Investigation of Virtual Multi-Family Therapy for Adolescent Anorexia Nervosa: Feasibility and Acceptability

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Broner, Kristen Anderson, Sara Desai, Karen Bernstein This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7255585/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Mar, 2026 Read the published version in Journal of Eating Disorders → Version 1 posted 10 You are reading this latest preprint version Abstract Background Multi-Family Therapy for Anorexia Nervosa (MFT-AN) unites families navigating similar difficulties to promote more rapid recovery for adolescents with eating disorders. Designed as a collaborative, group-based intervention, MFT-AN shows promise for enhancing clinical outcomes while also broadening access to evidence-based care. This pilot study seeks to investigate the feasibility and acceptability of MFT-AN adapted to a virtual format. Methods Seventy-seven adolescents and 130 parents enrolled in this single-arm, pilot study. Measures included treatment interest, eligibility, enrollment, and completion; surveys assessing acceptability, satisfaction, and perceived effectiveness; patient characteristics; eating disorder symptoms; body mass index; and fidelity. Results There was a high level of interest in virtual MFT-AN. Of recruited and eligible families, nearly half scheduled a baseline assessment. Both attendance and study completion were high, and treatment was delivered with acceptable fidelity. Participants generally expressed acceptability of the virtual format, which still fostered connection amongst the group members. Effect size changes for global eating disorder symptoms and BMI were large. Conclusions Preliminary data suggest that the virtual MFT-AN program is feasible and acceptable. Though larger effectiveness trials are needed, this research lays the foundation for one method of increasing access and enhancing outcomes in evidence-based treatment for adolescent anorexia nervosa. Trial registration : This study was registered with ClinicalTrials.gov (ID NCT06203418). adolescent anorexia nervosa multi-family therapy virtual feasibility acceptability Figures Figure 1 Figure 2 Plain English Summary There are well-researched and evidence-based treatment options for adolescents with anorexia nervosa, yet many adolescents who receive front-line interventions do not fully recover. There is a great need for additional treatment options that can expedite the recovery process, improve outcomes, and expand access for families affected by anorexia nervosa. One such intervention is Multi-Family Therapy for adolescent Anorexia Nervosa (MFT-AN). The current study evaluates whether MFT-AN delivered in a virtual format is a practical and satisfactory treatment option for families. Results showed that the model was generally feasible and acceptable, carving the path forward for larger effectiveness trials. Background Anorexia nervosa (AN) is a severe mental health disorder that is associated with significant individual, familial, and societal complications. In addition to poorer psychological functioning, and reduced quality of life, the medical sequelae of low weight and starvation can be fatal (Hambleton et al., 2022 ). The high-risk and ego-syntonic nature of the disorder can put strain on caregivers, especially in the acute phases of the illness, and economic burden on the healthcare system (van Hoeken & Hoek, 2020 ). AN often emerges in adolescence or young adulthood (Udo & Grilo, 2018 ), and early identification and intervention using evidence-based treatment is the front-line recommendation in the management of this life-threatening illness (Koreshe et al., 2023 ). Research consistently suggests that a group of family-based interventions, which empower parents and siblings with the skills necessary to promote recovery, are the most effective at achieving remission, facilitating weight gain, and decreasing hospital admissions for adolescents with AN (Austin et al., 2024 ; Lock et al., 2010 ). While the manualized version of this approach, Family-Based Treatment (FBT), produces good results for some families (60%-85%), others continue to struggle with recovery (Lock & Le Grange, 2019 ). This often results in multiple hospital stays and the use of other models of intensive care. Further, access to evidence-based treatment is limited by the cost of services and lack of trained specialists, especially in particular geographic regions (Sharpe et al., 2023 ). Emerging evidence supports the use of another family-based intervention, Multi-Family Therapy for adolescent Anorexia Nervosa (MFT-AN; Simic et al., 2022 ). MFT-AN is based on the principles of family therapy for AN, yet it is purposefully designed to add increased intensity and support. Given the group nature of the intervention, it also offers greater access to, and more cost-effective dissemination of, evidence-based treatment for young people and their parents. Initial data suggest that MFT-AN leads to decreases in eating disorder (ED) symptoms, depression, and parental burden, and improvements in weight, quality of life, self-perception, self-image, and self-esteem (Baudinet et al., 2021 ). Thus far, studies demonstrate the feasibility and acceptability of multifamily therapy for adults and young adults (Baudinet et al., 2021 ; Dimitropoulos et al., 2015 ; Eisler et al., 2016 ; Funderud et al., 2023 ; Salaminiou et al., 2015 ; Tantillo et al., 2019 ; Wierenga et al., 2018 ), but to our knowledge, no study has piloted MFT-AN in a virtual format. There is a large amount of evidence for the feasibility, acceptability, and efficacy of FBT delivered virtually (Anderson et al., 2017 ; Dufour et al., 2022 ; Pereira et al., 2023 ; Steinberg et al., 2023 ; Van Huysse et al., 2023 ), and for other types of virtual multifamily group therapy (Guarin et al., 2023 ), but none specifically for MFT-AN. Thus, the aims of the current study are to investigate the feasibility and acceptability of MFT-AN delivered in a virtual format. As this is a preliminary study, we do not seek to test specific hypotheses. Methods Participants Participants were adolescents ( N = 77) and their parent(s) ( N = 130) who were recruited over the course of two years to participate in the intervention through an outpatient clinic. Eligible participants were those (a) with a diagnosis of AN (as assessed by study clinicians, using the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition [DSM-5; American Psychiatric Association, 2013 ]), (b) between the ages of 11 and 18, (c) proficient in English, (d) living with at least one parent, (e) medically stable for outpatient treatment, and (f) with reliable internet connection. Exclusion criteria were (a) current or previous active psychosis or substance dependence (parent or adolescent), and (b) current or previous abuse or neglect. Multiple parents (i.e., mothers, fathers, stepmothers, stepfathers) per adolescent were invited to participate. As MFT-AN is an adjunctive intervention, participants were not prevented from initiating or continuing to receive outside care (e.g., FBT, individual therapy), and they were required to meet with their physician for ongoing medical monitoring. Procedure This study was registered with ClinicalTrials.gov (ID NCT06203418), and approved by the affiliated university’s Institutional Review Board. Interested families conducted a phone screen interview with the research coordinator to determine eligibility. Following this call, they were instructed to obtain medical clearance from the adolescent’s primary care physician. Families then met with a researcher virtually to review informed consent and complete the baseline assessment. Of note, if adolescents did not provide assent, parents were still able to participate in the study without their child, and complete the baseline and follow-up assessments to approximate their child’s behaviors and thoughts. This occurred with three families who participated. Recruitment was rolling and after they were deemed eligible, families were allocated to the next available group cohort. Each cohort completed a four-day intensive MFT-AN intervention, and booster sessions at two weeks, one month, and three months post-intervention (further details below). Adolescents and their parent(s) completed questionnaires at baseline, after Days 1 and 4 of the intervention, after Booster Sessions 1, 2, and 3 (i.e., two weeks, one month, and three months post-intervention), and 12 months post-intervention (i.e., approximately nine months after the third and final booster session). Interview-based assessments were also conducted with the adolescent at baseline and 12-month follow-up. Adolescents who completed the intervention received $ 200 for participation, and adolescents who completed the 12-month follow-up assessment received an additional $ 50. See Fig. 1 for the study flow diagram. [Insert Fig. 1 approximately here] Over the course of two years, clinicians conducted 13 MFT-AN groups consisting of three to eight families per cohort. Each group was run by two mid-career, masters-level, licensed clinicians, certified in FBT, along with interns and externs in social work and clinical psychology who helped facilitate the groups. All interventionists specialize in treating young people with EDs, and all were trained in the MFT-AN protocol by its developers at the Maudsley Hospital/King’s College London. Intervention: MFT-AN MFT-AN is a group-based therapy informed by the principles of FBT for AN. Throughout the intervention, families participate in a variety of planned activities designed to: (a) increase knowledge of eating disorders and their impact on the family; (b) manage mealtimes; (c) provide in vivo meal support; (d) problem solve regarding mealtimes; (e) explore the impact of the eating disorder on family relationships and set a path to improve them; and (f) plan for the future. MFT draws upon several hypothesized mechanisms of change. First, multiple individuals with different roles (i.e., professionals, parents, and young people) working together allows for participants to both give and receive therapeutic ideas, which can inspire hope and behavior change. Additionally, MFT-AN is purposefully designed with increased intensity and broadening of the treatment scope. To match the urgency of the eating disorder, and to catalyze behavior change, the intervention consists of many hours of treatment within a short span of days. This four-day “burst” is primarily aimed at increasing parental efficacy in taking charge of the adolescent’s illness, and follow-up sessions are intended to boost and monitor the effects of the intervention. Finally, the group setting is designed to increase solidarity, reduce isolation, and facilitate community-building to promote behavior change. This study followed the manual for MFT-AN (Simic et al., 2022 ) with modifications for a virtual format. The intervention consisted of a total of 27 hours of therapy – Day 1 was six hours; Days 2–4 were each four hours; and Booster Sessions 1–3 were each three hours long (see Fig. 1). In an effort to match the quality of an in-person group, families received a package of materials to use for group activities (e.g., glue sticks, sketch pads, food magazines), and a pulse oximeter to collect the adolescent’s heart rate at home. All families were required to have a scale to obtain weights at home throughout treatment. To avoid “screen fatigue,” families were given frequent breaks and were allowed to complete certain activities off-camera. Adolescents were invited to use the chat function of the virtual platform for participation if they felt uncomfortable speaking in front of others. Virtual MFT-AN activities were thoughtfully designed to invoke the therapeutic factors hypothesized to facilitate change (Asen & Scholz, 2010 ): creating solidarity; overcoming stigmatization and social isolation; stimulating new perspectives; learning from others; being mirrored in the other; positive use of group pressure; mutual support and feedback; discovering and building on competencies; experimenting with “foster” families; intensifying interactions and experiences; raising hope; practicing new behaviors in a safe space; strengthening self-reflectiveness; promoting openness; and increasing self-confidence through public exchanges and interactions. We made extra efforts to promote engagement, create solidarity, and reduce isolation given the virtual group context. For example, families were asked to send in lists of favorite or personally relevant songs to be played during breaks. Music served as a way to transition between activities, and also to facilitate sharing and meaning making around families’ stories. To engage adolescents and their families, we also added fun and educational “icebreakers” including trivia games and quizzes designed to promote connection and enhance learning. Further, while the majority of MFT-AN activities were drawn directly from the manual and adapted to the virtual setting, we created an additional activity based on The Boy, the Mole, the Fox and the Horse (Mackesy, 2019 ). This book illustrates life lessons of kindness, hope, and facing adversity. Participants in the group received a copy of the book, and created their own additional pages using the story as a model. We added this activity to creatively evoke the following themes: overcoming stigmatization, stimulating new perspectives, facilitating interpersonal learning, and helping people see themselves being mirrored in others. Finally, therapeutic techniques specific to MFT-AN were adapted for the virtual format. The “fishbowl” setup, a powerful way to highlight a group or topic, was created by “pinning” participants in the virtual frame. Role plays, another important therapeutic technique in MFT-AN, were made easier by choosing volunteers in advance, and similarly “pinning” participants on screen. Breakout rooms helped to facilitate small group huddles and separate groups (e.g., adolescents and parents separately) as would have been done in-person. In addition, we invited families to remain “off mute” so that we could facilitate more naturalistic discussions, rather than having people pause to “unmute” themselves. One group facilitator also observed facial reactions and monitored for lack of engagement to help facilitators involve participants based on non-verbal cues. Measures Feasibility The feasibility of virtual MFT-AN was assessed by the number of families who (a) expressed interest in participation, (b) were eligible for the study, (c) enrolled in the study, and (d) attended all sessions. Survey completion was also used to indicate the feasibility of recruiting for and maintaining participation in the research. Acceptability and satisfaction Parents, young people, and facilitators filled out the two-part Multi-Family Therapy Group Questionnaire (MFT-GQ; Baudinet, 2020 ) after study completion. The measure assessed the degree to which families and facilitators agreed the intervention achieved its intended goals related to hypothesized mechanisms of change and group processes. One set of questions focused on individual experiences (e.g., “Multi-Family Therapy group helped me to make practical changes to food/eating”), and the second set of questions asked about the group experience (e.g., “The intensity of the group helped move my family forward toward recovery”). Acceptability was rated on a 10-point Likert scale (1 = Strongly disagree to 10 = Strongly agree ). Cronbach’s alpha for the MFT-GQ in the current study was high for parents, young people, and facilitators alike (ɑ = .960, .977, and .896, respectively). Additionally, the authors created a post-intervention Multi-Family Therapy Feedback Form (MFT-FF) asking parents and facilitators about perceptions of acceptability and satisfaction at various points of the study (e.g., whether they believed information about the intervention was presented clearly prior to starting; whether participants felt comfortable sharing during the intervention; and whether the time commitment after finishing was as expected to families). The MFT-FF also asked questions specific to the virtual format. Answers were provided on a five-point Likert scale (1 = Strongly disagree to 5 = Strongly agree ). Cronbach’s alpha for the scale was excellent for facilitators and parents alike (ɑ = .939 for both). Finally, parents, adolescents, and facilitators had space to provide open-ended feedback about the intervention. Demographics Parents provided identities and background information for the adolescent and their family during the initial phone screen interview. This included the adolescent’s age, sex, duration of illness, race and ethnicity, family income, residential location, and parents’ highest levels of education. Outside Treatment During the initial phone intake, parents provided information on ED treatment history and current service utilization. Thereafter, parents gave an update on the nature of therapeutic services received since the last interview (at the baseline assessment, Booster Sessions 1–3, and the 12-month assessment). Eating Disorder Symptoms Study clinicians administered the Eating Disorder Examination (EDE Version 17.0D; Fairburn et al., 2014 ) at baseline and 12-month follow-up. The EDE is a semi-structured interview considered the “gold standard” measure of eating disorder psychopathology. Scores range from 0 to 6, with higher scores indicating greater distress. Cronbach’s alpha for the present study at baseline was good (ɑ = .894). Means and Cohen’s d for the EDE Global Score are reported to characterize the sample and indicate potential effect sizes for future trials. Body Mass Index The adolescent’s weight and height were measured at home and reported at each time point. Means and Cohen’s d from baseline to 12-month follow-up are reported to characterize the sample and indicate potential effect sizes for future trials. Fidelity Treatment fidelity was assessed using a fidelity checklist to determine whether the therapists adhered to their intended activity schedule for each day. The fidelity checklist was completed by a researcher who was not involved in administering the intervention. Results Participant Characteristics See Table 1 for a list of demographics and characteristics at baseline. Table 1 Sociodemographic Characteristics of Participants at Baseline Background characteristic n / M % / SD Adolescent age (years) 14.85 1.59 Adolescent duration of illness (years) a 1.19 1.04 Adolescent concurrent eating disorder therapy b 40 51.95% Adolescent sex Female 73 94.81% Male 2 2.60% Transgender or non-binary 2 2.60% Adolescent race and ethnicity c White (non-Hispanic/Latino) 45 58.44% Bi- or multi-racial 16 20.78% Hispanic/Latino 8 10.39% Black 3 3.90% Asian 1 1.30% Middle Eastern/Arabic 1 1.30% Family income level d $ 15k - $ 34k 1 1.30% $ 35k - $ 49k 5 6.49% $ 50k - $ 74k 9 11.69% $ 75k - $ 99k 12 15.58% $ 100k - $ 149k 16 20.78% $ 150k - $ 199k 13 16.88% $ 200k+ 19 24.68% Family highest level of household education d Less than high school 1 1.30% High school or GED 2 2.60% At least one year of college 6 7.79% Associate’s degree 3 3.90% Bachelor’s degree 20 25.97% Graduate degree 43 55.84% Family location d Arizona 1 1.30% California 3 3.90% Florida 1 1.30% Illinois 61 79.22% Kentucky 1 1.30% Michigan 2 2.60% Minnesota 2 2.60% New York 1 1.30% Pennsylvania 2 2.60% Wisconsin 1 1.30% a Missing 5 responses. b Missing 16 responses. c Missing 3 responses. d Missing 2 responses. [Insert Table 1 approximately here] Feasibility Recruitment Two hundred two families expressed interest in the study. Many were families who connected with the study site (51.49%; e.g., visited the website, had an intake, were on the mailing list, were currently in treatment, or were on the waitlist). Another common source was referral by a pediatrician or physician specializing in EDs (35.15%). The remainder were referred by other therapy providers, clinics, or dietitians (5.45%), national organizations (4.46%), and other sources (3.47%; e.g., word of mouth). Twenty-five families were deemed ineligible per the pre-specified exclusionary criteria: having a different eating disorder diagnosis (most commonly, ARFID; 72%); safety concerns (8%), the need for a higher level of care (8%), age outside of the specified age range (8%), and substance dependence (4%). Of the 177 eligible families, nearly half (86) scheduled an intake assessment. Causes for non-scheduling included unknown reasons (52.75%), logistical (e.g., time) constraints (20.89%), family wanting individual therapy or FBT (15.38%), and treatment not being a good fit (e.g., discomfort with the group setting; 10.99%). Of the 86 families who scheduled the baseline assessment, 77 adolescents and 130 parents assented/consented to treatment. Reasons for lack of assent/consent to treatment included disinterest in the program, emergency scheduling changes, and becoming ineligible (i.e., needing a higher level of care). Treatment attendance and study completion were high – only two families discontinued after treatment initiation for unknown reasons. Study Participation As seen in Fig. 2 , roughly half of young people and over half of parents completed all questionnaires through the final booster session. [Insert Fig. 2 approximately here] Acceptability Parents, young people, and facilitators rated the degree to which MFT-AN helped families to work toward key therapeutic goals as 7.56, 6.16, and 8.19 out of 10, on average (see Table 2 , individual questions). They rated therapeutic and group process elements as 7.99, 6.71, and 9.00 out of 10, on average (see Table 2 , group questions). Table 2 Multi-Family Therapy Group Questionnaire (MFT-GQ) Question Parents Young People Facilitators M SD M SD M SD Individual Questions a Understand anorexia better 8.55 1.69 6.41 2.53 9.71 0.76 Understand my child (parents) better 7.73 2.18 6.00 2.47 8.71 1.25 Understand my family better 7.23 1.79 5.59 2.18 8.57 1.13 Make practical changes to food/eating 7.23 2.30 6.53 2.62 8.00 1.15 Communicate better within my family 7.25 1.72 6.18 2.79 7.86 1.57 Feel more connected as a family 7.23 1.91 5.71 2.64 7.57 1.90 Feel more confident about recovery 7.78 2.20 6.00 2.45 8.86 0.90 Feel more hopeful about recovery 8.30 1.95 6.18 2.58 8.71 0.95 Set clearer boundaries/expectations for my child 7.18 2.11 - - 7.86 1.07 Understand when to be firm and when to be flexible with the eating disorder 7.48 1.99 - - 7.86 1.57 Improve how my partner and I work together to manage the eating disorder * If partnered 7.11 2.36 - - 7.71 1.70 Increase motivation to recover - - 6.47 2.24 7.00 1.41 Understand my relationship with the eating disorder better - - 6.53 2.29 8.00 1.73 Group Questions b I felt my/my family’s difficulties were similar to the difficulties of the others in the group 7.62 1.95 6.93 2.23 9.00 1.00 I felt less isolated by coming to the group 8.21 2.00 5.64 2.84 9.71 0.49 The group helped me to gain new perspectives on my/my family’s difficulties 8.33 1.54 5.71 2.33 10.00 0.00 I learned from others in the group 8.62 1.29 6.50 2.50 9.86 0.38 I noticed other families doing similar things to what I do/my family does 7.97 1.71 6.93 2.43 9.29 1.11 I felt pressure from the group to keep going even when I might have otherwise given up 5.05 2.04 4.29 2.20 7.29 1.80 I felt supported and encouraged by the group 8.38 1.74 6.93 2.56 9.57 0.79 By coming to the group, I realized I/my family is more capable than I thought 7.62 2.20 5.21 2.29 9.14 1.07 Working with people outside my immediate family was helpful 8.36 1.80 6.36 2.73 9.29 0.95 The intensity of the group helped move my family forward toward recovery 7.08 2.49 6.00 2.54 8.14 1.35 The group gave me/my family more hope about recovery 7.97 1.94 6.57 2.82 9.14 0.69 I tried out new behaviors in the group (e.g., a new type of food, expressing different thought or emotion) 7.77 2.01 5.57 2.65 8.43 0.98 I understand myself and my own strengths and limitations better after coming to the group 7.59 2.02 5.43 2.77 8.57 1.13 Meeting others in a similar situation to me/my family has helped me open up 7.69 2.32 6.57 2.77 9.29 1.11 I was very active in the group 7.59 1.71 5.29 2.09 7.43 0.98 I felt supported by the group 8.49 1.41 6.71 2.16 9.14 0.90 I felt understood by the group 8.36 1.63 6.93 2.50 8.86 0.90 I trusted the group 8.54 1.41 5.86 2.57 9.00 0.82 I felt supported by the MFT therapists 8.82 1.43 7.07 2.46 9.57 0.53 I felt understood by the MFT therapists 8.74 1.73 7.50 2.28 9.14 0.90 I trusted the MFT therapists 8.97 1.68 6.71 2.87 9.14 0.69 Note . Questions were rated on a scale from 1 = Strongly disagree to 10 = Strongly agree . Question wording was modified for the appropriate reference group while maintaining the content of the question. Facilitators were asked to rate their perceptions of families’ experiences. For example, for facilitators, “Multi-Family Therapy (MFT) group helped me to feel more hopeful about recovery” was changed to “Multi-Family Therapy (MFT) group helped families to feel more hopeful about recovery.” Similarly, “I trusted the group” was changed to “Families trusted the group.” a N parent = 40; N young people = 17; N facilitator = 7 b N parent = 39; N young people = 14; N facilitator = 7 Parents and facilitators also reported positive experiences with and outcomes of the intervention, including logistical elements prior to study initiation ( M = 4.56 and 4.50 out of 5); logistical and therapeutic elements during treatment ( M = 4.51 and 4.63 out of 5); and satisfaction and hope at the end of the study ( M = 4.04 and 4.25 out of 5). Importantly, parents and facilitators alike tended to “agree” to “strongly agree” that the virtual nature of the study was satisfactory and acceptable ( M = 4.24 and 4.32 out of 5). See Table 3 for item-level means for the MFT-FF. Table 3 Multi-Family Therapy Feedback Form (MFT-FF) Question Parents Facilitators M SD M SD About Prior to Starting The information presented to me about the research and study treatment was easy for me and my family to understand. 4.54 0.68 4.40 0.55 All my questions about the research intervention were answered prior to starting the study. 4.41 0.79 4.40 0.55 My family and I felt comfortable asking questions before starting the study. 4.64 0.54 4.40 0.55 Communication with the treatment team was easy and responded to within a reasonable time frame. 4.67 0.53 4.80 0.45 About During the Study Overall, I was satisfied with conducting the study online through [virtual platform]. 4.51 0.64 4.29 0.49 The study visits were scheduled at a convenient time for our family. 4.21 0.80 4.00 0.58 My questions were answered adequately by the treatment team. 4.62 0.59 4.71 0.49 The treatment team treated my child with respect. 4.77 0.43 5.00 0.00 The treatment team treated me (and my child’s other parent/guardian if applicable) with respect. 4.87 0.34 5.00 0.00 The caregivers in my family (myself +/- a co-parent/guardian) felt empowered by the treatment team. 4.44 0.68 4.86 0.38 The caregivers in my family (myself +/- a co-parent/guardian) felt supported by the treatment team. 4.56 0.55 4.86 0.38 The caregivers in my family (myself +/- a co-parent/guardian) understood how to generalize what we were learning in the study treatment to our time outside of the research. 4.44 0.64 4.29 0.49 The caregivers in my family (myself +/- a co-parent/guardian) felt comfortable sharing difficult moments and questions with the treatment team and other families. 4.49 0.60 4.57 0.53 My family felt connected with the other families in the study. 4.15 0.78 4.71 0.49 About End of Study Overall, my family and I were satisfied with the study treatment. 4.44 0.79 4.29 0.49 Compared to other treatment options our family used, I feel that Multi-Family Therapy was the best option for our family. 3.90 1.14 4.14 0.38 Compared to other treatment options our family used, I feel that Multi-Family Therapy was the best option for my child. 3.59 1.16 3.86 0.38 I felt hopeful for my child’s immediate (short-term) recovery after completing the treatment. 4.08 1.01 4.14 0.69 I felt hopeful for my child’s long-term recovery after completing the treatment. 4.08 0.96 4.29 0.49 I felt comfortable continuing the treatment plan at home after the study was completed. 3.90 1.05 4.29 0.49 I felt satisfied with the information I received about other supports for my child (e.g., additional family-based treatment, other treatment options). 4.03 1.01 4.43 0.53 The commitment required of my family in our study participation was similar to our expectations before we began the study. 4.31 0.73 4.57 0.53 About Virtual Overall, I believe that online treatment in the study was as satisfactory as in-person treatment would have been for our family. 4.10 0.94 4.14 0.69 My family and I were able to connect to other families using the online platform. 4.23 0.81 4.57 0.53 The online platform was easy to use. 4.64 0.54 4.43 0.53 I felt that the asynchronous activities were just as important and effective as the synchronous activities. 3.97 0.84 4.14 0.69 Note . Questions were rated on a scale from 1 = Strongly disagree to 5 = Strongly agree . Question wording was modified for the appropriate reference group while maintaining the content of the question. Facilitators were asked to rate their perceptions of families’ experiences. For example, for facilitators, “My family and I felt comfortable asking questions before starting the study” was changed to “Families seemed to feel comfortable asking questions before starting the study.” a N parent = 40; N facilitator = 7 b N parent = 40; N facilitator = 7 Qualitatively, families expressed satisfaction with the virtual format, and with MFT-AN overall. One parent noted, “I'm really sure this treatment saved us. That we could do [it] virtually was much, much easier on my child. Virtual was a very good option for our family at that stage of my daughter's disease, and what we were able to manage in order to effectively get her help. Thank you.” Another stated, “I felt connected to the facilitator team and to the other families, and even a bit more to my partner and child. I imagine this would have felt even better if not virtual, but I am not sure how we would have navigated in person.” Suggestions for improvement related to the virtual adaptation included (a) more frequent breaks, (b) having the facilitators nominate participants to share (rather than waiting for people to speak), and (c) having separate groups for those who prefer to keep their cameras off to foster more connection within the groups. Fidelity Per the MFT-AN manual, the model is flexible and adaptable to meet the unique needs of each group. Thus, fidelity to the intervention is not as straightforward as in other manualized interventions. With that said, across the 13 cohorts, fidelity averaged 93.75%. Preliminary Effectiveness See Table 4 for preliminary EDE and BMI means, standard deviations, and effect sizes. Table 4 Multi-Family Therapy Group Questionnaire (MFT-GQ) Measure Baseline 12-Month Follow-Up N M SD M SD Cohen’s d EDE 42 2.62 1.55 1.08 1.12 .898 BMI 46 18.04 2.61 20.60 3.01 .947 Note . Cohen’s d values of 0.2, 0.5, and 0.8 are generally considered to represent small, medium, and large effects, respectively. Discussion The present study is the first of our knowledge to evaluate the feasibility and acceptability of virtual MFT-AN. MFT-AN was designed to rely on the group format to promote change. Thus, a fundamental question remained as to whether the key ingredients and therapeutic processes could successfully translate to the virtual format. Ultimately, significant efforts and adjustments were necessary to execute this trial with no face-to-face contact. Our findings expand upon the emerging evidence base demonstrating the feasibility of making manual modifications to deliver virtual family-based interventions (Dufour et al., 2022 ) by demonstrating real-world implementation in a non-academic setting. Family interest in virtual MFT-AN was high, and treatment uptake and retention were similar to other virtual adaptations of family-based interventions (e.g., Anderson et al., 2017 ). Fidelity to the manualized intervention was also high, which is often a challenge in routine clinical settings (Waller, 2016 ). Further, our results point to high levels of treatment acceptability and satisfaction, including perceived effectiveness. Of particular interest, parents indicated that they understood how to generalize what they were learning in treatment to real life, and adolescents felt understood, supported, and encouraged by the group. No mean rating on any of the acceptability/satisfaction items fell below “neutral” or the midpoint of the scale for parents, young people, or facilitators. These results are in line with both qualitative and quantitative data about in-person MFT-AN, which suggest that while adolescents can feel apprehensive about attending and participating, the treatment helps to decrease isolation and increase connection from supportive others (Baudinet et al., 2021 ). Most central to our research question, though, was acceptability and satisfaction with the virtual format itself. Overall, families and facilitators alike were highly satisfied with conducting the study online. They believed that online treatment allowed for connection with other families, and even was as satisfactory as in-person treatment would have been. However, it is important to consider the distinct processes by which connection may occur through a virtual medium (Moore et al., 2024 ). Future research should continue to explore group processes and dynamics in virtual group psychotherapy. Finally, preliminary outcome data on virtual MFT-AN is promising, especially considering the length of follow-up. Effect size changes for both ED symptoms and BMI in the present study were large. Previous research suggests that changes in weight for adolescents undergoing MFT tend to be large, and changes in ED symptoms medium, potentially signaling that virtual MFT-AN is no less effective than the in-person modality. Of course, future randomized-controlled trials are necessary to substantiate this claim. The present findings are notable for several reasons. First, a recent study found that among a community sample presenting to an ED treatment facility, 84.04% of participants with AN in general and 90.12% with AN-Restricting subtype were White (Gorrell et al., 2021 ). Authors noted that this demographic may have been overrepresented due to larger systemic barriers impacting rates of treatment-seeking. Indeed, research suggests that EDs affect different racial and ethnic groups at a similar rate (Cheng et al., 2019 ). The lower proportion of White individuals in our sample, and the virtual nature of the study, represent a step toward accessibility. Yet, greater efforts to increase accessibility are needed, including innovative approaches that could help reach families who, for various reasons, declined to participate in our study. Despite this, our method of delivering MFT-AN provides a pathway for cost-effective treatment for families in need, particularly those in areas of the country where access to evidence-based options is limited. Overall, the findings of the present study should be treated as tentative, initial evidence for the promise of virtual MFT-AN. Several limitations of the current research are worth noting. First, the nature of the study site allowed for sufficient time and resources for outreach, recruitment, and retention. This likely contributed to the high attendance rate in our study. Further research in other settings is warranted to confirm feasibility. Second, as is common in this type of research, survey-based acceptability and satisfaction can be affected by response bias, potentially leading to an overestimation of satisfaction levels (Popovic & Huecker, 2023 ). Finally, this study was a non-randomized pilot trial, and thus, we cannot isolate the effects of MFT-AN. Larger, randomized-controlled trials (e.g., those comparing virtual MFT-AN to standard MFT-AN; and FBT to FBT + MFT-AN) would contribute greatly to this growing body of work on adjunctive treatment options for youth and their families. Conclusions This study is the first of our knowledge to pilot the recently manualized MFT-AN in a virtual context. Our findings demonstrate the feasibility of successfully implementing virtual MFT-AN in a real-world clinic setting. Importantly, parents, adolescents, and facilitators alike indicated that the intervention incorporated its intended therapeutic mechanisms, such as facilitating interpersonal learning, consistent with the treatment’s theoretical model. Our findings offer substantial grounds for future research to evaluate virtual MFT-AN in a controlled trial, with the ultimate goal of increasing access and improving outcomes for families affected by AN. Abbreviations AN Anorexia nervosa BMI Body mass index DSM-5 Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition ED Eating disorder EDE Eating Disorder Examination FBT Family-Based Treatment MFT-AN Multi-Family Therapy for Anorexia Nervosa MFT-FF Multi-Family Therapy Feedback Form MFT-GQ Multi-Family Therapy Group Questionnaire Declarations Human ethics and consent to participate The study was approved by the University of Illinois Chicago’s Institutional Review Board. Consent was obtained from parents, and assent was obtained from adolescents to enroll in the intervention. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This project was funded by Blue Cross Blue Shield of Illinois/Health Care Service Corporation. Authors' contributions KA, SD, and KB were involved in the conceptualization and implementation of the study, including funding acquisition, project administration, and obtaining resources. SB was involved in data curation, formal analysis, visualization, and writing of the original draft. All authors reviewed, edited, and approved of the final manuscript. Acknowledgements The authors would like to thank all adolescents and families for their willingness to engage in this treatment experience with us. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Anderson KE, Byrne CE, Crosby RD, Le Grange D. Utilizing telehealth to deliver family-based treatment for adolescent anorexia nervosa. Int J Eat Disord. 2017;50(10):1235–8. https://doi.org/10.1002/eat.22759 . Asen E, Scholz M. Multi-Family Therapy: Concepts and techniques. Routledge; 2010. Austin A, Anderson AG, Lee J, Steen V, Savard H, Bergmann C, Singh C, Devoe M, Gorrell D, Patten S, Le Grange S, D., Dimitropoulos G. Efficacy of eating disorder focused family therapy for adolescents with anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord. 2024;0:1–34. https://doi.org/10.1002/eat.24252 . Baudinet J. (2020). Multi-Family Therapy Group Questionnair e [Unpublished measure]. Maudsley Centre for Child and Adolescent Eating Disorders, King’s College London . Baudinet J, Eisler I, Dawson L, Simic M, Schmidt U. Multi-family therapy for eating disorders: A systematic scoping review of the quantitative and qualitative findings. Int J Eat Disord. 2021;54(12):2095–120. https://doi.org/10.1002/eat.23616 . Cheng ZH, Perko VL, Fuller-Marashi L, Gau JM, Stice E. Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eat Behav. 2019;32:23–30. https://doi.org/10.1016/j.eatbeh.2018.11.004 . Dimitropoulos G, Farquhar JC, Freeman VE, Colton PA, Olmsted MP. Pilot study comparing multi-family therapy to single family therapy for adults with anorexia nervosa in an intensive eating disorder program. Eur Eat Disorders Rev. 2015;23(4):294–303. https://doi.org/10.1002/erv.2359 . Dufour R, Novack K, Picard L, Chadi N, Booij L. The use of technology in the treatment of youth with eating disorders: A scoping review. J Eat Disorders. 2022;10(1):182. https://doi.org/10.1186/s40337-022-00697-5 . Eisler I, Simic M, Hodsoll J, Asen E, Berelowitz M, Connan F, Ellis G, Hugo P, Schmidt U, Treasure J, Yi I, Landau S. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry. 2016;16(422). https://doi.org/10.1186/s12888-016-1129-6 . Fairburn C, Cooper Z, O'Connor M. (2014). Eating Disorder Examination (Edition 17.0D ; April, 2014). Funderud I, Halvorsen I, Kvakland AL, Nilsen JV, Skjønhaug J, Stedal K, Rø Ø. Multifamily therapy for adolescent eating disorders: A study of the change in eating disorder symptoms from start of treatment to follow-up. J Eat Disorders. 2023;11(1):92. https://doi.org/10.1186/s40337-023-00814-y . Gorrell S, Le Grange D, Blalock DV, Mehler PS, Johnson C, Manwaring J, Duffy A, Huston E, McClanahan S, Rienecke RD. (2021). Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample. Journal of Behavioral and Cognitive Therapy , 31 (1), 77–89. https://doi.org.10.1016/j.jbct.2020.11.006. Guarin MR, Rueda JG, Castro SM, Ospina MM, Betancourth CV, Amórtegui JP, Vázquez L. Feasibility and acceptability of comprehensive virtual treatment in eating disorders: Perspectives from patients, parents and therapists during the COVID-19 pandemic. Revista Colombiana de Psiquiatria (English ed). 2023;52(4):337–44. https://doi.org/10.1016/j.rcpeng.2023.11.003 . Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: Findings from a rapid review of the literature. J Eat Disorders. 2022;10(1):132. https://doi.org/10.1186/s40337-022-00654-2 . Koreshe E, Paxton S, Miskovic-Wheatley J, Bryant E, Le A, Maloney D, National Eating Disorder Research Consortium, Touyz S, Maguire S. Prevention and early intervention in eating disorders: Findings from a rapid review. J Eat Disorders. 2023;11(1):38. https://doi.org/10.1186/s40337-023-00758-3 . Lock J, Le Grange D. Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders. Int J Eat Disord. 2019;52(4):481–7. https://doi.org/10.1002/eat.22980 . Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. 2010;67(10):1025–32. https://doi.org/10.1001/archgenpsychiatry.2010.128 . Mackesy C. (2019). The boy, the mole, the fox and the horse: Inspiring conversations on hope, love and personal growth. HarperOne. Moore E, Paré C, Carde E, Pagé MG. Virtual group psychotherapy for chronic pain: Exploring the impact of the virtual medium on participants’ experiences. Pain Med. 2024;25(2):131–8. https://doi.org/10.1093/pm/pnad130 . Pereira J, Boachie A, Shipley C, McLeod M, Garfinkel S, Dowdall J. Paediatric eating disorders: Exploring virtual family therapy during a global pandemic. Early Interv Psychiat. 2023;17(7):743–6. https://doi.org/10.1111/eip.13395 . Popovic A, Huecker MR. Study bias. Statpearls [Internet]. StatPearls Publishing; 2023. Salaminiou E, Campbell M, Simic M, Kuipers E, Eisler I. Intensive multi-family therapy for adolescent anorexia nervosa: An open study of 30 families. J Family Therapy. 2015;39(4):498–513. https://doi.org/10.1111/1467-6427.12075 . Sharpe SL, Adams M, Smith EK, Urban B, Silverstein S. Inaccessibility of care and inequitable conceptions of suffering: A collective response to the construction of terminal anorexia nervosa. J Eat Disorders. 2023;11(1):66. https://doi.org/10.1186/s40337-023-00791-2 . Simic M, Baudinet J, Blessitt E, Wallis A, Eisler I. (2022). Multi-family therapy for anorexia nervosa: A treatment manual (pp. xii, 158). Routledge. Steinberg D, Perry T, Freestone D, Bohon C, Baker JH, Parks E. Effectiveness of delivering evidence-based eating disorder treatment via telemedicine for children, adolescents, and youth. Eat Disord. 2023;31(1):85–101. https://doi.org/10.1080/10640266.2022.2076334 . Tantillo M, McGraw JS, Lavigne HM, Brasch J, Le Grange D. A pilot study of multifamily therapy group for young adults with anorexia nervosa: Reconnecting for recovery. Int J Eat Disord. 2019;52(8):950–5. https://doi.org/10.1002/eat.23097 . Udo T, Grilo CM. Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of U.S. adults. Biol Psychiatry. 2018;84(5):345–54. https://doi.org/10.1016/j.biopsych.2018.03.014 . van Hoeken D, Hoek HW. Review of the burden of eating disorders: Mortality, disability, costs, quality of life, and family burden. Curr Opin Psychiatry. 2020;33(6):521–7. https://doi.org/10.1097/YCO.0000000000000641 . Van Huysse JL, Prohaska N, Miller C, Jary J, Sturza J, Etsell K, Bravender T. Adolescent eating disorder treatment outcomes of an in-person partial hospital program versus a virtual intensive outpatient program. Int J Eat Disord. 2023;56(1):192–202. https://doi.org/10.1002/eat.23866 . Waller G. Treatment protocols for eating disorders: Clinicians’ attitudes, concerns, adherence and difficulties delivering evidence-based psychological interventions. Curr Psychiatry Rep. 2016;18(4):36. https://doi.org/10.1007/s11920-016-0679-0 . Wierenga CE, Hill L, Knatz Peck S, McCray J, Greathouse L, Peterson D, Scott A, Eisler I, Kaye WH. The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5‐day multifamily treatment for adults with anorexia nervosa. Int J Eat Disord. 2018;51(8):863–9. https://doi.org/10.1002/eat.22876 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Mar, 2026 Read the published version in Journal of Eating Disorders → Version 1 posted Editorial decision: Revision requested 06 Oct, 2025 Reviews received at journal 05 Oct, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviews received at journal 10 Sep, 2025 Reviewers agreed at journal 31 Aug, 2025 Reviewers agreed at journal 02 Aug, 2025 Reviewers invited by journal 02 Aug, 2025 Editor assigned by journal 01 Aug, 2025 Submission checks completed at journal 01 Aug, 2025 First submitted to journal 30 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7255585","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495794233,"identity":"7995e2d4-6782-4650-b0e9-2601d39a0e69","order_by":0,"name":"Sarah E. Broner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqklEQVRIiWNgGAWjYDACCQglxwem2EjQYsxGspbENqK1yM/uffi4oOJeeptE8gOGD2WHCWsxuHPc2HjGmeLcNok0A8YZ54jRIpHGJs3blgDUksPAzNtGhBb5GSAt/xLS2UBa/hKjheEGSEtDQgJYCyMxWgzuHGM25jmWYNjG88zgYM+5dCIcNruN8TFPTYI8P3vywwc/yqyJcBgyOECi+lEwCkbBKBgFuAAAwH8xH5lzkqMAAAAASUVORK5CYII=","orcid":"","institution":"Chicago Center for Evidence Based Treatment","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"E.","lastName":"Broner","suffix":""},{"id":495794236,"identity":"725424f5-d1d5-4217-92d3-3e9e62b45735","order_by":1,"name":"Kristen Anderson","email":"","orcid":"","institution":"Chicago Center for Evidence Based Treatment","correspondingAuthor":false,"prefix":"","firstName":"Kristen","middleName":"","lastName":"Anderson","suffix":""},{"id":495794237,"identity":"a3a429bc-f3b5-40d9-9610-540d2404dfd0","order_by":2,"name":"Sara Desai","email":"","orcid":"","institution":"Chicago Center for Evidence Based Treatment","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Desai","suffix":""},{"id":495794239,"identity":"ccb5bf01-b095-42f0-ae35-cfd788aabb61","order_by":3,"name":"Karen Bernstein","email":"","orcid":"","institution":"University of Chicago Medicine","correspondingAuthor":false,"prefix":"","firstName":"Karen","middleName":"","lastName":"Bernstein","suffix":""}],"badges":[],"createdAt":"2025-07-30 18:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7255585/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7255585/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40337-026-01575-0","type":"published","date":"2026-03-27T16:09:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88756409,"identity":"64bbcd6a-a789-46be-8e0b-bfe717833167","added_by":"auto","created_at":"2025-08-11 07:17:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115944,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eStudy Procedure Flow Diagram\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. This figure illustrates study procedures, including intervention and assessment, from phone intake through 12-month follow-up.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7255585/v1/aac8525f46764cb81f947cae.png"},{"id":88755014,"identity":"6459878c-0f8d-4cdb-b1f5-06e30526de12","added_by":"auto","created_at":"2025-08-11 07:09:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":179775,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eParent and Young Person Survey Completion\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7255585/v1/4a6ee4f419ad2e3eb9bdbb55.png"},{"id":105755542,"identity":"9484a4a1-e15a-495b-b633-40b9b27dd6ed","added_by":"auto","created_at":"2026-03-30 16:27:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1366329,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7255585/v1/3aac089f-ee4e-4ff3-93a7-ec5a10c07ac5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigation of Virtual Multi-Family Therapy for Adolescent Anorexia Nervosa: Feasibility and Acceptability","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eThere are well-researched and evidence-based treatment options for adolescents with anorexia nervosa, yet many adolescents who receive front-line interventions do not fully recover. There is a great need for additional treatment options that can expedite the recovery process, improve outcomes, and expand access for families affected by anorexia nervosa. One such intervention is Multi-Family Therapy for adolescent Anorexia Nervosa (MFT-AN). The current study evaluates whether MFT-AN delivered in a virtual format is a practical and satisfactory treatment option for families. Results showed that the model was generally feasible and acceptable, carving the path forward for larger effectiveness trials.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eAnorexia nervosa (AN) is a severe mental health disorder that is associated with significant individual, familial, and societal complications. In addition to poorer psychological functioning, and reduced quality of life, the medical sequelae of low weight and starvation can be fatal (Hambleton et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The high-risk and ego-syntonic nature of the disorder can put strain on caregivers, especially in the acute phases of the illness, and economic burden on the healthcare system (van Hoeken \u0026amp; Hoek, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAN often emerges in adolescence or young adulthood (Udo \u0026amp; Grilo, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and early identification and intervention using evidence-based treatment is the front-line recommendation in the management of this life-threatening illness (Koreshe et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Research consistently suggests that a group of family-based interventions, which empower parents and siblings with the skills necessary to promote recovery, are the most effective at achieving remission, facilitating weight gain, and decreasing hospital admissions for adolescents with AN (Austin et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lock et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). While the manualized version of this approach, Family-Based Treatment (FBT), produces good results for some families (60%-85%), others continue to struggle with recovery (Lock \u0026amp; Le Grange, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This often results in multiple hospital stays and the use of other models of intensive care. Further, access to evidence-based treatment is limited by the cost of services and lack of trained specialists, especially in particular geographic regions (Sharpe et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmerging evidence supports the use of another family-based intervention, Multi-Family Therapy for adolescent Anorexia Nervosa (MFT-AN; Simic et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). MFT-AN is based on the principles of family therapy for AN, yet it is purposefully designed to add increased intensity and support. Given the group nature of the intervention, it also offers greater access to, and more cost-effective dissemination of, evidence-based treatment for young people and their parents. Initial data suggest that MFT-AN leads to decreases in eating disorder (ED) symptoms, depression, and parental burden, and improvements in weight, quality of life, self-perception, self-image, and self-esteem (Baudinet et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus far, studies demonstrate the feasibility and acceptability of multifamily therapy for adults and young adults (Baudinet et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Dimitropoulos et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Eisler et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Funderud et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Salaminiou et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tantillo et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wierenga et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), but to our knowledge, no study has piloted MFT-AN in a virtual format. There is a large amount of evidence for the feasibility, acceptability, and efficacy of FBT delivered virtually (Anderson et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Dufour et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pereira et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Steinberg et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Van Huysse et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and for other types of virtual multifamily group therapy (Guarin et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but none specifically for MFT-AN. Thus, the aims of the current study are to investigate the feasibility and acceptability of MFT-AN delivered in a virtual format. As this is a preliminary study, we do not seek to test specific hypotheses.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were adolescents (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;77) and their parent(s) (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;130) who were recruited over the course of two years to participate in the intervention through an outpatient clinic. Eligible participants were those (a) with a diagnosis of AN (as assessed by study clinicians, using the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition [DSM-5; American Psychiatric Association, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e]), (b) between the ages of 11 and 18, (c) proficient in English, (d) living with at least one parent, (e) medically stable for outpatient treatment, and (f) with reliable internet connection. Exclusion criteria were (a) current or previous active psychosis or substance dependence (parent or adolescent), and (b) current or previous abuse or neglect. Multiple parents (i.e., mothers, fathers, stepmothers, stepfathers) per adolescent were invited to participate. As MFT-AN is an adjunctive intervention, participants were not prevented from initiating or continuing to receive outside care (e.g., FBT, individual therapy), and they were required to meet with their physician for ongoing medical monitoring.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study was registered with ClinicalTrials.gov (ID NCT06203418), and approved by the affiliated university\u0026rsquo;s Institutional Review Board. Interested families conducted a phone screen interview with the research coordinator to determine eligibility. Following this call, they were instructed to obtain medical clearance from the adolescent\u0026rsquo;s primary care physician. Families then met with a researcher virtually to review informed consent and complete the baseline assessment. Of note, if adolescents did not provide assent, parents were still able to participate in the study without their child, and complete the baseline and follow-up assessments to approximate their child\u0026rsquo;s behaviors and thoughts. This occurred with three families who participated. Recruitment was rolling and after they were deemed eligible, families were allocated to the next available group cohort. Each cohort completed a four-day intensive MFT-AN intervention, and booster sessions at two weeks, one month, and three months post-intervention (further details below). Adolescents and their parent(s) completed questionnaires at baseline, after Days 1 and 4 of the intervention, after Booster Sessions 1, 2, and 3 (i.e., two weeks, one month, and three months post-intervention), and 12 months post-intervention (i.e., approximately nine months after the third and final booster session). Interview-based assessments were also conducted with the adolescent at baseline and 12-month follow-up. Adolescents who completed the intervention received \u003cspan\u003e$\u003c/span\u003e200 for participation, and adolescents who completed the 12-month follow-up assessment received an additional \u003cspan\u003e$\u003c/span\u003e50. See Fig.\u0026nbsp;1 for the study flow diagram.\u003c/p\u003e\u003cp\u003e[Insert Fig.\u0026nbsp;1 approximately here]\u003c/p\u003e\u003c/p\u003e\u003cp\u003eOver the course of two years, clinicians conducted 13 MFT-AN groups consisting of three to eight families per cohort. Each group was run by two mid-career, masters-level, licensed clinicians, certified in FBT, along with interns and externs in social work and clinical psychology who helped facilitate the groups. All interventionists specialize in treating young people with EDs, and all were trained in the MFT-AN protocol by its developers at the Maudsley Hospital/King\u0026rsquo;s College London.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention: MFT-AN\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMFT-AN is a group-based therapy informed by the principles of FBT for AN. Throughout the intervention, families participate in a variety of planned activities designed to: (a) increase knowledge of eating disorders and their impact on the family; (b) manage mealtimes; (c) provide in vivo meal support; (d) problem solve regarding mealtimes; (e) explore the impact of the eating disorder on family relationships and set a path to improve them; and (f) plan for the future. MFT draws upon several hypothesized mechanisms of change. First, multiple individuals with different roles (i.e., professionals, parents, and young people) working together allows for participants to both give and receive therapeutic ideas, which can inspire hope and behavior change. Additionally, MFT-AN is purposefully designed with increased intensity and broadening of the treatment scope. To match the urgency of the eating disorder, and to catalyze behavior change, the intervention consists of many hours of treatment within a short span of days. This four-day \u0026ldquo;burst\u0026rdquo; is primarily aimed at increasing parental efficacy in taking charge of the adolescent\u0026rsquo;s illness, and follow-up sessions are intended to boost and monitor the effects of the intervention. Finally, the group setting is designed to increase solidarity, reduce isolation, and facilitate community-building to promote behavior change.\u003c/p\u003e\u003cp\u003eThis study followed the manual for MFT-AN (Simic et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) with modifications for a virtual format. The intervention consisted of a total of 27 hours of therapy \u0026ndash; Day 1 was six hours; Days 2\u0026ndash;4 were each four hours; and Booster Sessions 1\u0026ndash;3 were each three hours long (see Fig.\u0026nbsp;1). In an effort to match the quality of an in-person group, families received a package of materials to use for group activities (e.g., glue sticks, sketch pads, food magazines), and a pulse oximeter to collect the adolescent\u0026rsquo;s heart rate at home. All families were required to have a scale to obtain weights at home throughout treatment. To avoid \u0026ldquo;screen fatigue,\u0026rdquo; families were given frequent breaks and were allowed to complete certain activities off-camera. Adolescents were invited to use the chat function of the virtual platform for participation if they felt uncomfortable speaking in front of others.\u003c/p\u003e\u003cp\u003eVirtual MFT-AN activities were thoughtfully designed to invoke the therapeutic factors hypothesized to facilitate change (Asen \u0026amp; Scholz, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e): creating solidarity; overcoming stigmatization and social isolation; stimulating new perspectives; learning from others; being mirrored in the other; positive use of group pressure; mutual support and feedback; discovering and building on competencies; experimenting with \u0026ldquo;foster\u0026rdquo; families; intensifying interactions and experiences; raising hope; practicing new behaviors in a safe space; strengthening self-reflectiveness; promoting openness; and increasing self-confidence through public exchanges and interactions. We made extra efforts to promote engagement, create solidarity, and reduce isolation given the virtual group context. For example, families were asked to send in lists of favorite or personally relevant songs to be played during breaks. Music served as a way to transition between activities, and also to facilitate sharing and meaning making around families\u0026rsquo; stories. To engage adolescents and their families, we also added fun and educational \u0026ldquo;icebreakers\u0026rdquo; including trivia games and quizzes designed to promote connection and enhance learning. Further, while the majority of MFT-AN activities were drawn directly from the manual and adapted to the virtual setting, we created an additional activity based on \u003cem\u003eThe Boy, the Mole, the Fox and the Horse\u003c/em\u003e (Mackesy, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This book illustrates life lessons of kindness, hope, and facing adversity. Participants in the group received a copy of the book, and created their own additional pages using the story as a model. We added this activity to creatively evoke the following themes: overcoming stigmatization, stimulating new perspectives, facilitating interpersonal learning, and helping people see themselves being mirrored in others.\u003c/p\u003e\u003cp\u003eFinally, therapeutic techniques specific to MFT-AN were adapted for the virtual format. The \u0026ldquo;fishbowl\u0026rdquo; setup, a powerful way to highlight a group or topic, was created by \u0026ldquo;pinning\u0026rdquo; participants in the virtual frame. Role plays, another important therapeutic technique in MFT-AN, were made easier by choosing volunteers in advance, and similarly \u0026ldquo;pinning\u0026rdquo; participants on screen. Breakout rooms helped to facilitate small group huddles and separate groups (e.g., adolescents and parents separately) as would have been done in-person. In addition, we invited families to remain \u0026ldquo;off mute\u0026rdquo; so that we could facilitate more naturalistic discussions, rather than having people pause to \u0026ldquo;unmute\u0026rdquo; themselves. One group facilitator also observed facial reactions and monitored for lack of engagement to help facilitators involve participants based on non-verbal cues.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFeasibility\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe feasibility of virtual MFT-AN was assessed by the number of families who (a) expressed interest in participation, (b) were eligible for the study, (c) enrolled in the study, and (d) attended all sessions. Survey completion was also used to indicate the feasibility of recruiting for and maintaining participation in the research.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcceptability and satisfaction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParents, young people, and facilitators filled out the two-part Multi-Family Therapy Group Questionnaire (MFT-GQ; Baudinet, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) after study completion. The measure assessed the degree to which families and facilitators agreed the intervention achieved its intended goals related to hypothesized mechanisms of change and group processes. One set of questions focused on individual experiences (e.g., \u0026ldquo;Multi-Family Therapy group helped me to make practical changes to food/eating\u0026rdquo;), and the second set of questions asked about the group experience (e.g., \u0026ldquo;The intensity of the group helped move my family forward toward recovery\u0026rdquo;). Acceptability was rated on a 10-point Likert scale (1\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly disagree\u003c/em\u003e to 10\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly agree\u003c/em\u003e). Cronbach\u0026rsquo;s alpha for the MFT-GQ in the current study was high for parents, young people, and facilitators alike (ɑ = .960, .977, and .896, respectively). Additionally, the authors created a post-intervention Multi-Family Therapy Feedback Form (MFT-FF) asking parents and facilitators about perceptions of acceptability and satisfaction at various points of the study (e.g., whether they believed information about the intervention was presented clearly prior to starting; whether participants felt comfortable sharing during the intervention; and whether the time commitment after finishing was as expected to families). The MFT-FF also asked questions specific to the virtual format. Answers were provided on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly disagree\u003c/em\u003e to 5\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly agree\u003c/em\u003e). Cronbach\u0026rsquo;s alpha for the scale was excellent for facilitators and parents alike (ɑ = .939 for both). Finally, parents, adolescents, and facilitators had space to provide open-ended feedback about the intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParents provided identities and background information for the adolescent and their family during the initial phone screen interview. This included the adolescent\u0026rsquo;s age, sex, duration of illness, race and ethnicity, family income, residential location, and parents\u0026rsquo; highest levels of education.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutside Treatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring the initial phone intake, parents provided information on ED treatment history and current service utilization. Thereafter, parents gave an update on the nature of therapeutic services received since the last interview (at the baseline assessment, Booster Sessions 1\u0026ndash;3, and the 12-month assessment).\u003c/p\u003e\u003cp\u003e\u003cb\u003eEating Disorder Symptoms\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudy clinicians administered the Eating Disorder Examination (EDE Version 17.0D; Fairburn et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) at baseline and 12-month follow-up. The EDE is a semi-structured interview considered the \u0026ldquo;gold standard\u0026rdquo; measure of eating disorder psychopathology. Scores range from 0 to 6, with higher scores indicating greater distress. Cronbach\u0026rsquo;s alpha for the present study at baseline was good (ɑ = .894). Means and Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e for the EDE Global Score are reported to characterize the sample and indicate potential effect sizes for future trials.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBody Mass Index\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe adolescent\u0026rsquo;s weight and height were measured at home and reported at each time point. Means and Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e from baseline to 12-month follow-up are reported to characterize the sample and indicate potential effect sizes for future trials.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTreatment fidelity was assessed using a fidelity checklist to determine whether the therapists adhered to their intended activity schedule for each day. The fidelity checklist was completed by a researcher who was not involved in administering the intervention.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eParticipant Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSee Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for a list of demographics and characteristics at baseline.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eSociodemographic Characteristics of Participants at Baseline\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBackground characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e / \u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% / \u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent age (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent duration of illness (years)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent concurrent eating disorder therapy\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.95%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94.81%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransgender or non-binary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdolescent race and ethnicity\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite (non-Hispanic/Latino)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi- or multi-racial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.78%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic/Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.39%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle Eastern/Arabic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily income level\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e15k - \u003cspan\u003e$\u003c/span\u003e34k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35k - \u003cspan\u003e$\u003c/span\u003e49k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.49%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50k - \u003cspan\u003e$\u003c/span\u003e74k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.69%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75k - \u003cspan\u003e$\u003c/span\u003e99k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.58%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100k - \u003cspan\u003e$\u003c/span\u003e149k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.78%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e150k - \u003cspan\u003e$\u003c/span\u003e199k\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.88%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e200k+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.68%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily highest level of household education\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school or GED\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt least one year of college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.79%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily location\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArizona\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalifornia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlorida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIllinois\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79.22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKentucky\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMichigan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinnesota\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew York\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePennsylvania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWisconsin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e Missing 5 responses.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003eb\u003c/sup\u003e Missing 16 responses.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ec\u003c/sup\u003e Missing 3 responses.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ed\u003c/sup\u003e Missing 2 responses.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e approximately here]\u003c/p\u003e\u003cp\u003e\u003cb\u003eFeasibility\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecruitment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo hundred two families expressed interest in the study. Many were families who connected with the study site (51.49%; e.g., visited the website, had an intake, were on the mailing list, were currently in treatment, or were on the waitlist). Another common source was referral by a pediatrician or physician specializing in EDs (35.15%). The remainder were referred by other therapy providers, clinics, or dietitians (5.45%), national organizations (4.46%), and other sources (3.47%; e.g., word of mouth). Twenty-five families were deemed ineligible per the pre-specified exclusionary criteria: having a different eating disorder diagnosis (most commonly, ARFID; 72%); safety concerns (8%), the need for a higher level of care (8%), age outside of the specified age range (8%), and substance dependence (4%). Of the 177 eligible families, nearly half (86) scheduled an intake assessment. Causes for non-scheduling included unknown reasons (52.75%), logistical (e.g., time) constraints (20.89%), family wanting individual therapy or FBT (15.38%), and treatment not being a good fit (e.g., discomfort with the group setting; 10.99%). Of the 86 families who scheduled the baseline assessment, 77 adolescents and 130 parents assented/consented to treatment. Reasons for lack of assent/consent to treatment included disinterest in the program, emergency scheduling changes, and becoming ineligible (i.e., needing a higher level of care). Treatment attendance and study completion were high \u0026ndash; only two families discontinued after treatment initiation for unknown reasons.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Participation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e, roughly half of young people and over half of parents completed all questionnaires through the final booster session.\u003c/p\u003e\u003cp\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e approximately here]\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcceptability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParents, young people, and facilitators rated the degree to which MFT-AN helped families to work toward key therapeutic goals as 7.56, 6.16, and 8.19 out of 10, on average (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, individual questions). They rated therapeutic and group process elements as 7.99, 6.71, and 9.00 out of 10, on average (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, group questions).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMulti-Family Therapy Group Questionnaire (MFT-GQ)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eYoung People\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eFacilitators\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eIndividual Questions\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand anorexia better\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand my child (parents) better\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand my family better\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMake practical changes to food/eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunicate better within my family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeel more connected as a family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeel more confident about recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeel more hopeful about recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSet clearer boundaries/expectations for my child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand when to be firm and when to be flexible with the eating disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImprove how my partner and I work together to manage the eating disorder *\u003cem\u003eIf partnered\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncrease motivation to recover\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand my relationship with the eating disorder better\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eGroup Questions\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt my/my family\u0026rsquo;s difficulties were similar to the difficulties of the others in the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt less isolated by coming to the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe group helped me to gain new perspectives on my/my family\u0026rsquo;s difficulties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI learned from others in the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI noticed other families doing similar things to what I do/my family does\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt pressure from the group to keep going even when I might have otherwise given up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt supported and encouraged by the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBy coming to the group, I realized I/my family is more capable than I thought\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking with people outside my immediate family was helpful\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe intensity of the group helped move my family forward toward recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe group gave me/my family more hope about recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI tried out new behaviors in the group (e.g., a new type of food, expressing different thought or emotion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI understand myself and my own strengths and limitations better after coming to the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeeting others in a similar situation to me/my family has helped me open up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI was very active in the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt supported by the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt understood by the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI trusted the group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt supported by the MFT therapists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt understood by the MFT therapists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI trusted the MFT therapists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e. Questions were rated on a scale from 1\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly disagree\u003c/em\u003e to 10\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly agree\u003c/em\u003e. Question wording was modified for the appropriate reference group while maintaining the content of the question. Facilitators were asked to rate their perceptions of families\u0026rsquo; experiences. For example, for facilitators, \u0026ldquo;Multi-Family Therapy (MFT) group helped me to feel more hopeful about recovery\u0026rdquo; was changed to \u0026ldquo;Multi-Family Therapy (MFT) group helped families to feel more hopeful about recovery.\u0026rdquo; Similarly, \u0026ldquo;I trusted the group\u0026rdquo; was changed to \u0026ldquo;Families trusted the group.\u0026rdquo;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eparent\u003c/em\u003e\u003c/sub\u003e = 40; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eyoung people\u003c/em\u003e\u003c/sub\u003e = 17; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efacilitator\u003c/em\u003e\u003c/sub\u003e = 7\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eparent\u003c/em\u003e\u003c/sub\u003e = 39; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eyoung people\u003c/em\u003e\u003c/sub\u003e = 14; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efacilitator\u003c/em\u003e\u003c/sub\u003e = 7\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParents and facilitators also reported positive experiences with and outcomes of the intervention, including logistical elements prior to study initiation (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.56 and 4.50 out of 5); logistical and therapeutic elements during treatment (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.51 and 4.63 out of 5); and satisfaction and hope at the end of the study (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.04 and 4.25 out of 5). Importantly, parents and facilitators alike tended to \u0026ldquo;agree\u0026rdquo; to \u0026ldquo;strongly agree\u0026rdquo; that the virtual nature of the study was satisfactory and acceptable (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.24 and 4.32 out of 5). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for item-level means for the MFT-FF.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMulti-Family Therapy Feedback Form (MFT-FF)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eFacilitators\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbout Prior to Starting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe information presented to me about the research and study treatment was easy for me and my family to understand.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll my questions about the research intervention were answered prior to starting the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy family and I felt comfortable asking questions before starting the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunication with the treatment team was easy and responded to within a reasonable time frame.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbout During the Study\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall, I was satisfied with conducting the study online through [virtual platform].\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe study visits were scheduled at a convenient time for our family.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy questions were answered adequately by the treatment team.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe treatment team treated my child with respect.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe treatment team treated me (and my child\u0026rsquo;s other parent/guardian if applicable) with respect.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe caregivers in my family (myself +/- a co-parent/guardian) felt empowered by the treatment team.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe caregivers in my family (myself +/- a co-parent/guardian) felt supported by the treatment team.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe caregivers in my family (myself +/- a co-parent/guardian) understood how to generalize what we were learning in the study treatment to our time outside of the research.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe caregivers in my family (myself +/- a co-parent/guardian) felt comfortable sharing difficult moments and questions with the treatment team and other families.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy family felt connected with the other families in the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbout End of Study\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall, my family and I were satisfied with the study treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompared to other treatment options our family used, I feel that Multi-Family Therapy was the best option for our family.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompared to other treatment options our family used, I feel that Multi-Family Therapy was the best option for my child.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt hopeful for my child\u0026rsquo;s immediate (short-term) recovery after completing the treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt hopeful for my child\u0026rsquo;s long-term recovery after completing the treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt comfortable continuing the treatment plan at home after the study was completed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt satisfied with the information I received about other supports for my child (e.g., additional family-based treatment, other treatment options).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe commitment required of my family in our study participation was similar to our expectations before we began the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbout Virtual\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall, I believe that online treatment in the study was as satisfactory as in-person treatment would have been for our family.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy family and I were able to connect to other families using the online platform.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe online platform was easy to use.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI felt that the asynchronous activities were just as important and effective as the synchronous activities.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e. Questions were rated on a scale from 1\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly disagree\u003c/em\u003e to 5\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly agree\u003c/em\u003e. Question wording was modified for the appropriate reference group while maintaining the content of the question. Facilitators were asked to rate their perceptions of families\u0026rsquo; experiences. For example, for facilitators, \u0026ldquo;My family and I felt comfortable asking questions before starting the study\u0026rdquo; was changed to \u0026ldquo;Families seemed to feel comfortable asking questions before starting the study.\u0026rdquo;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eparent\u003c/em\u003e\u003c/sub\u003e = 40; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efacilitator\u003c/em\u003e\u003c/sub\u003e = 7\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003e \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003eparent\u003c/em\u003e\u003c/sub\u003e = 40; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efacilitator\u003c/em\u003e\u003c/sub\u003e = 7\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eQualitatively, families expressed satisfaction with the virtual format, and with MFT-AN overall. One parent noted, \u0026ldquo;I'm really sure this treatment saved us. That we could do [it] virtually was much, much easier on my child. Virtual was a very good option for our family at that stage of my daughter's disease, and what we were able to manage in order to effectively get her help. Thank you.\u0026rdquo; Another stated, \u0026ldquo;I felt connected to the facilitator team and to the other families, and even a bit more to my partner and child. I imagine this would have felt even better if not virtual, but I am not sure how we would have navigated in person.\u0026rdquo; Suggestions for improvement related to the virtual adaptation included (a) more frequent breaks, (b) having the facilitators nominate participants to share (rather than waiting for people to speak), and (c) having separate groups for those who prefer to keep their cameras off to foster more connection within the groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePer the MFT-AN manual, the model is flexible and adaptable to meet the unique needs of each group. Thus, fidelity to the intervention is not as straightforward as in other manualized interventions. With that said, across the 13 cohorts, fidelity averaged 93.75%.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreliminary Effectiveness\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSee Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for preliminary EDE and BMI means, standard deviations, and effect sizes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMulti-Family Therapy Group Questionnaire (MFT-GQ)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e12-Month Follow-Up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEDE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.947\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e values of 0.2, 0.5, and 0.8 are generally considered to represent small, medium, and large effects, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study is the first of our knowledge to evaluate the feasibility and acceptability of virtual MFT-AN. MFT-AN was designed to rely on the group format to promote change. Thus, a fundamental question remained as to whether the key ingredients and therapeutic processes could successfully translate to the virtual format. Ultimately, significant efforts and adjustments were necessary to execute this trial with no face-to-face contact.\u003c/p\u003e\u003cp\u003eOur findings expand upon the emerging evidence base demonstrating the feasibility of making manual modifications to deliver virtual family-based interventions (Dufour et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) by demonstrating real-world implementation in a non-academic setting. Family interest in virtual MFT-AN was high, and treatment uptake and retention were similar to other virtual adaptations of family-based interventions (e.g., Anderson et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Fidelity to the manualized intervention was also high, which is often a challenge in routine clinical settings (Waller, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurther, our results point to high levels of treatment acceptability and satisfaction, including perceived effectiveness. Of particular interest, parents indicated that they understood how to generalize what they were learning in treatment to real life, and adolescents felt understood, supported, and encouraged by the group. No mean rating on any of the acceptability/satisfaction items fell below \u0026ldquo;neutral\u0026rdquo; or the midpoint of the scale for parents, young people, or facilitators. These results are in line with both qualitative and quantitative data about in-person MFT-AN, which suggest that while adolescents can feel apprehensive about attending and participating, the treatment helps to decrease isolation and increase connection from supportive others (Baudinet et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Most central to our research question, though, was acceptability and satisfaction with the virtual format itself. Overall, families and facilitators alike were highly satisfied with conducting the study online. They believed that online treatment allowed for connection with other families, and even was as satisfactory as in-person treatment would have been. However, it is important to consider the distinct processes by which connection may occur through a virtual medium (Moore et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Future research should continue to explore group processes and dynamics in virtual group psychotherapy.\u003c/p\u003e\u003cp\u003eFinally, preliminary outcome data on virtual MFT-AN is promising, especially considering the length of follow-up. Effect size changes for both ED symptoms and BMI in the present study were large. Previous research suggests that changes in weight for adolescents undergoing MFT tend to be large, and changes in ED symptoms medium, potentially signaling that virtual MFT-AN is no less effective than the in-person modality. Of course, future randomized-controlled trials are necessary to substantiate this claim.\u003c/p\u003e\u003cp\u003eThe present findings are notable for several reasons. First, a recent study found that among a community sample presenting to an ED treatment facility, 84.04% of participants with AN in general and 90.12% with AN-Restricting subtype were White (Gorrell et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Authors noted that this demographic may have been overrepresented due to larger systemic barriers impacting rates of treatment-seeking. Indeed, research suggests that EDs affect different racial and ethnic groups at a similar rate (Cheng et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The lower proportion of White individuals in our sample, and the virtual nature of the study, represent a step toward accessibility. Yet, greater efforts to increase accessibility are needed, including innovative approaches that could help reach families who, for various reasons, declined to participate in our study. Despite this, our method of delivering MFT-AN provides a pathway for cost-effective treatment for families in need, particularly those in areas of the country where access to evidence-based options is limited. Overall, the findings of the present study should be treated as tentative, initial evidence for the promise of virtual MFT-AN.\u003c/p\u003e\u003cp\u003eSeveral limitations of the current research are worth noting. First, the nature of the study site allowed for sufficient time and resources for outreach, recruitment, and retention. This likely contributed to the high attendance rate in our study. Further research in other settings is warranted to confirm feasibility. Second, as is common in this type of research, survey-based acceptability and satisfaction can be affected by response bias, potentially leading to an overestimation of satisfaction levels (Popovic \u0026amp; Huecker, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Finally, this study was a non-randomized pilot trial, and thus, we cannot isolate the effects of MFT-AN. Larger, randomized-controlled trials (e.g., those comparing virtual MFT-AN to standard MFT-AN; and FBT to FBT\u0026thinsp;+\u0026thinsp;MFT-AN) would contribute greatly to this growing body of work on adjunctive treatment options for youth and their families.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study is the first of our knowledge to pilot the recently manualized MFT-AN in a virtual context. Our findings demonstrate the feasibility of successfully implementing virtual MFT-AN in a real-world clinic setting. Importantly, parents, adolescents, and facilitators alike indicated that the intervention incorporated its intended therapeutic mechanisms, such as facilitating interpersonal learning, consistent with the treatment\u0026rsquo;s theoretical model. Our findings offer substantial grounds for future research to evaluate virtual MFT-AN in a controlled trial, with the ultimate goal of increasing access and improving outcomes for families affected by AN.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAnorexia nervosa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSM-5\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiagnostic and Statistical Manual of Mental Disorders - Fifth Edition\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEating disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEDE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEating Disorder Examination\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFBT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFamily-Based Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMFT-AN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMulti-Family Therapy for Anorexia Nervosa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMFT-FF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMulti-Family Therapy Feedback Form\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMFT-GQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMulti-Family Therapy Group Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Illinois Chicago’s Institutional Review Board. Consent was obtained from parents, and assent was obtained from adolescents to enroll in the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was funded by Blue Cross Blue Shield of Illinois/Health Care Service Corporation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKA, SD, and KB were involved in the conceptualization and implementation of the study, including funding acquisition, project administration, and obtaining resources. SB was involved in data curation, formal analysis, visualization, and writing of the original draft. All authors reviewed, edited, and approved of the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all adolescents and families for their willingness to engage in this treatment experience with us.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. 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Curr Opin Psychiatry. 2020;33(6):521\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/YCO.0000000000000641\u003c/span\u003e\u003cspan address=\"10.1097/YCO.0000000000000641\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Huysse JL, Prohaska N, Miller C, Jary J, Sturza J, Etsell K, Bravender T. Adolescent eating disorder treatment outcomes of an in-person partial hospital program versus a virtual intensive outpatient program. Int J Eat Disord. 2023;56(1):192\u0026ndash;202. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/eat.23866\u003c/span\u003e\u003cspan address=\"10.1002/eat.23866\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaller G. 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Int J Eat Disord. 2018;51(8):863\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/eat.22876\u003c/span\u003e\u003cspan address=\"10.1002/eat.22876\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adolescent, anorexia nervosa, multi-family therapy, virtual, feasibility, acceptability","lastPublishedDoi":"10.21203/rs.3.rs-7255585/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7255585/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMulti-Family Therapy for Anorexia Nervosa (MFT-AN) unites families navigating similar difficulties to promote more rapid recovery for adolescents with eating disorders. Designed as a collaborative, group-based intervention, MFT-AN shows promise for enhancing clinical outcomes while also broadening access to evidence-based care. This pilot study seeks to investigate the feasibility and acceptability of MFT-AN adapted to a virtual format.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventy-seven adolescents and 130 parents enrolled in this single-arm, pilot study. Measures included treatment interest, eligibility, enrollment, and completion; surveys assessing acceptability, satisfaction, and perceived effectiveness; patient characteristics; eating disorder symptoms; body mass index; and fidelity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a high level of interest in virtual MFT-AN. Of recruited and eligible families, nearly half scheduled a baseline assessment. Both attendance and study completion were high, and treatment was delivered with acceptable fidelity. Participants generally expressed acceptability of the virtual format, which still fostered connection amongst the group members. Effect size changes for global eating disorder symptoms and BMI were large.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreliminary data suggest that the virtual MFT-AN program is feasible and acceptable. Though larger effectiveness trials are needed, this research lays the foundation for one method of increasing access and enhancing outcomes in evidence-based treatment for adolescent anorexia nervosa.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: This study was registered with ClinicalTrials.gov (ID NCT06203418).\u003c/p\u003e","manuscriptTitle":"Investigation of Virtual Multi-Family Therapy for Adolescent Anorexia Nervosa: Feasibility and Acceptability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 07:09:43","doi":"10.21203/rs.3.rs-7255585/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T10:22:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T06:46:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230927437558845492632547217901477895289","date":"2025-09-12T00:30:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-10T15:53:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304089993195080404293622932782301811951","date":"2025-08-31T23:15:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308163306185472226801382864500365548127","date":"2025-08-02T18:27:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-02T15:30:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-01T12:52:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T10:55:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Eating Disorders","date":"2025-07-30T18:07:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"76e55943-ccf9-4f7c-b218-69fbbb6c55a3","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:23:43+00:00","versionOfRecord":{"articleIdentity":"rs-7255585","link":"https://doi.org/10.1186/s40337-026-01575-0","journal":{"identity":"journal-of-eating-disorders","isVorOnly":false,"title":"Journal of Eating Disorders"},"publishedOn":"2026-03-27 16:09:03","publishedOnDateReadable":"March 27th, 2026"},"versionCreatedAt":"2025-08-11 07:09:43","video":"","vorDoi":"10.1186/s40337-026-01575-0","vorDoiUrl":"https://doi.org/10.1186/s40337-026-01575-0","workflowStages":[]},"version":"v1","identity":"rs-7255585","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7255585","identity":"rs-7255585","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}