Attachment-Based Family Therapy for Suicidal Adolescents

描述(申请人提供)：自杀是美国青少年的第三大死因。每年有近100万青少年企图自杀，每年约有50万青少年因自杀未遂或有严重自杀念头而住进精神病院。这导致家庭的情感成本和卫生系统的财务成本居高不下。然而，没有药物治疗，只有不到10项心理治疗研究集中在自杀青年身上，结果喜忧参半。Brent(2006)和Jensen(2006)呼吁采用新的创新方法治疗抑郁症，强调了对自杀青年进行替代干预的必要性。基于依恋的家庭治疗(ABFT)为以前的治疗提供了一种很有前途的替代方案。这是一种针对与自杀和抑郁症相关的过程的手动家庭治疗。ABFT寻求通过提高家庭讨论和谈判关系中充满感情的问题的能力来改善青少年和照顾者的关系。依恋关系的改善为青少年提供了更好的情感调节能力，以及将照顾者作为保护和支持来源的能力。这些优势可以缓冲青少年的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，平均效应量为0.97。不幸的是，由于缺乏对照对照治疗，这些研究的解释受到了影响。这项研究的目的是使用一个对照组来测试ABFT的疗效，对照组控制治疗剂量、持续时间、治疗师的专业知识、生态因素和家庭参与。这项研究包括一年的随访数据、对治疗条件视而不见的评估人员以及对声称的ABFT有效成分的测试。将测试可能的变化过程，包括：a)青少年对父母在场的期望，b)在亲子冲突讨论期间的情绪调节，以及c)丢失和虐待的解决。为了测试这一点，领先的青少年依恋研究人员科巴克博士将使用成人依恋访谈和家庭互动任务的观察性编码来测试这些治疗机制。如果成功，这些发现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130名青少年并随机进行为期16周的ABFT或家庭增强型非指导性支持疗法(FE-NST)。评估将在基线、8周、16周、32周和52周进行。主要和次要目标评估ABFT是否比对照更有效地减少自杀意念、抑郁、家庭冲突和未来的自杀企图。探索性目标测试a)ABFT是否能改善亲子依恋，b)依恋是否起中介作用，以及是否有创伤、父母抑郁或家庭冲突的病史起中介作用。这项研究的对象是从市中心的少数民族青年中挑选出来的有严重和持续自杀意念的青少年。

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.