The Impact of Emotion Coaching on Changes in Caregiver Burden and Distress Tolerance During Family-Based Treatment

Caregivers often experience elevated stress while supporting a loved one with an eating disorder. This study was a secondary analysis exploring changes in caregiver burden (EDSIS), distress tolerance (DTS), and emotion regulation (ERQ) during family-based treatment (FBT) among caregivers high in expressed emotion (EE) participating in an emotion coaching or control intervention.

Forty-one adolescents with anorexia nervosa (AN) or atypical AN (M _age = 14.88, SD = 1.63) and a caregiver scoring high in EE participated in FBT and were randomized to an emotion coaching or caregiver support group. Structural equation modeling was used to examine changes in the EDSIS, DTS, and ERQ from the start and end of FBT and at three-month follow-up.

In the full sample, EDSIS decreased from baseline to end of treatment (p = 0.008) and end of treatment to 3-month follow up (p = 0.014). However, caregivers in the emotion coaching group experienced greater reductions in EDSIS (β = -0.46 vs. -0.14, p = 0.042) and improvements in DTS (β = 0.25 vs. -0.06, p = 0.042) from baseline to end of treatment than caregivers in the support group. Caregivers did not report significant changes on the ERQ.

This is among the first studies to demonstrate reductions in caregiver burden during FBT, especially among caregivers who participated in an emotion coaching group focused on validation and communication skills. Emotion coaching interventions may support FBT outcomes among caregivers high in EE while reducing caregiver burden and distress.