Attachment-Based Family Therapy for Suicidal Adolescents

描述（由申请人提供）：自杀是美国青少年死亡的第三大原因。每年有近100万青少年企图自杀，每年约有50万青少年因自杀企图或严重的自杀意念而被送入精神病院。这给家庭带来了高昂的情感成本，给卫生系统带来了高昂的财务成本。然而，没有药物治疗，只有不到10项心理治疗研究关注于有自杀倾向的青少年，研究结果好坏参半。Brent（2006）和Jensen（2006）呼吁采用新的和创新的方法来治疗抑郁症，这也强调了对有自杀倾向的青少年采取替代干预措施的必要性。以依恋为基础的家庭治疗（ABFT）提供了一种有希望的替代先前治疗的方法。这是一种针对自杀和抑郁相关过程的手动家庭治疗。ABFT旨在通过增加家庭讨论和谈判关系中有效的问题的能力来改善青少年与照顾者的关系。依恋关系的改善为青少年提供了更好的情感调节能力和利用照顾者作为保护和支持来源的能力。这些优势使青少年避免自杀和其他危险行为。四项研究表明，ABFT可以减少自杀意念和抑郁症状，平均效应值为0.97。不幸的是，对这些研究的解释由于缺乏对照治疗而受到损害。本研究旨在测试ABFT的疗效，采用对照组，控制治疗剂量，持续时间，治疗师专业知识，生态因素和家庭参与。该研究包括一年的随访数据，评估人员对治疗情况一无所知，并对ABFT的所谓有效成分进行测试。假定的变化过程将被测试，包括：a)青少年对父母可用性的期望，b)父母-青少年冲突讨论中的情绪调节，以及c)对损失和虐待的解决。为了验证这一点，Kobak博士，一位领先的青少年依恋研究者，将使用成人依恋访谈和家庭互动任务的观察编码来测试这些治疗机制。如果成功，研究结果将为基于家庭的治疗机制的有效性和特异性提供证据。我们将招募并随机分配130名青少年进行16周的ABFT或家庭增强-非指导性支持治疗（FE-NST）。评估将在基线、8周、16周、32周和52周进行。主要和次要目的评估ABFT是否比控制更有效地减少自杀意念、抑郁、家庭冲突和未来的自杀企图。探索性目的测试a) ABFT是否可以改善父母-青少年依恋，b)依恋是否介导结果，以及创伤史、父母抑郁或家庭冲突是否调节结果。本研究以具有严重持续性自杀意念的城市少数民族青少年为研究对象。

DESCRIPTION (provided by applicant): Suicide is the third leading cause of death for American adolescents. Nearly one million adolescents a year attempt suicide and about 500,000 adolescents a year are admitted to psychiatric hospitals for suicide attempts or serious suicidal ideation. This leads to high emotional costs for families and financial cost for the health system. Yet, no medication, and less than 10 psychotherapy studies have focused on suicidal youth and findings are mixed. Brent (2006) and Jensen's (2006) call for new and innovative approaches for depression treatment highlights the need for alternative interventions for suicidal youth as well. Attachment-Based Family Therapy (ABFT) offers a promising alternative to prior treatments. It is a manualized family therapy targeting processes associated with suicide and depression. ABFT seeks to improve the adolescent-caregiver relationship by increasing the family's capacity for discussing and negotiating affectively charged issues in the relationship. Improvements in the attachment relationship provide adolescents with improved capacity for affect regulation and the ability to use the caregiver as a source of protection and support. These strengths buffer adolescents against suicide and other risk behaviors. Four studies have demonstrated that ABFT can reduce suicidal ideation and depressive symptoms with an average effect size of .97. Unfortunately, interpretation of these studies is compromised by lack of a controlled comparison treatment. This study aims to test the efficacy of ABFT using a comparison group that controls for treatment dose, duration, therapist expertise, ecological factors, and family involvement. The study includes one year follow-up data, assessment staff blind to treatment condition and tests of the purported active ingredients of ABFT. Putative change processes will be tested including: a) adolescents' expectancies for parent availability, b) emotion regulation during parent-adolescent conflict discussions, and c) resolution of loss and abuse. To test this, Dr. Kobak, a leading adolescent attachment researcher, will use the Adult Attachment Interview and observational coding of the family interaction task to test these treatment mechanisms. If successful, the findings will provide evidence for both the efficacy and specificity of a family based treatment mechanism. We will recruit and randomize 130 adolescents to 16 weeks of ABFT or Family Enhanced-Non-directive Supportive Therapy (FE-NST). Assessments will be conducted at baseline, 8, 16, 32 and 52 weeks. The primary and secondary aims assess whether ABFT reduces suicidal ideation, depression, family conflict, and future suicide attempts more effectively than control. Exploratory aims test a) whether ABFT can improve parent- adolescent attachment, b) if attachment mediates outcome, and if a history of trauma, parental depression or family conflict moderate outcome. The study targets adolescents with severe and persistent suicidal ideation selected from inner city, minority youth.