Still, being in the group isn't easy, she said. Her own eating issues “became very loud” when she saw her daughter refusing to eat. “It's incredibly hard to remember that I have to take care of myself by getting my three meals and snacks in every day, in order to set a good example for my child.”
Mrs. Hernandez isn't alone in expressing her positive experiences with the group. Dr. Zucker recently presented the results of the first of several studies on the group skills-training model. Fourteen caregivers and 10 adolescents were interviewed before and after the parents' 4 months of group work
Among the patients, weight concern scores fell from 3.16 to 1.40, shape concern scores fell from 3.48 to 2.03, and restraint scores fell from 2.88 to 1.20. The patients' body mass indexes increased a mean of 2 kg/m2, from 16.72 kg/m2 to 18.62 kg/m2.
Among the parents, 91% strongly agreed that the group was essential for their children's improvement and 82% strongly agreed that their children would not be doing as well if they had not participated in the group.
Last spring, Dr. Zucker received a $10,000 grant from the National Eating Disorders Association (NEDA) for further research into the group model. Her ongoing studies compare the skills-training model to a parent education-only model, and she is investigating different methods of delivering the group content, perhaps via a Web-based program.
Dr. Zucker is now analyzing preliminary data from these studies, and the results will provide a key insight into the usefulness of her model in other practices, said James Mitchell, M.D., professor and chair of the department of neuroscience at the University of North Dakota and chairman of the NEDA grant awards committee that evaluated Dr. Zucker's program.
Sometimes, he said, group therapy models accomplish wonderful results under the hand of a particularly enthusiastic and inspiring leader, but those results are not reproducible with a different leader. “Like everything else, initial results can look very good at the first pass, but sometimes don't stand up under scrutiny,” he said. “She needs to show that her results are due to the model itself and that others can use it just as well. Those questions need to be answered. But it looks like it has a lot of promise.”
The parent group model is just one facet of a comprehensive eating disorders treatment program that could include psychiatrists and other M.Ds., psychologists, dietitians, and exercise physiologists committed to working with both patient and family, Dr. Mitchell noted. “Research shows quite clearly that you have a better success rate if you involve the family of an adolescent. One question, however, is how to involve that family. Should it be included in the treatment as a unit, or should you work with the family separately? Dr. Zucker's program is one that's trying to answer that question.”
Dr. Zucker has applied her model's general tenets to two new pilot eating disorder programs: an intensive weekend parent training group for parents who live out of town and a prevention program aimed at high school freshmen. Presented as part of the school's health curriculum, the program focuses on building good mental health, including healthy attitudes about eating, within the family unit.
“We don't give information about eating disorders,” she said. “The key things we focus on are the importance of quality family interaction during consistent meals, separating the negative aspects of perfectionism from the positive, and taking the shame away from making mistakes.”