Behavioral Family Therapy Research Articles

Bipolar Disorder: A Comprehensive Analysis of its Etiology, Impact, and Treatment Options

Bipolar disorder (BD) is a disorder significantly impacts individuals worldwide, marked by alternating episodes of mania and depression. The onset and progression of the disease are impact by a interplay of genetic factors, neurobiological differences, environmental stressors, hormonal imbalances, and circadian rhythm disruptions. These factors collectively contribute to the manifestation and exacerbation of the disorder. The disorder profoundly affect both mental and physical health. The pervasive impact on daily life can be overwhelming, resulting in severe emotional distress. This distress is compounded by the high risk of suicide associated with the disorder, underscoring the critical need for vigilant care and comprehensive support to ensure the well-being of affected individuals. Effective treatment requires a holistic approach combining pharmacological interventions, psychotherapy, and lifestyle adjustments. Mood stabilizers, antipsychotics, and antidepressants, alongside Cognitive Behavioral Therapy (CBT), psychoeducation, and family therapy, form the cornerstone of treatment. Lifestyle modifications, including regular exercise, adequate sleep, and balanced nutrition, are crucial for symptom management. Electroconvulsive Therapy (ECT) is considered for severe cases. This review underscores the need for continuous research and innovation in therapeutic strategies and emphasizes bridging global disparities in mental health services to ensure equitable care and improve the well-being of people with bipolar disorder.

Exploring clinicians’ experience of using Behavioural Family Therapy within an older adult community mental health service

This service evaluation summarises the experience of staff offering Behavioural Family Therapy (BFT) in a community mental health setting for older people. Semi-structured interviews were conducted to gather staff views and a Template Analysis was used to summarise feedback. This evaluation indicates that BFT were seen as beneficial to Older Adults (OA) across a range of mental health problems and adaptations were needed to support this patient group and their families.

The Role of Cognitive Behavioural Therapy, Family Therapy and Psychopharmacological Interventions in Internet Gaming Disorder: A Systematic Review

The Role of Cognitive Behavioural Therapy, Family Therapy and Psychopharmacological Interventions in Internet Gaming Disorder: A Systematic Review

Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions.

Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.

Service evaluation of an embedded Early Intervention in Psychosis programme.

An average of 1300 adults develop First Episode Psychosis (FEP) in Ireland each year. Early Intervention in Psychosis (EIP) is now widely accepted as best practice in the treatment of conditions such as schizophrenia. A local EIP programme was established in the Dublin South Central Mental Health Service in 2012. This is a cross-sectional study of service users presenting to the Dublin South Central Mental Health Service with FEP from 2016 to 2022 following the introduction of the EIP programme. We compared this to a previously published retrospective study of treatment as usual from 2002 to 2012. Most service users in this study were male, single, unemployed and living with their partner or spouse across both time periods. Cognitive Behavioural Therapy for psychosis was provided to 12% (n = 8) of service users pre-EIP as compared to 52% (n = 30) post-programme introduction (p < 0.001), and 3% (n = 2) of service users engaged with behavioural family therapy pre-EIP as opposed to 15% (n = 9) after (p < 0.01). Rates of composite baseline physical healthcare monitoring improved significantly (p < 0.001). Exclusive allocation of multidisciplinary team staff to EIP leads to improved compliance with recommended guidelines, particularly CBT-p, formal family therapy and physical health monitoring.

Retention in Individual Trauma-Focused Treatment Following Family-Based Treatment Among US Veterans

Despite the availability of several empirically supported trauma-focused interventions, retention in posttraumatic stress disorder (PTSD) psychotherapy is poor. Preliminary efficacy data shows that brief, family-based interventions may improve treatment retention in a veteran's individual PTSD treatment, although whether this occurs in routine clinical practice is not established. To characterize receipt of family therapy among veterans diagnosed with PTSD and evaluate whether participation in family therapy is associated with an increased likelihood of completing individual trauma-focused treatment. This retrospective cohort study used the Veterans Health Administration (VHA) Informatics and Computing Infrastructure to extract electronic health record data of participants. All participants were US veterans diagnosed with PTSD between October 1, 2015, and December 31, 2019, who attended at least 1 individual trauma-focused treatment session. Statistical analysis was performed from May to August 2023. Receipt of any family psychotherapy and subtype of family-based psychotherapy. Minimally adequate individual trauma-focused treatment completion (ie, 8 or more sessions of trauma-focused treatment in a 6-month period). Among a total of 1 516 887 US veterans with VHA patient data included in the study, 58 653 (3.9%) received any family therapy; 334 645 (23.5%) were Black, 1 006 168 (70.5%) were White, and 86 176 (6.0%) were other race; 1 322 592 (87.2%) were male; 1 201 902 (79.9%) lived in urban areas; and the mean (SD) age at first individual psychotherapy appointment was 52.7 (15.9) years. Among the 58 653 veterans (3.9%) who received any family therapy, 36 913 (62.9%) received undefined family therapy only, 15 528 (26.5%) received trauma-informed cognitive-behavioral conjoint therapy (CBCT) only, 5210 (8.9%) received integrative behavioral couples therapy (IBCT) only, and 282 (0.5%) received behavioral family therapy (BFT) only. Compared with receiving no family therapy, the odds of completing individual PTSD treatment were 7% higher for veterans who also received CBCT (OR, 1.07 [95% CI, 1.01-1.13]) and 68% higher for veterans received undefined family therapy (OR, 1.68 [95% CI, 1.63-1.74]). However, compared with receiving no family therapy care, veterans had 26% lower odds of completing individual PTSD treatment if they were also receiving IBCT (OR, 0.74 [95% CI, 0.66-0.82]). In this cohort study of US veterans, family-based psychotherapies were found to differ substantially in their associations with individual PTSD psychotherapy retention. These findings highlight potential benefits of concurrently providing family-based therapy with individual PTSD treatment but also the need for careful clinical attention to the balance between family-based therapies and individual PTSD treatment.

A Systematic Review of Evidence-Based Interventions for Afghan Refugee Mental Health: A Cultural Adaptation Analysis

Under the United Nations High Commissioner for Refugees’ (UNHCR) seven-decade mandate, Afghan refugees have faced some of the largest and most protracted experiences with forced displacement. This intergenerational exposure to forced migration has had innumerable consequences for the mental health of this population across different stages of their displacement. Afghan refugees who have resettled into Western nations face a unique set of challenges as they must navigate resettlement into societies that are linguistically, culturally, and spiritually distinct from their own backgrounds. This systematic review explores the (a) effectiveness and (b) cultural adaptation of interventions that have addressed the mental health of Afghan refugees resettled into Western countries since the year 2000. This systematic review will employ the Cultural Treatment Adaptation Framework (CTAF) to organize the extent of cultural adaptations. Through the systematic search of four databases, 1709 studies emerged from our search terms, seven of which met the criteria for this review, for example, study includes more than 2/3 Afghan participants; study includes outcome variables. Studies included programs in Germany, Serbia, Sweden, and Austria. The most common outcomes that interventions addressed included posttraumatic stress disorder (PTSD) ( n = 5), depression ( n = 3), and quality of life ( n = 3). Program modalities ranged between Cognitive Behavioral Therapy ( n = 4), emotion regulation ( n = 1), family therapy ( n = 1), and multimodal interventions ( n = 2). Most studies only incorporated peripheral changes to interventions in the service of cultural adaptation, and only one intervention included core changes. This program reported the highest effect sizes in reducing PTSD and depressive symptoms when compared with the rest of the studies. These findings provide a direction for future studies as they consider whether the extent of cultural adaptations can influence the effectiveness of programs for Afghan refugee populations. We provide recommendations for mental health practice with this population, including a special attention to the role of daily stressors, the significance of faith and culture-based meaning making in the service of coping, and the salience of isolation.

A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID).

This scoping review identifies and describes psychological interventions for avoidant restrictive food intake disorder (ARFID) and summarizes how outcomes are measured across such interventions. Five databases (Cochrane, Embase, Medline, PsycInfo, Web of Science) were searched up to December 22, 2022. Studies were included if they reported on psychological interventions for ARFID. Studies were excluded if participants did not have an ARFID diagnosis and if psychological interventions were not delivered or detailed. Fifty studies met inclusion criteria; almost half were single-case study designs (23 studies) and most studies reported on psychological interventions for children and adolescents with ARFID (42 studies). Behavioral interventions (16 studies), cognitive-behavioral therapy (10 studies), and family therapy (5 studies), or combinations of these therapeutic approaches (19 studies) were delivered to support patients with ARFID. Many studies lacked validated measures, with outcomes most commonly assessed via physical health metrics such as weight. This review provides a comprehensive summary of psychological interventions for ARFID since its introduction to the DSM-5. Across a range of psychological interventions and modalities for ARFID, there were common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement. Currently, studies reporting on psychological interventions for ARFID are characterized by small samples and high levels of heterogeneity, including in how outcomes are measured. Based on reviewed studies, we outline suggestions for clinical practice and future research. Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food. We reviewed the literature on psychological interventions for ARFID and the outcomes used to measure change. Several psychological interventions have been developed and applied to patients with ARFID. Outcome measurement varies widely and requires further development and greater consensus.

Internet addiction: issues and concerns

There is some addictive use of the internet which ultimately refers to a disorder. Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that led to impairment or distress. The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. This proposed condition is limited to gaming and does not include problems with general use of the internet, online gambling, or use of social media or smartphones.Co morbidity found in this addictive behavior like depression and anxiety. Treatment options are limited, including Cognitive behavioral therapy, family therapy, couple therapy, antidepressant, anti-anxiety drugs and naltrexone. The mental health professionals, information technologists, young and students affairs professionals should be alert to this disorder. Internet addiction is a growing concern in today’s digital age. With the widespread availability and use of the internet, many people are finding it difficult to control their usage, leading to negative consequences in their daily lives. Some of the issues and concerns related to internet addiction include: Social isolation, Poor academic or work performance, Physical health problems, Sleep disturbances, Risks of Cyber bullying, financial problems, Behavioral and Relationship issues. It is important to seek help if you or someone you know is struggling with internet addiction. Management options may include psychotherapy, support groups, and behavior modification techniques to help individuals regain control of their internet use and improve their overall well-being and sometimes medication need when intractable behavioral issues persist. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183-184

Bipolar Disorder with Psychosis Featured in Patient with Systemic Lupus Erythematosus

Abstracts Introductions: Bipolar disorder (BD) is a mental disorder that imposes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks, characterized by biphasic mood episodes of mania or hypomania and depression. More than half of all individuals diagnosed with BD experience psychosis features in their lifetime. The cause of BD is not entirely known, study claims that BD may occur due to or associated with autoimmune diseases. Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with various physical manifestations, including neuropsychiatric features. Case: This case report will discuss a 22-year-old female with BD admitted to the emergency room due to solid psychosis features. The patient was diagnosed with SLE 3 years ago but never controlled prior to the disease history. The psychiatrist’s treatment in the emergency room was an extra injection of haloperidol 5 mg IM and diazepam 10 mg IM, continued with oral medication clozapine 25 mg two times a day and additional therapies such as cognitive behavioral therapy (CBT) and family therapy. The treatment from the internist was symptomatic medication due to the acute SLE symptoms, followed by autoimmune medicines such as steroids and hydroxychloroquine. Conclusions: BD may be associated with SLE. Psychosis features generally occur in BD, usually in the manic period. Treatment should be done for both psychiatric and internal medicine problems. As the SLE symptom was controlled, the BD symptom improved.

Effectiveness of Cognitive–Behavioral Family Therapy: A Systematic Review of Randomized Controlled Trials

Cognitive–behavioral family therapy (CBFT) is used for a wide range of psychological and physical problems in integration with different treatment protocols. Effectiveness of CBFT research studies on the control group are limited in literature, even though this treatment is used frequently. Although various studies highlighted the effectiveness of CBFT, no systematic reviews were conducted. The study aims to review randomized controlled trials on CBFT. The study used keywords to identify 402 related articles in commonly used psychology databases (ULAKBİM, American Psychological Association, Psychology Database, Web of Science, Medline, and Scopus). The PRISMA diagram was used for analysis. Studies assessed with control groups were included without a historical limitation. The articles were screened according to inclusion and exclusion criteria. Fourteen articles were evaluated in terms of sample characteristics, content, application methods, characteristics of control and comparison groups, assessment tools, and findings. The results indicated that CBFT is especially more effective than individual CBT, psychoeducation or waitlist for various issues, such as anxiety disorders, obsessive compulsive disorders, pediatric bipolar disorder, substance use disorder, anorexia nervosa and chronic physical problems. The study inferred that CBFT can be used to improve mutual interaction between mental or physical problems with family. In other words, CBFT can be used to improve the effect of disorders experienced by one member on the family and the effect of the family on the disorders. In this manner, the risk of relapse can be reduced in the treatment of certain disorders. Therefore, the study suggests that CBFT should be used increasingly and that this field warrants further research.

A Cognitive Behavioral Family Therapy Approach: The Impact of Divorce on a Hispanic Adolescent with an Eating Disorder

Each year, millions of marriages end up in divorce which can cause teenagers to experience multiple physiological and psychological issues. Cognitive Behavioral Family Therapy (CBFT) has become increasingly popular among family therapists in recent decades, who utilize it either as a stand-alone technique within a system perspective or integrated into other approaches with couples and family therapy. There is a gap in the literature regarding the utilization of CBFT to a divorced family of Hispanic/Latinx descent with an adolescent who developed an eating disorder. The overall aim of this article is to provide insight for marriage and family therapists (MFTs), other mental health professionals, professors/teachers, researchers, and virtually everyone. The researchers hope to provide the ability to conceptualize eating disorders in a way that promotes empathy, compassion, and awareness. Barriers unique to Hispanic/Latinx families, clinical implications, and future directions will be discussed.

Psychosocial interventions to support retirement well-being and adjustment: a systematic review

ABSTRACT Objective Adjustment to retirement is heterogeneous in nature, and for some, but not all individuals, may require well-being support. However, limited information is available on the types of psychosocial interventions that can be effective during this time of transition with pre-retirees or retirees. This review identified psychosocial interventions with adults before and during retirement, and their effectiveness in maintaining or increasing well-being. Method Following PRISMA guidelines, a multi-database systematic literature review, with a two-stage screening process, was conducted utilising narrative synthesis. Records were independently screened by two screeners against set inclusion and exclusion criteria. Results Two thousand four hundred and thirty-six records were identified for screening with 20 studies found eligible for final review. These included seven randomised controlled trial studies (RCT), six non-randomised quasi-experimental controlled studies, and seven single group pre/post intervention studies. Interventions covered cognitive behavioural therapy (CBT), positive psychology, mentoring, family therapy and others. Conclusions The review highlighted the benefits of psychosocial support to adults’ well-being before and after they retire, especially with participation in group-based programs utilising elements of CBT. There was also evidence for well-being maintenance with longer running interventions. Results should be considered in the development of future psychosocial interventions to support individuals during this important life phase in older adulthood.

Effectiveness of 12 Types of Interventions in Reducing Juvenile Offending and Antisocial Behaviour

The main aim of this article is to summarize the best available evidence (from systematic reviews) of the effectiveness of 12 types of interventions in reducing juvenile offending and antisocial behaviour. In the interests of making the results widely understandable to researchers, practitioners, policy makers, and the general public, all effect sizes are converted into percentage decreases in antisocial behaviour or offending. Based on the most important systematic review in each category, the most effective interventions are parent training, focused deterrence, child skills training, cognitive–behavioural therapy, mentoring, and family therapy. Anti-bullying programs, anti-cyberbullying programs, and pre-court diversion programs are quite effective, while school exclusion reduction, after-school programs, and boot camps are least effective. The good news is that, based on estimated reductions in offending, intervention programs are usually found to be much more effective than is commonly believed (based on other measures).

The Effectiveness of Behavioral Family Therapy on Substance Use Craving in Substance Abuse Quitting Adolescents

The Effectiveness of Behavioral Family Therapy on Substance Use Craving in Substance Abuse Quitting Adolescents

Exploring service user perspectives of behavioural family therapy in early intervention in psychosis.

Family intervention (FI) is recommended in national guidance to be offered to all service users accessing an early intervention in psychosis (EIP) team, due to the consistent evidence base in reducing relapse and rehospitalisation rates. However, FI implementation is poor nationally. Although barriers have been identified at the level of staff member and the organisation, there is a paucity of research identifying service user perspectives. A qualitative questionnaire design was used to explore service user perspectives of behavioural family therapy (BFT) within a specialist EIP service in northwest England. Most participants contacted reported they lacked knowledge and understanding of BFT, with 54% reporting that this intervention had not been offered to them. This finding was unexpected and is inconsistent with the offer of BFT documentation in their clinical notes. Reasons for accepting BFT included to increase understanding of family members and for them to also be supported. Reasons for declining BFT included a preference for one-to-one interventions and not wanting family involved in their care. National guidance on FI for psychosis is not reliably being translated to clinical practice, with many participants reporting that they were not offered this intervention. A key factor in accepting or declining an offer of BFT appeared to be whether participants wanted family members to be involved in their care. A lack of understanding of the BFT approach was evident, it is recommended that the offer of FI in psychosis is improved for service users to make an informed decision.

Abstract- Poster

BACKGROUNDAn aggressive patient presenting at a Mental Health Care Facility may be diagnosed with a psychotic disorder and administration of psychotropics may obscure the existence of a long-standing Personality Disorder.AIMSTo highlight the challenges in diagnosis and management of a case of non-psychotic aggression in a 22-year-old male with history of aggressive outbursts since childhood.METHODSStandardised scales like Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and ICD 10 International Personality Disorder Examination (IPDE) were used to rule out any psychotic/mood disorders and to assess the personality of the patient, respectively.RESULTSTrial of psychotropics in the past and after in-patient treatment showed little response and the patient’s scores on IPDE suggested a mixed disorder comprising Dissocial Personality Disorder, Emotionally Unstable Personality Disorder: Impulsive Type and/or Borderline Type. The patient started showing improvement only with Dialectical Behaviour Therapy (DBT) and Family Therapy along with Sodium Valproate 500mg BD.CONCLUSIONPersonality Disorders may present with extreme aggression and poor response to psychotropics where we should consider entertaining a diagnosis of a Personality Disorder which carry poor prognosis and need Psychotherapeutic intervention more than Psychopharmacological intervention alone.

Collaborer avec les familles des jeunes adultes lors d’un premier épisode psychotique : psychoéducation ou dialogue réflexif ?

Early intervention programs for young adults with a first psychotic épisode value and promote collaboration with families. This collaboration is justified in particular by the influence of family tensions on relapse and the importance of redefining ties at this stage of life. However, the implementation of interventions for families remains complex and there are often differences between displayed will and effective practices. Early intervention programs around the world often favor a psychoeducational approach with families. However, an alternative practice with young adults developed in Finnish psychiatry under the name of “open dialogue” involves a discussion about the process of care during family sessions with the aim of improving it. The purpose of this article is to present these two common forms of intervention that differ in how collaboration is implemented. On one hand, we present a psychoeducational approach that is widely developed in the Anglo-Saxon world. In order to illustrate the actual implementation of this practice we present the behavioural family therapy approach of Ian Falloon, a New Zealand psychiatrist and psychotherapist. This approach is based on a neurodevelopmental model of psychotic disorders and has the overall aim of transforming strong destructive expressed emotions into more nuanced and supportive ones. It also aims to teach family members some basic care skills and rehabilitation strategies. On the other hand, we present approaches adopting a more reflexive position (i.e. “Open Dialogue”) that have been successfully developed in Finnish psychiatry in particular by Jakko Seikkulla, a psychologist and psychotherapist. Concretely, it is a networking practice which brings together the necessary conditions for a dialogue to take place between the different partners. Thus, with the term “open dialogue”, these authors are following a practice of “treatment adapted to needs” which aims to rely as much as possible on the resources of the patient and his network. This practice of “open dialogue” is characterised by three central principles named (1) tolerance of uncertainty, (2) dialogism and (3) polyphony of the social network. Our article discusses these approaches, underlining both their differences and their similarities. Among their differences we note in particular the representation of psychotic disorders as the manifestations of a neurodevelopmental disease to be central in psychoeducational approach; in contrast in open dialogue the diagnosis is not considered as a prerequisite for the prescription of the most suitable drug treatment and for complementary psychosocial interventions. Among their similarities, we note, that both approaches show a centrality of a intervention on young adult autonomisation, the importance of constructing a good alliance with families, an interest in changing the way they communicate.

Couple and family therapy for substance use disorders: Evidence‐based update 2010–2019

This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.

Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme.

Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn't a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.