Is online training in family-based treatment for anorexia nervosa feasible and can it improve fidelity to key components affecting outcome?

Summary In order to evaluate the feasibility of conducting an online training focusing on two key treatment components (externalization and agnosticism) to improve fidelity to Family-based Treatment (FBT), we conducted a study that compared the training outcomes of therapists randomized to standard online training or enhanced online training with increased emphasis on the two key components of FBT. Forty-six therapists were randomized to: (1) standard online training, or (2) enhanced online training in FBT on key components. The main outcome was change in knowledge and skills related to the two key components that were targeted in the enhanced training condition. The study appeared feasible from a recruitment and retention perspective. We were able to recruit 57 therapists into the study, which was above our target of 46. Of the therapists who entered the study, 9 (19%) dropped out. Neither training approach significantly improved knowledge, with no differences within or between training groups. For behavioral skills assessment using videotapes of recorded therapeutic responses to clinical vignette/role plays, externalization significantly improved in both groups, but there was no difference between groups. However, agnosticism scores were significantly higher in the enhanced training group compared to the standard training group with a large effect size (1.069, 95% confidence interval [0.179,1.963]). It is feasible to conduct an RCT of therapists using online training in FBT addressing key components of fidelity.