Parent-Focused Group Schema Coaching; CAREFREE (Carers Programme for Fluency in Resonance and Empowerment in Eating Disorders) Intervention for Parents of Adolescents With Anorexia Nervosa: A Multiple Baseline Design

Although family-based interventions are effective for adolescents with anorexia nervosa (AN), they often neglect the intense emotional burden faced by parents, which may limit their full therapeutic impact. This study aimed to pilot the CAREFREE parent-focused schema coaching programme and evaluate its feasibility, acceptability and preliminary effects on parental emotion regulation, parent–child interaction and adolescent AN outcomes. A three-tiered non-concurrent multiple baseline design was employed. Participants were Iranian mothers (M = 44.7 years, SD = 2.19) of female adolescents with AN (M = 15.16 years, SD = 5.54) enrolled in the 12-week online CAREFREE intervention. Outcomes were assessed at four time points using validated measures of parental difficulties in emotion regulation (DERS-16), parent–child interaction (PACHIQ-R) and adolescent percentage of median body mass index (%mBMI), alongside weekly visual analogue scales (VAS) assessing parental guilt, anger management, empathy and emotional presence. Feasibility, acceptability, and intervention fidelity were evaluated. Data were analysed in R software using visual inspection, non-overlap indices and linear mixed-effects modelling. Significant improvements were observed in all parental outcomes, including guilt, anger management, empathy, emotional presence, difficulties in emotion regulation and parent–child interaction, with effects maintained at follow-up. Adolescents' %mBMI significantly increased, whereas no significant changes were found in their body image-related outcomes. Feasibility and acceptability were supported by acceptable completion rates and high parent satisfaction. The CAREFREE intervention was feasible and acceptable and showed promising effects on parental functioning and adolescent weight outcomes. However, future research should incorporate direct adolescent-focused components, and larger controlled trials are required to more rigorously assess the intervention's impact.

Trial Registration: Iranian Registry of Clinical Trials: IRCT20220714055467N1