caseload, and reported use of FBT manuals and core therapeutic tasks, as well as a measure of anxiety. RESULTS: The use of core FBT tasks was higher than for other therapies, but there were still noteworthy gaps between recommended and reported practice. Approximately a third of clinicians reported delivering "FBT" that deviated very substantially from evidence-based protocols, often appearing to be on an individual therapy basis. Using an FBT manual to guide treatment delivery was associated with greater adherence to recommended techniques. Clinician caseload and anxiety were associated with differences in the use of specific FBT tasks. DISCUSSION: Consistent with previous research regarding clinicians' use of other therapies, the delivery of FBT for the eating disorders is not homogeneous. CONCLUSION: Further investigation of this phenomenon is needed to determine the impact of deviating from treatment protocols on the effectiveness of FBT for the eating disorders.
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Few therapists adhere to evidence-based treatment protocols for eating disorders.
“which may be due to few therapists adhering to evidence-based treatment protocols (Kosmerly et al., 2015; von Ranson et al., 2013; Waller, 2016).”
From Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa (2022) · cites this paper as Kosmerly et al., 2015
The Discussion reports that about two-thirds of the surveyed FBT clinicians used manual-recommended techniques, while one-third deviated substantially. That is contrary to the claim that few therapists adhere, though the study did find noteworthy gaps in adherence. Its findings concern clinicians who reported using family-based therapy, not all eating-disorder therapists. (LLM, conf=0.84)
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McCormack, M., Shand, T., Conti, J., Heruc, G. A., McLean, S. A., Prnjak, K., Barns, R., & Hay, P. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01690-y · Cited by 1 · see citing works
Kiser, E., & Ratcliff, C. G. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x26100865
- Authors
- Kosmerly, S., Waller, G., & Robinson, A. L.
- Affiliations
- Laurentian University (CA)
- University of Sheffield (GB)
- Department of Psychology Laurentian University Canada
- ORCID
- Waller, Glenn
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2014-03-20
- Volume
- 48
- Issue
- 2
- Pages
- 223-229
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2142360113
- Cited by
- 83
- References
- 29
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 9 · 2019: 2 · 2018: 7 · 2017: 8 · 2016: 7 · 2015: 7 · 2014: 3
- FWCI
- 9.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- family-based treatment, eating disorders, medication adherence, evidence-based practice, clinician characteristics, clinician anxiety, caseloads, individual psychotherapy
- MeSH terms
- Adult, Anxiety, Feeding and Eating Disorders, Delivery of Health Care, Family Therapy, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Practice Guidelines as Topic, Guideline Adherence
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