Attachment-Based Family Therapy for Suicidal Adolescents

针对自杀青少年的依恋家庭治疗

• 批准号: 8109642
• 负责人: GUY Sigmond DIAMOND
• 金额: $ 61.46万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8109642
• 关键词: 18 year old; Adolescent; Adult; Affect; Aftercare; American; Attention; Behavior; Buffers; Caregivers; Cause of Death; Charge; Code; Communities; Conflict (Psychology); Data; Depression and Suicide; Dose; Emotional; Expectancy; Family; Family Process; Family psychotherapy; Feeling suicidal; Financial cost; Functional disorder; Future; Gender; Goals; Health Professional; Health system; Hospitalization; Institute of Medicine (U.S.); Intervention; Interview; Interviewer; Measures; Mediating; Mediation; Mental Depression; Minority; Modeling; Outcome; Outpatients; Parenting behavior; Parents; Patient Self-Report; Patients; Pharmaceutical Preparations; Prevention; Primary Health Care; Problem Solving; Process; Psychiatric Hospitals; Psychiatry; Psychotherapy; Public Health; Randomized; Recording of previous events; Recruitment Activity; Regulation; Relative (related person); Research; Research Design; Research Methodology; Research Personnel; Resolution; Risk; Risk Behaviors; Risk Factors; Sample Size; Sampling; Schools; Source; Specificity; Suicide; Suicide attempt; Supportive care; Target Populations; Testing; Time; Trauma; Treatment outcome; Waiting Lists; Youth; base; blind; cohesion; comparative efficacy; comparison group; cost; depressive symptoms; design; developmental psychology; dissemination research; effective therapy; efficacy testing; emotion regulation; expectation; follow-up; improved; inner city; innovation; prevent; reducing suicide; repaired; secondary outcome; suicidal adolescent; suicidal behavior; suicidal risk; treatment as usual

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. PUBLIC HEALTH RELEVANCE: Adolescent suicide is the third leading cause of death in adolescents and over one million adolescent a year attempt suicide, yet there are few effective treatments for preventing this serious public health problem. Building on very promising pilot data, this study will test the efficacy of Attachment Based Family Therapy for reducing the risk factors that are highly predictive of future suicide: suicide ideation, depression, and family conflict. The treatment model aims to achieve this goal by strengthening and or repairing the appropriate parent-adolescent attachment bond so that adolescents are more likely to turn to parents for support and protection the next time they feel suicidal.

描述（由申请人提供）：自杀是美国青少年的第三大死因。每年有近 100 万青少年试图自杀，每年约有 50 万青少年因自杀未遂或严重自杀意念而被送进精神病院。这给家庭带来了高昂的情感成本，也给卫生系统带来了高昂的经济成本。然而，没有药物治疗，而且只有不到 10 项心理治疗研究关注有自杀倾向的青少年，而且研究结果好坏参半。 Brent (2006) 和 Jensen (2006) 呼吁采用新的创新方法来治疗抑郁症，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。 基于依恋的家庭治疗（ABFT）为先前的治疗提供了一种有前途的替代方案。这是一种针对与自杀和抑郁症相关过程的手动家庭治疗。 ABFT 旨在通过提高家庭讨论和谈判关系中情感问题的能力来改善青少年与照顾者的关系。依恋关系的改善提高了青少年的情感调节能力以及利用照顾者作为保护和支持来源的能力。这些优势可以帮助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，平均效应大小为 0.97。不幸的是，由于缺乏对照比较治疗，这些研究的解释受到影响。 本研究旨在使用控制治疗剂量、持续时间、治疗师专业知识、生态因素和家庭参与的对照组来测试 ABFT 的疗效。该研究包括一年的随访数据、不了解治疗条件的评估人员以及对 ABFT 声称的活性成分的测试。将测试假定的变化过程，包括：a）青少年对父母陪伴的期望，b）父母与青少年冲突讨论期间的情绪调节，以及c）解决失去和虐待的问题。为了测试这一点，领先的青少年依恋研究者 Kobak 博士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 130 名青少年并随机分配他们接受 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、第 8、16、32 和 52 周进行。主要和次要目标评估 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。探索性目标测试 a) ABFT 是否可以改善父母与青少年的依恋，b) 依恋是否会调节结果，以及创伤史、父母抑郁或家庭冲突是否会调节结果。该研究针对的是从市中心的少数族裔青年中选出的具有严重和持续自杀意念的青少年。 公共卫生相关性：青少年自杀是青少年死亡的第三大原因，每年有超过一百万青少年试图自杀，但很少有有效的治疗方法可以预防这一严重的公共卫生问题。基于非常有希望的试点数据，这项研究将测试基于依恋的家庭疗法在减少高度预测未来自杀的危险因素（自杀意念、抑郁和家庭冲突）方面的功效。该治疗模式旨在通过加强和/或修复适当的父母与青少年的依恋关系来实现这一目标，以便青少年在下次感到自杀时更有可能向父母寻求支持和保护。