Cognitive Behavioural Family Intervention Research Articles

Leader and Provider Perspectives on Implementing Safe Alternatives for Teens and Youth - Acute (SAFETY-A) in Public School Districts Serving Racial/ethnic Minoritized Youth.

Racial/ethnic minoritized (REM) youth represent a high-risk group for suicide, yet there are striking disparities in their use of mental health services (MHS) even after risk is identified in schools. Prior research suggests that school-based risk assessments and hospitalization encounters can be negatively experienced by REM youth and families, thus deterring likelihood of seeking follow-up care. The Safe Alternatives for Teens and Youth-Acute (SAFETY-A) is a brief, strengths-based, cognitive-behavioral family intervention demonstrated to increase linkage to MHS when implemented in emergency departments. With its focus on strengths and family engagement, SAFETY-A may cultivate a positive therapeutic encounter suited to addressing disparities in MHS by enhancing trust and family collaboration, if appropriately adapted for schools. Thirty-seven school district leaders and frontline school MHS providers from districts serving primarily socioeconomically disadvantaged REM communities participated in key informant interviews and focus groups. First, interviews were conducted to understand usual care processes for responding to students with suicidal thoughts and behaviors, and perspectives on the strengths and disadvantages of current practices. An as-is process analysis was used to describe current practices spanning risk assessment, crisis intervention, and follow-up. Second, focus groups were conducted to solicit perceptions of the fit of SAFETY-A for these school contexts. Thematic analysis of the interviews and focus groups was used to identify multilevel facilitators and barriers to SAFETY-A implementation, and potential tailoring variables for implementation strategies across school districts.

Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta-analysis of randomized controlled trials.

WHAT IS KNOWN ON THE SUBJECT?: Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence-based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta-analysis have been conducted. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this review suggest that the brief CBFI is an effective family-inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. Abstract Introduction Cognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI. Aim This review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families. Method Eligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random-effects models. Results Four studies consisting of 524 participants were included. The risk of bias was low-unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post-treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal. Discussion The findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention. Implications for Practice Mental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse-led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.

Group Cognitive Behavioural Family Intervention (CBFI) for People With Schizophrenia and Their Families

Group Cognitive Behavioural Family Intervention (CBFI) for People With Schizophrenia and Their Families

Antecedents of Treatment Resistant Depression in Children Victimized by Peers.

Children victimized by peers are at increased risk of ongoing depression. This study investigates treatment resistant depression in children victimized by peers, following participation in a targeted cognitive behavioral family intervention. The sample comprised 39 children aged 6-12years with elevated depression compared with a general sample, prior to the intervention. Six months after the intervention, 26 were no longer depressed and 13 were still depressed. This study investigated the differentiation of these two groups on the basis of parenting and child factors. Children with treatment resistant depression were discriminated from other children by lower levels of peer support and facilitative parenting immediately after the intervention. It was concluded that ongoing support from parents and peers is needed to reduce the risk of ongoing depression even if victimization has been reduced. Further research could develop a comprehensive profile of children at risk of depression following peer victimization.

Psychosocial therapeutic techniques to reduce family care burden in psychiatric disorders

The purpose of this review was to address current psychosocial therapeutic techniques which reduce family care burden in psychiatric disorders. Various types of psychosocial/psychotherapeutic techniques have been developed to reduce the family burden in key caregivers and to provide support. These techniques include training programs, spiritual support, religious coping, psychotherapy, cognitive-behavioral family intervention, enhancing social support, and a combination of education and emotional support.

Interventions for people bereaved through suicide: systematic review

Promoting the mental health of people bereaved through suicide is a key aim of the National Suicide Prevention Strategy. To evaluate the effects of interventions to support people bereaved through suicide. We conducted a systematic review of data from controlled studies of interventions for people bereaved through suicide. Studies were identified using systematic searches, the methodological quality of included studies was assessed and narrative synthesis conducted. Eight studies were identified. None was UK-based and all but one study had substantial methodological limitations. When compared with no intervention, there was evidence of some benefit from single studies of a cognitive-behavioural family intervention of four sessions with a psychiatric nurse; a psychologist-led 10-week bereavement group intervention for children; and 8-week group therapy for adults delivered by a mental health professional and volunteer. The findings from studies comparing two or more active interventions were more equivocal. Although there is evidence of some benefit from interventions for people bereaved by suicide, this is not robust. Further methodologically sound evidence is required to confirm whether interventions are helpful and, if so, for whom.

Meta-análise de ensaios clínicos de intervenção familiar na condição esquizofrenia

The present study aimed to assess the efficacy of cognitive-behavioral family interventions by relatives of schizophrenic patients under community care, specifically targeting relapse and family burden as outcomes. Independent researchers conducted the analyses of the pertinence and quality of trials identified through a search strategy, following a previously developed protocol. Eleven randomized or quasi-randomized trials were selected. The summary relative risk of relapse using the fixed effects model was favorable to family intervention, with estimated efficacy reaching nearly 60% (50%-70%). Summary relative risk in the cognitive-behavioral therapy trials subgroup [RR = 0.43 (0.28-0.67)] was equivalent to that of the behavioral therapy subgroup [RR = 0.37 (0.23-0.60)] and the "pragmatic" subgroup [RR = 0.37 (0.21-0.66)], although the "pragmatic" trials were generally analyzed for effective treatment. The difference in summary overall risk of relapse was nearly 30% using the random effects model. Only four trials analyzed family burden as outcome, including different dimensions of burden. Results of individual trials were generally favorable to family intervention, for both the objective and subjective dimensions.

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.

Long-Term Outcome of Family Therapy in Schizophrenia

Introduction: Cognitive-behavioral family interventions in schizophrenia have proven to be effective in reducing relapse and readmission rates, and also appear to offer other benefits to patients and their families, at least in the short-term. Of particular interest to mental health services is ascertaining how long family interventions should last to maintain their benefits over the course of time. Objective: To determine whether or not the benefits of a family intervention in schizophrenia, conducted in the clinical practice framework, are sustainable over a five-year period. Method: A follow-up over a five-year period with a representative sample of patients and their families who, five years ago, participated in a twelve-month long, cognitivebehavioral family intervention. Results: 53.5% of patients had at least one relapse, and 16.9% followed a continuous course. The number of positive symptoms was higher after follow-up than at the end of the intervention, with significant worsening in delusions (Wi...

The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury.

Objective: To examine whether an online cognitive‐behavioral intervention could improve child adjustment following traumatic brain injury (TBI). Participants: Thirty-nine families of children with moderate to severe TBI. Intervention: Families were randomly assigned to the online family problem-solving (FPS) group or to the Internet resources comparison (IRC) group. Main Outcome Measures: Outcomes included child behavior problems, social competence, and self-management/compliance. Results: The FPS group reported better child self-management/compliance at follow-up than did the IRC group. The child’s age and socioeconomic status (SES) moderated treatment effects, with older children and those of lower SES who received FPS showing greater improvements in self-management and behavior problems, respectively. Conclusions: Findings suggest that an online cognitive‐behavioral approach can improve child adjustment after TBI, particularly in older children and children of lower SES.

Treatment of Nonorganic Recurrent Abdominal Pain

We evaluated the efficacy of cognitive-behavioral family intervention in the treatment of crises of pain in children with nonorganic recurrent abdominal pain (RAP) and the thresholds of pain for 17 body surface areas in these children. A randomized clinical trial was undertaken with 32 children between the ages of 5.1 and 13.9 years with nonorganic RAP. A group of 15 patients, aged 9.9 +/- 2.2 years (11 girls), received standard pediatric care and cognitive-behavioral family intervention for treatment of pain crises. The control group of 17 children, aged 8.4 +/- 2.0 years (11 girls), received only standard pediatric care. These procedures were undertaken by general pediatricians over 4 monthly sessions. An analog visual scale was used to measure the frequency and intensity of the pain crises per month and a mechanical pressure algometer for the measurement of pain threshold. The median frequency of pain crises per month reported by patients at the 3 monthly cognitive-behavioral family intervention sessions was 15, 5, 2 and 2, respectively. In contrast, the median frequency for pain crises per month reported by the control group was 12, 8, 10 and 8, respectively. The difference between the intervention group and the controls was statistically significant for frequency of pain at the second, third and fourth visits. There was no statistical difference for intensity of pain or for measured pain thresholds between the control and the intervention group. The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP. This successful intervention was carried out by the intervention of general pediatricians.

A Randomized Controlled Trial of a Cognitive-Behavioral Family Intervention for Pediatric Recurrent Abdominal Pain

To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone. Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts. Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed. These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services.

A needs based cognitive behavioural family intervention for schizophrenia reduced relapse in the long term

Sellwood W, Barrowclough C, Tarrier N , et al. Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12-month follow-up. Acta Psychiatr Scand2001 Nov; 104 : 346 –55...

A cognitive behavioural family intervention reduced psychiatric morbidity in caregivers of patients with Alzheimer's disease

Marriott A, Donaldson C, Tarrier N, et al. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Br J Psychiatry2000 Jun;...

A cognitive behavioural family intervention reduced psychiatric morbidity in caregivers of patients with Alzheimer's disease

Marriott A, Donaldson C, Tarrier N , et al. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Br J Psychiatry2000...

Treatment of depressed mothers with disruptive children: A controlled evaluation of cognitive behavioral family intervention

This study compared the effects of two forms of behavioral family intervention in reducing mothers' depression and disruptive behavior problems in families with a clinically depressed parent and a child with significant conduct problems. Forty-seven parents were randomly assigned to either a Behavioral Family Intervention (BFI) or to Cognitive Behavioral Family Intervention (CBFI) which integrated cognitive therapy strategies to treat depression and teaching of parenting skills. Both treatments were equally effective in reducing mothers' depression and child disruptive behavior on observational and self-report measures at postintervention. However, at 6-month follow-up more families in CBFI (53%) compared to BFI (13%) experienced concurrent clinically reliable reductions in maternal depression and child disruptive behavior. These findings support the value of CBFI in reducing depression in mothers of children with disruptive behavior problems.

Staff training in cognitive-behavioral family intervention in mental illness using the multiple-family group approach: a pilot study.

This article describes a pilot project in which eight Community Mental Health Centre staff were trained in a cognitive-behavioral intervention for families of 37 mentally ill clients. After involvement in training, the staff demonstrated more regular inclusion of family members in routine clinical practice, and a trend towards an increase in relevant knowledge. After involvement in the program, the families experienced a decrease in burden (Family Burden Interview Schedule) even though the primary clients' functioning (Global Assessment of Functioning) did not change. The results are encouraging, indicating that it is possible to train staff in ordinary clinical settings in effective cognitive-behavioral family interventions. The findings need to be replicated in a controlled study with larger samples.

Predictors of Clinical Improvement in Children with Recurrent Abdominal Pain

Forty-three children with recurrent abdominal pain who had received treatment from a paediatric gastroenterology clinic were reassessed 6 and 12 months after initial presentation. Measures of children's pain included a pain diary (PD) which measured pain intensity, a parent observation record (POR) which assessed pain behaviour and a structured interview to assess the degree to which pain interferes with the child's activities. Pretreatment measures of the child's history of pain, coping strategies in dealing with pain, and their mother's caregiving strategies were examined as predictors of two indices of clinical improvement: the extent of change in pain on the child's pain diary from pre-test to 6 months follow-up, and the degree of interference to the child's activities. All children had shown significant improvement in the level of pain at follow up, with 74.4% being pain free at 12 month follow-up on the PD and 83.7% being pain free on the POR. The amount of change they showed varied, with some showing residual impairment even though they were significantly improved. Regression analyses showed that children with greatest reductions on the child's pain diary at the 6 month follow-up were those with a stress-related mode of onset, whose mothers used more adaptive caregiving strategies, and who received cognitive behavioural family intervention. There was also a non significant trend for younger children to fare better. These data suggest the importance of early diagnosis and routinely assessing parental caregiving behaviour and beliefs about the origins of pain in planning treatment for children with RAP.

Cognitive-Behavioural Family Interventions for Major Mental Disorders

Cognitive-behavioural family interventions for major mental disorder have undergone significant refinement over recent years. This paper reviews the current techniques for assessing mental disorder in the family. The initial task of the therapist is to undertake a comprehensive family assessment, including an assessment of their stress management. Specific information must be obtained about each family member's view of the presenting problems, interaction within the family system, and function in settings outside the family, as well as the family's effectiveness in problem solving and quality of life. Key goals of cognitive-behavioural family therapy are personal goal setting, education, and communication training that enhance the efficiency of family problem solving. The efficiency of cognitive-behavioural therapies in treating major mental disorders is also reviewed in relation to the family's ability to achieve specific goals in therapy and to modify the outcome of major mental illness. Particular attention is given to the strengths and weaknesses of the research, and to possible future research directions. Cognitive-behavioural family interventions are found to be effective in reducing clinical, social, and family morbidity.

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.