Behavioral Family Therapy Research Articles

A Randomized Controlled Study of Cognitive Behavior Therapy and Behavioral Family Therapy for Anorexia Nervosa Patients

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21–25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had “good” outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

Psychotherapeutic Debriefing of Children and Adolescents After Exposure to Violence in Home or Community: Integrating Narrative Techniques

The integration of several techniques drawn from the field of child and adolescent psychotherapy offers a model for the debriefing of children or adolescents exposed to violence in their home or community. Drawing on cognitive behavioral techniques, family therapy, and narrative work, this article offers a model of intervention. It focuses on framing the violent event to accentuate mastery and help symptomatic children regain a sense of comfort and control. It asks their families to manage the children's emotional and behavioral responses in ways that facilitate both the child and the family's recovery and prompts appropriate parent and child connections.

How was it for you? Families' experiences of receiving Behavioural Family Therapy.

The benefits of family interventions for families having to cope with serious mental health problems are well documented but routine implementation of these interventions is often problematic. Despite a wealth of research on the clinical outcomes of such interventions, very little is known about families' subjective perceptions of receiving them. This study reports the findings of a phenomenological enquiry into the lived experience of 10 families who received Behavioural Family Therapy (BFT) as part of a training initiative in the West Midlands Health Region of the UK. The results show that families were very satisfied with the intervention. They reported reductions in the levels of stress within the family, reduction in levels of carer burden, enhanced communication skills and a positive sense of empowerment. They attributed these changes to receiving BFT. The majority of families viewed mental health professionals and services more favourably compared to their experiences before receiving BFT. This is an important finding for service providers, commissioners and mental heath workers.

Childhood behavioral and emotional disorders.

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.

Trainee Perceptions of Teaching of Different Psychotherapies

Objective: To investigate the perceptions of senior psychiatric trainees regarding the extent and satisfaction of the teaching during psychiatric training of five different psychotherapies, namely cognitive behavioural therapy (CBT), dynamic therapy, family therapy, group therapy and supportive therapy. Method: A 60-item questionnaire was completed by 95 senior psychiatric trainees in Australia and New Zealand. This questionnaire used Likert scales to examine the degree of satisfaction in the quality of teaching received in the five psychotherapies. The teaching mostly consisted of seminars and supervision. Qualitative responses were also sought regarding the experience of teaching and suggestions for improvement. Results: Satisfaction rates in the quality of teaching varied from 7 to 41% and in the extent of teaching ranged from 4 to 20%. Trainees wished for more training in CBT, group, family and supportive therapies, practical seminars, and better supervision. Conclusions: Psychiatric trainees view the extent and quality of teaching in the psychotherapies as being deficient. Implications of these findings are discussed.

The Effects of Mothers' Depression on the Behavioral Assessment of Disruptive Child Behavior

ABSTRACT Assessment issues with families of disruptive children ages 3 to 8 years, and depressed mothers are of significant clinical and research importance. Given the long-term deleterious effects that parenting styles of depressed mothers may have on children, and given that interventions for families with disruptive children frequently include behavioral family therapy, clinical assessment should include some evaluation of how parenting is related to the behavior of children of depressed mothers. Previous observational studies of depressed mothers and their disruptive children have failed to identify behavioral differences between these families and families of similarly disruptive children whose mothers are not depressed. This failure to identify differences presents a conundrum for clinicians: a widely reported parenting style, with well-reported child behavior sequelae has not yet been linked with identified moment-to moment interactions between mother and child. This paper investigates some characteristics of families with disruptive children and depressed mothers, and compares the observed behaviors of disruptive children of depressed and non-depressed mothers. Fifty mother-child dyads: 14 depressed mothers with disruptive children, 17 non-depressed mothers with disruptive children, and 19 non-problem controls participated. Differences observed suggest that, while children of depressed mothers employed a similar range of disruptive behaviors to other disruptive children, the density of those behaviors differed. Implications for intervention are discussed.

Pseudostatus epilepticus in childhood

Pseudostatus epilepticus in childhood has not been well reported in the literature. We describe the clinical presentation and management of a 9-year-old child with well-controlled epilepsy who presented in a prolonged period of pseudoseizures. Intensive care management over a number of weeks with multiple high-dose antiepileptic drugs, anesthesia, and ventilation at a tertiary care pediatric center was performed before the diagnosis of pseudostatus epilepticus was made. Initiation of family counseling and behavior therapy after diagnosis of the nonepileptic nature of the protracted paroxysmal events with video telemetry in our pediatric epilepsy unit was followed by remission. The patient reported herein illustrates the risks of iatrogenic morbidity that may result from a delay in the diagnosis of pseudoseizures and pseudostatus epilepticus in childhood.

Family Behavior Therapy in a Conduct-Disordered and Substance-Abusing Adolescent

The present case study describes a Family Behavior Therapy (FBT) method used to treat an adolescent substance-dependent youth who evidenced co-occurring symptoms of conduct disorder and major depressive disorder. The case example includes a description of the youth's assessment, including mental status, relevant background information, substance abuse history, use of standardized measures and urine drug assay tests, diagnostic impressions, conceptualization, and method of developing the treatment plan. Implementation of the FBT program is fully delineated, including examples of completed therapy worksheets and ongoing assessments of drug use, conduct, school performance, and mood. Results, albeit uncontrolled, indicated significant progress throughout intervention and at 6 month follow-up.

Involvement of fathers in therapy: A survey of clinicians.

Clinicians providing treatment for children and families often question which family members to include in therapy. Historically, mothers were included in child-oriented therapy to a greater degree than were fathers. To determine actual rates of including fathers in therapy, 219 clinicians with specialization in clinical child psychology and family therapy were surveyed. In addition, personal and professional characteristics of clinicians were examined to establish the association between these characteristics and inclusion of fathers in treatment. Ways to help clinicians include fathers in child-oriented therapy are discussed in light of the findings. When referring children for treatment, parents or other family members frequently ask clinicians whom should be present at the first appointment. It is typically in the first contact with the clinician or the office staff that parents are educated as to how the treatment will involve them in their child’s therapeutic services. Traditionally, parents’ inclusion in treatment has been a theoretical matter—that is, depending on the type of treatment the therapist conducts. Most cognitive– behavioral therapies focus solely on the child (Hibbs & Jensen, 1996; LeCroy, 1994), including parents in these sessions only in a psychoeducational manner to teach the parents what the children have been taught. Conversely, most family therapies focus on all family members and include parents in nearly all of the therapy sessions (Becvar & Becvar, 1993; Kaslow, Kaslow, & Farber, 1999). In fact, some family therapists do not include the children themselves in treatment depending on the focus of the problem. In a survey of family therapists, Johnson and Thomas (1999) found that family therapists were less likely to include children in therapy sessions when the children’s problem was externalizing in nature, perhaps because children with these types of problems are considered challenging and disruptive in family sessions. Their findings also indicated that children were less likely to be included in sessions when the identified problem focused on one of the parent’s issues. The issue of involving parents in child-oriented therapy, other than behavioral parent training or family therapy, has largely been ignored (Kaslow & Thompson, 1998; Mash, 1998), often leaving the clinician with little guidance from an empirical viewpoint as to whom to include in treatment. Parental issues, such as parental psychopathology, living cir

School-Based Treatment of Adolescents with ADHD

Pelham, W. E., & Fabiano, G. A. (2001). Treatment of attention–deficit hyperactivity disorder: The impact of comorbidity. Journal of Clinical Psychology and Psychotherapy, 8, 315–329. Pelham, W. E., Gnagy, E. M., Burrows– Maclean, L., Williams, A., Fabiano, G.A., Morrissey, S. M., Chronis, A. M., Forehand, G. L., Nguyen, C. A., Hoffman, M. T., Lock, T. M., Fielbelkorn, K., Morse, E., Coles, E. K., Panahon, C. J., Steiner, R. L., Meichenbaum, D. L., & Onyango, A. N. (2001). Once–a–day Concerta Methylphenidate Versus t.i.d. Methylphenidate in Laboratory and Natural Settings. Pediatrics, 107, http://www.pediatrics.org/cgi/content/full/107/6/e105.

Psychological counselling in problematic diabetes: does it help?

In past decades clinicians have increasingly recognized the importance of psychological support for people with diabetes and their families, and many have recommended integrating psychological counselling into routine diabetes care. It is therefore important to consider whether psychological interventions in diabetes are effective in improving clinical outcomes. This review was limited to the literature reporting on the treatment of five common psychological problems known to complicate diabetes management: depression, eating disorders, anxiety/stress, self-destructive behaviour and interpersonal/family conflicts. A literature search was undertaken using MedLine and PsychInfo, including studies published in English peer-reviewed journals between 1990 and 2001, reporting on the effects of psychological interventions in the areas mentioned. Case studies were excluded from the review. In line with earlier reviews, relatively little empirical research was found to substantiate the effect of psychological counselling in complicated diabetes. Most studies are uncontrolled, and involve small samples. In total only 11 randomized controlled trials were identified. Results indicate that cognitive behaviour therapy (CBT) is effective in the treatment of depression in Type 2 diabetes patients, both in reducing depressive symptoms and HbA1c. Favourable effects have been observed in pilot studies applying CBT in the field of stress management, eating disorders and self-destructive behaviour, but future research should substantiate these preliminary findings. Behaviour family therapy proved beneficial in terms of resolving family conflicts, but did not impact glycaemic control. Evidence to support the effect of psychological treatment in problematic diabetes is still scarce, due to limited research in this area. Suggestions are made to further develop psychotherapeutic research in diabetes care. We conclude that future research should gain from a behavioural medicine approach to diabetes, with close collaboration between diabetologists and psychologists.

A Controlled Evaluation and Description of Individual-Cognitive Problem Solving and Family-Behavior Therapies in Dually-Diagnosed Conduct-Disordered and Substance-Dependent Youth

ABSTRACT There is a strong comorbid relationship between conduct and substance disorders in youth. However, there is an absence of controlled studies that have explicitly examined treatment efficacy in this dually-diagnosed population. In the present study, 56 such youth were randomly assigned to receive either individual-cognitive therapy or family-behavioral therapy. Subjects in both intervention groups demonstrated significant improvements in their conduct and reductions in their use of illicit drugs from pretreatment to post-treatment, and these results were maintained at follow-up. Measures of youth satisfaction with parents, parent satisfaction with youth, and overall mood of these youth demonstrated similar improvements and closely corresponded with improvements in standardized measures of conduct and drug use. No significant differences were found in conduct or reductions of illicit drug use between subjects in the two intervention conditions at post-treatment, or at 6-month follow-up. Study implications are discussed in light of these results.

Harvey, E. A. (2000). Parenting similarity in children with ADHD. Child and family Behavior Therapy, 22, 39-54.

Harvey, E. A. (2000). Parenting similarity in children with ADHD. Child and family Behavior Therapy, 22, 39-54.

The impact of behavior-specific and behavior-nonspecific reinforcement on child compliance to mother directives

Theories of child socialization differ with regard to the influence they attribute to behavior-specific reinforcement contingencies versus behavior-nonspecific reinforcement contingencies (i.e. social responsiveness). The present research investigated, at a within-individual level, the relationship between both types of reinforcement and child compliance with maternal directives. Behavior-specific reinforcement was defined as the history of reinforcement obtained by children for prior episodes of compliance and noncompliance to mother directives. Behavior-nonspecific reinforcement was defined as the history of reinforcement obtained by children for prosocial and aversive behaviors unrelated to mother directives. It was hypothesized that both reinforcement processes would be related to child responses to subsequent mother directives. The findings support these hypotheses. The discussion addresses caretaker social responsiveness as an intervention target of behavioral family therapy.

Family treatment and medication dosage reduction in schizophrenia: Effects on patient social functioning, family attitudes, and burden.

The effects of 2 family intervention programs (supportive family management [SFM], including monthly support groups for 2 years; or applied family management [AFM], including 1 year of behavioral family therapy plus support groups for 2 years), and 3 different neuroleptic dosage strategies (standard, low, targeted) on social functioning of patients with schizophrenia. their relatives' attitudes, and family burden were examined. AFM was associated with lower rejecting attitudes by relatives toward patients and less friction in the family perceived by patients. Patients in both AFM and SFM improved in social functioning but did not differ, whereas family burden was unchanged. Medication strategy had few effects, nor did it interact with family intervention. The addition of time-limited behavioral family therapy to monthly support groups improved family atmosphere, but did not influence patient social functioning or family burden.

Behavioural family therapy reduced disruptive behaviour in children at risk for developing conduct problems

Behavioural family therapy reduced disruptive behaviour in children at risk for developing conduct problems

The American Psychiatric Association practice guidelines for schizophrenia: Scientific base and relevance for behavior therapy

The American Psychiatric Association's practice guidelines for schizophrenia provide a general blueprint for treating people with the illness. They are primarily oriented toward psychiatrists and pharmacological management. However, the guidelines also discuss the importance of psychosocial treatments, including behavioral therapy techniques. We provide an overview of the treatment guidelines and their empirical base. The pharmacological recommendations are generally consonant with the literature, albeit they have become somewhat dated due to the rapid progress in studies of the effects of new generation antipsychotics. We next review recommendations concerning social skills training, cognitive therapy and rehabilitation, behavioral family therapy, and vocational rehabilitation. Overall, the guidelines are quite positive about the potential benefit of these interventions, but they are appropriately conservative in interpreting the literature. There are promising data to support the efficacy of each of these approaches, but effectiveness data are lacking and questions remain about their actual impact on community functioning. Schizophrenia has not received sufficient attention from behavior therapists since the early successes achieved by operant programs. The optimistic stance taken by the guidelines should, if anything, encourage students to pursue careers working with this very needy population.

Cognitive behavioural therapy, systemic behavioural family therapy, and non-directive supportive therapy had similar long term effectiveness for major depressive disorder in adolescents

Cognitive behavioural therapy, systemic behavioural family therapy, and non-directive supportive therapy had similar long term effectiveness for major depressive disorder in adolescents

Integration of family and cognitive behavioral therapy for treating sexually abused children

This paper demonstrates the application and integration of family systems therapy and cognitive behavioral therapy for the treatment of symptomatic children with histories of sexual abuse. This is achieved via the case of Ryan, a 12-year-old boy who had been sexually abused by two family members and who was experiencing affective/anxiety symptoms and acting-out behavior problems. While this paper provides a theoretical rationale and comprehensive treatment plan, additional details of specific treatment interventions, from both treatment modalities, are delineated. From the family systems perspective, an emphasis is placed upon the discussion of realignment of family structure and changing familial communication patterns (including messages about safety, protection, and validation of children's experiences). From the cognitive behavioral paradigm, exposure therapy and cognitive restructuring are accentuated. Finally, the importance of the integration of both modalities without violating the theoretical assumptions of either is highlighted.

A modern behavioral perspective on child conduct disorder: Integrating behavioral momentum and matching theory

It has been suggested that knowledge produced within the operant laboratory is of little or no use to clinicians. I argue, on the contrary, that laboratory science has provided clinicians with two general principles that may expand the focus of behavioral family therapy to incorporate a wide range of clinical interventions that have heretofore been considered nonbehavioral. These principles, matching theory and behavioral momentum, outline the relativity of reinforcement and the persistence of behavior in the absence of reinforcement, respectively. These principles make specific predictions concerning clinical interventions aimed not only at identified reinforcement contingencies, but also the context within which reinforcement contingencies are operative. This expanded behavioral formulation allows both the clinician and the researcher a framework for designing, implementing, and assessing techniques that target cognition, affect, and interpersonal relationships, as well as specific behaviors.