Attachment Based Family Therapy for Suicidal Adolescents
Condition: Suicide; Depression; Family Relationships
MeSH terms: Depression; Suicide
Study type: Interventional

Summary: 
      This study will evaluate the efficacy of attachment based family therapy (ABFT) for treatment
      of suicidality in adolescents. The study will compare 16 weeks of treatment with ABFT to a
      control condition Family Enhanced Non-directive Supportive Therapy (FE-NST).
    

Detailed description: 
      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.
      There has been a 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. The investigators 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.
    

Intervention name(s): Attachment-Based Family Therapy; Family-Enhanced Non-directive Supportive Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Although ABFT therapists implement behavior focused and psychoeducational interventions, the model is primarily a process oriented, emotion focused treatment guided by a semi-structured treatment protocol. ABFT aims to improve the family's capacity for problem solving, affect regulation, and organization. This strengthens family cohesion which can buffer against depression, suicidal thinking, and risk behaviors.; Family-Enhanced Non-directive Supportive Therapy (FE-NST) is a 16 week therapy designed to control for the non-specific effects of psychotherapy with suicidal youth. FE-NST aims toward relief or reduction of symptoms without expectation of change in the basic personality structure. We have added a parent component to: a) control for parent involvement and b) improve the generalizability and safety of the FE-NST treatment. This enhancement consists of 5 potential parent sessions beginning with a family safety plan in the initial treatment session that will be monitored regularly throughout the treatment. The remaining 4 parent psycho-education sessions offer parents knowledge, skills and support to improve management of the suicidal teen.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Suicide; Depression; Family Relationships