Family-based Therapy Research Articles

Alliance Between Therapist and Multi-stressed Families During the COVID-19 Pandemic: The Effect of Family-Based Videoconferencing

BackgroundA strong therapeutic alliance or working relationship is essential for effective face-to-face family-based psychotherapy. However, little is known about the use of VC on alliance in family-based therapy. The recent COVID-19 pandemic led to a national lockdown during which most family-based therapy transferred to VC.ObjectiveThe current study analyzed the development and strength of alliance prior and during lockdown for multi-stressed families participating in Multisystemic Therapy (MST).MethodAlliance with the therapist was reported monthly by 846 caregivers (81% female). Using latent growth curve models (longitudinal approach), the development of alliance was estimated for families participating in MST prior to the lockdown, transferring to VC early in treatment or late in treatment. Using regression analyses (cross-sectional approach), lockdown (yes/no) was included as predictor of alliance. In these analyses, type of family (regular; intellectual disability; concerns regarding child abuse or neglect) and gender of caregiver were included as moderators.ResultsBoth analytical approaches showed that alliance was not affected by VC, except for families with concerns of child abuse, who reported lower alliances during lockdown. However, these results where no longer significant when controlling for multiple testing.ConclusionsStrong alliances can be developed and maintained during family-based VC sessions with multi-stressed families. However, for some subgroups, such as families with concerns of child abuse, VC might not be suitable or sufficient. Future research needs to investigate the potential and limitations of using VC with families.

Family-Based Therapies, Mindfullnes-Based Therapies and Dialectical Behavior Therapy in Common Eating Disorders

Eating disorders are characterized by individuals' distorted perceptions and irregular eating habits. Evidence obtained from clinical practices shows that eating disorders bring along various medical problems, and complete recovery is difficult; thus, relapse rates are high. In eating disorders, the importance of early diagnosis and treatment is emphasized; however, the effectiveness and suitability of the treatment method are also crucial. Accordingly, increasing knowledge about the contemporary psychotherapy approaches used in the treatment of eating disorders subtypes is significant for those who work in the field of mental health. In this review, contemporary therapy approaches that should be taken into consideration when working with individuals diagnosed with eating disorders are presented. Family-based therapies, mindfulness-based therapies, and dialectical behavioral therapies are emphasized with their underlying assumptions about eating disorders as well as their main techniques and therapy goals. In addition, effectiveness of these approaches was examined, and previous studies are found to be limited based on their amount and methodology. However, these psychotherapies were considered as useful approaches in terms of reducing the symptoms of eating disorders and providing different methods in treatment. Keywords: Eating disorders, family-based therapy, mindfulness-based therapy, dialectical behavior therapy

Feasibility and acceptability of home treatment as an add-on to family based therapy for adolescents with anorexia nervosa. A case series.

ObjectiveThis study examines the feasibility, acceptability, and preliminary effect sizes on outcome measures of home treatment (HT) as an add‐on to family‐based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re‐establish family meals in the home environment.MethodForty‐five (43 female, 2 male) adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa received FBT augmented with HT over 12 weeks. Eating disorder (ED) diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI‐2) at baseline (BL) and after 3‐monthsResultsAll participants and parents were retained and found HT acceptable. At the end of Treatment (EOT) participants showed a significant early weight gain, a reduction in the AN psychopathology assessed with the EDE interview and a reduction in EDI‐2 total scores. None of the patients had to be admitted to hospital. Treatment satisfaction was high in both patients and parents.DiscussionFindings provide preliminary evidence that HT is feasible, acceptable and produces clinically significant improvements in targeted outcome.

The Effect of Family Participation on the Cognitive-Behavioral Therapy of Children with Obsessive-Compulsive Disorder

Background: Obsessive-Compulsive Disorder (OCD) is a time-consuming and severe mental illness that causes significant distress and impaired functioning. Therefore, this study aimed to investigate the effect of family-based cognitive-behavioral therapy on the symptoms and functions of children with OCD. Materials and Methods: The research plan was single-case or single-subject. The statistical population of this research included all the children with OCD within the age range of 7-12 years who referred to counseling and psychiatric centers in Ahvaz, Iran, in 2020. In total, four children who were diagnosed with OCD were selected by the available sampling method and received family-based cognitive-behavioral therapy intervention in 12 sessions. In this study, the required data were collected using Yale-Brown Child Obsessive-Compulsive Disorder Scale and the Child Obsessive-Compulsive Disorder Impact Scale. Data analysis was performed using visual charting or graphical analysis methods, reliable change index, and percentage of improvement. Results: The results showed that a reliable change index was significant for symptoms and function in treatment and follow-up (P<0.05). Moreover, the percentage of overall improvement showed the effectiveness of family-based cognitive-behavioral therapy on the symptoms and function of children with OCD in treatment and follow-up stages. All four children were in the successful treatment category based on the Classification of Blanchard. Conclusion: Family-based cognitive-behavioral therapy can be beneficial and effective on the symptoms and function of children with OCD.

Home treatment for adolescents with eating disorders as an add-on to family based therapy

IntroductionFamily-based therapy (FBT) has been proven effective in treating eating disorders among children and adolescents. However, many families have difficulties implementing the measures recommended in outpatient therapy.ObjectivesThis study examines the effectiveness of add-on home treatment (HT) to family based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re-establish family meals in the home environment.MethodsWe performed an case-control study in AN patients comparing 44 (42 female, 2 male) adolescents receiving FBT augmented with HT compared to 22 (22 female, 1 male) participants receiving FBT alone. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using (EDE, EDI-2) and clinical parameters (BMI, menstrual status, level of over-exercising) at baseline and after 3-months.ResultsAfter 3 months both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI-2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBT-only group. In the combined HT/FBT group none of the patients had to be admitted to hospital while 13.6% of the FBT-only group had to be referred to inpatient treatment. Treatment satisfaction in the combined HT/FBT group was high in both patients and parents.ConclusionsOur results suggest that HT augmented FBT is superior compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN.DisclosureNo significant relationships.

Remote delivery of a therapeutic intervention to court-mandated youths of Haitian descent during COVID-19.

The threat generated by the COVID‐19 pandemic has triggered sudden institutional changes in an effort to reduce viral spread. Restrictions on group gatherings and in‐person engagement have increased the demand for remote service delivery. These restrictions have also affected the delivery of court‐mandated interventions. However, much of the literature has focused on populations that voluntarily seek out face‐to‐face medical care or mental health services, whereas insufficient attention has been paid to telehealth engagement of court‐mandated populations. This article draws on data gathered on an NIH/NIDA‐funded study intervention implemented with juvenile justice‐involved youths of Haitian heritage in Miami‐Dade County, Florida, during the COVID‐19 public health crisis. We explore the process of obtaining consent, technological access issues, managing privacy, and other challenges associated with remote delivery of family‐based therapy to juvenile justice‐involved youth. Our aim is to provide some insights for consideration by therapists, healthcare workers, advocates, researchers, and policymakers tasked with finding alternative and safer ways to engage nontraditional populations in health services. The clinical trial registration number is NCT03876171.

A Systematic Review and Meta-Analysis of Psychosocial Intervention Targeting Social and Occupational Function in Early Psychosis

Background: Psychosis, including early psychosis, ranks highly among the causes of disability worldwide, even when clinical symptoms are well managed. This has resulted in an increased focus on how recovery of social and occupational functioning can be targeted using psychosocial interventions. The purpose of this review and meta-analysis was to survey psychosocial interventions in current use and provide an estimate of their effectiveness. Methods: An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to May 2020 and is reported following PRISMA guidelines. Data were extracted on social and occupational functioning outcomes from included studies. Pooled standardised difference in means (SMD) were estimated with Comprehensive Meta-Analysis Software (CMA), Version 3. Findings: In total, 31 studies involving 2811 participants were included in our analysis. Studies were categorised by psychosocial intervention type as follows: Cognitive Behavioural Therapy for Psychosis (CBTp), Family Based Therapy (FBT), Supported Employment, Cognitive Remediation (CR), and Multi-Component psychosocial interventions. Across the interventions considered, psychosocial interventions were associated with improvements in social and occupational function: CBTp (d= 0∙139), FBT (d=0∙299), Supported Employment (d= 0∙611), CR (d=0∙301), and Multi-Component psychosocial intervention (d=0∙452), Effect sizes varied by intervention type, stage of illness (ultra-high-risk v first episode v early psychosis), length and duration of treatment, and measure used. Interpretation: Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services. Funding Statement: This work was funded by the Irish Health Research Board as part of the collaborative doctoral award in Youth Mental Health [YOULEAD] (HRB grant number:CDA-2018 001). Declaration of Interests: None to declare.

Behavioral Assessment and Treatment of Selective Mutism in Identical Twins

Selective mutism (SM) is a childhood disorder characterized by persistent failure to speak in situations where speech is expected. There is evidence that behavioral interventions are effective for increasing speech in children with SM but studies have been limited by small, relatively homogeneous samples. Although twins appear to be disproportionately represented among children with SM, little is known about their specific treatment needs and barriers to effective treatment implementation in this population. This case study presents family-based behavioral therapy delivered to a set of 8-year-old, identical twins with SM. At posttreatment, both children displayed marked improvements in speaking and social engagement. Clinical considerations for working with twins with SM are discussed.

Childhood Avoidant/Restrictive Food Intake Disorder: Review of Treatments and a Novel Parent-Based Approach.

Avoidant/Restrictive food intake disorder (ARFID) is characterized by dietary restrictions that are not based on weight or shape concerns but that result in marked interference in feeding, growth, or psychosocial functioning (American Psychiatric Association, 2013; Eddy et al., 2019). The aim of the current article was to review available reports of treatment for childhood ARFID published since its inclusion in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and to introduce a novel parent-based treatment for child ARFID through a case presentation. Empirical support for psychosocial treatments for child ARFID currently stems from two small-scale pilot randomized control trials, one pilot open trial, case reports, case series, and retrospective chart reviews. Treatment approaches for outpatient care generally apply family-based therapy, child-centered cognitive behavioral therapy, or parent-based behavioral approaches. SPACE-ARFID is a novel outpatient parent-based treatment that focuses on parental responses to child problematic eating habits. SPACE-ARFID aims to promote flexibility and adjustment in food related situations. The treatment helps parents to systematically reduce family accommodation, or changes that they make to their own behavior to help their child avoid or alleviate distress related to the disorder, while increasing supportive responses to the child's symptoms.

Parents’ Experiences of Family Therapy for Adolescent Anorexia Nervosa

ABSTRACT This study examined parents’ experiences of family-based interventions for the treatment of adolescents with anorexia nervosa (AN). Nine parents whose child’s weight had reached the healthy weight range post-treatment were interviewed about their experiences of parenting a child with AN in either manualised family-based therapy (FBT) (n = 6) or non-manualised family systematic interventions (n = 3). The interviews were analysed using interpretative phenomenological analysis. Findings draw attention to the impact of AN on the whole family, the gatekeeping role of health professionals in accessing support and treatment, the value of externalisation, the prime importance of the therapeutic alliance between parents and clinicians, and the importance of tailoring treatment to the unique circumstances, values, and culture of each family. IMPLICATIONS Practitioners should be alert to the feelings of shock, guilt, and responsibility felt by parents of a child with anorexia nervosa and recognise the challenges faced by parents in accessing treatment and responding to their child’s behaviour, alongside the demands of family, work, and other social roles. The quality of the parent–practitioner therapeutic relationship influences parental perceptions of support and of the effectiveness of treatment. Regardless of the treatment model, parents respond well to therapists who express empathy, pay attention to building trust, respect, and activate the family’s unique circumstances and values, offer support, explain the nature and purpose of the treatment, and provide feedback. From the parent perspective, practitioners are more effective if they clarify parents’ value and belief systems and use these to engage parents with the treatment process.

Family Based Therapy for Eating Disorders in Children and Adolescents

Family-Based Therapy (FBT) is a new family therapy method used in the treatment of eating disorders by combining certain methods in family therapy approaches. FBT or Maudsley approach that was developed for anorexia nervosa eventually spread all over the world. Family-based therapy is an effective treatment method that brings adolescents together with their families. FBT is accepted as the gold standard treatment for adolescent anorexia nervosa (AN) and childhood obesity is an effective way to treat adolescent bulimia nervosa (BN) even though the evidence value is low. FBT consists of three phases for AN. At phase 1, the therapist just focuses on eating and gaining weight. Parents are given the eating responsibility of the adolescent. The self-blame of the family is overcome by emphasizing the positive aspects of the family in this phase. When the patient reaches 90 % of the calculated target weight, treatment is passed to phase 2. Previous postponed problems begin to be raised at this phase. Control over eating passes from parents to the adolescent with the supervision of parents, gradually. In phase 3, the family boundaries should be redrawn by increasing the autonomy of the adolescent. When this goal is achieved, the treatment process is terminated. Although FBT is the first-line modality for adolescent AN and childhood obesity, only a few therapists apply this therapy in our country. Because it is easy to apply and highly effective therapy, FBT has great importance in the treatment of children and adolescent eating disorders. For FBT to be widely used in Turkey, the training process needs to be started, and FBT therapists need to be increased. Thus, patients with eating disorders will have the opportunity to be treated on the evidence-based approach.

Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study.

Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient’s family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital.Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology).Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge.Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.

The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review

BackgroundYouth often experience unique pathways into homelessness, such as family conflict, child abuse and neglect. Most research has focused on adult homeless populations, yet youth have specific needs that require adapted interventions. This review aims to synthesize evidence on interventions for youth and assess their impacts on health, social, and equity outcomes.MethodsWe systematically searched Medline, Embase, PsycINFO, and other databases from inception until February 9, 2018 for systematic reviews and randomized controlled trials on youth interventions conducted in high income countries. We screened title and abstract and full text for inclusion, and data extraction were completed in duplicate, following the PRISMA-E (equity) review approach.ResultsOur search identified 11,936 records. Four systematic reviews and 18 articles on randomized controlled trials met the inclusion criteria. Many studies reported on interventions including individual and family therapies, skill-building, case management, and structural interventions. Cognitive behavioural therapy led to improvements in depression and substance use, and studies of three family-based therapies reported decreases in substance use. Housing first, a structural intervention, led to improvements in housing stability. Many interventions showed inconsistent results compared to services as usual or other interventions, but often led to improvements over time in both the intervention and comparison group. The equity analysis showed that equity variables were inconsistently measured, but there was data to suggest differential outcomes based upon gender and ethnicity.ConclusionsThis review identified a variety of interventions for youth experiencing homelessness. Promising interventions include cognitive behavioural therapy for addressing depression, family-based therapy for substance use outcomes, and housing programs for housing stability. Youth pathways are often unique and thus prevention and treatment may benefit from a tailored and flexible approach.

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Comparing Treatment Modalities For Juvenile Delinquency

Juvenile delinquency has improved by 65 percent from 1980 through 2016. The criminal justice system has explored various means of treating juvenile delinquents over the years to improve recidivism rates and to give youth a rewarding adult life. Most juvenile delinquency programs use a Usual Community Service (UCS) treatment method while the youth are incarcerated or immediately after release. UCS uses cognitive behavioral therapy (CBT) techniques to help the juvenile link their thoughts and behaviors. While Short-term Behavioral Therapy did not take off with the public or juvenile justice system, Multisystemic Therapy (MST) has showed progress in reducing recidivism of juvenile offenders. Studies have found that engaging the family in the treatment process has contributed to the reduced recidivism rates. For example, participants that enrolled in the UCS treatment modality had an increased recidivism rate of 75 percent while 29.2 percent of the group members from the MST recidivated within a year. At the end of a longitudinal study (8.9 years), researchers found that juveniles who received UCS treatment re-offended with a sex crime 45.8 percent and 58.3 percent re-offended for non-sexual crimes. After incarceration, 24 families participated in the MST treatment model. After a year, 8.3 percent re-offended for a sex crime and 29.2 percent re-offended with a non-sexual crime. Therefore, a family-based therapy model is salient to reduce recidivism compared to CBT based. This paper employs a meta-analysis and statistical analysis of seminal knowledge and law enforcement reports to construct the importance of effective therapeutic treatments by comparing treatment modalities for juvenile delinquents. Keywords: Juvenile Delinquency, Youth, Usual Community Service, Short-term Behavioral, Therapy, Systems Theory, Multisystemic Therapy, Recidivism, Antisocial Behavior

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies.

To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches. Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.

Efficacy, Moderators and Mediators of Manualized Family-Based Treatments in Adolescents with Eating Disorders: A Systematic Review

Family-based therapy (FBT) is currently the most evidence-based treatment for adolescents with eating disorders. The aim of this review is to summarize previous research results regarding the efficacy of the manualized FBT according to Lock and Le Grange and to report on moderators and mediators. In 5 randomized controlled trials (RCTs) in anorexia nervosa (N=560) remission rates were between 21.2-42% at end of treatment, between 21.8-40% at 6-month follow-up, and between 29-49% at 12-month follow-up. Remission rates for patients with bulimia nervosa (2 RCTs, N=210) were 39%, 29-44% and 49% respectively. It would be desirable to replicate these results through independent working groups and in other countries. In addition, it would also be important to evaluate FBT in comparison to cognitive behavioral therapy and psychodynamic therapy, and to further explore strategies for non-responders.

\u201cAs long as they eat\u201d? Therapist experiences, dilemmas and identity negotiations of Maudsley and family-based therapy for anorexia nervosa

BackgroundMaudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the “real world” of clinicians who work with adolescent AN.AimsThis research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved.MethodsNine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists’ experiences and identity negotiations in their practice of FBT-AN.ResultsThese therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family.ConclusionsThese therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.

Family therapy approaches for anorexia nervosa.

Family therapy approaches for anorexia nervosa.

Understanding Gendered Realities: Mothers and Father Roles in Family Based Therapy for Adolescent Eating Disorders

Eating disorders are serious and life threatening illnesses that typically present during adolescence. The current recommended treatment for adolescents diagnosed with anorexia nervosa and bulimia nervosa is Family-Based Therapy. Family-Based Therapy is a manualized treatment that empowers parents to temporarily take control of the eating disorder symptoms. However, literature often discusses the role of parents in treatment, yet the reality is that mothers are often tasked with the difficult role of interrupting symptoms for their adolescent, while fathers remain absent or, at best, a support to the mother. By removing the gender from literature, we are failing to examine ways to better support mothers and engage fathers in family-based treatment. Through the use of case studies and limited literature, this paper will examine how these mothering and fathering expectations surface in treatment, how they may be perpetuated by professionals, and the impact that these gendered expectations may have on mothers and fathers.