Family Therapeutic Interventions Research Articles

Experiences of Burden and Coping Strategies and their Associations with Mental Health and Well-Being in COPD - a Mixed Methods Study

Understanding trigger and maintaining factors regarding psychiatric comorbidities in COPD is of great importance. In the presented mixed-methods study, qualitative interview data on burden experience and coping were related to psychiatric comorbidity (using PHQ-D) and quality of live (Positive Affect Negative Affect Schedulde, PANAS and Satisfaction with Life Scale, SWLS) and extended by the Freiburg Questionnaire on Coping with Illness (FKV-LIS). The two interview questions prompting narrative were 1.) "What is currently bothering you most?"; 2.) "How do you cope with your chronic disease in everyday life?" A total of 62 patients who were hospitalized due to COPD participated. The severity of physical impairment was assessed using GOLD stage and the Charlson Comorbidity Index (CCI). The interviews conducted were content analyzed and then quantified. The collected data were then compared between two groups with regard to mental distress. 13 themes of burden and 11 coping strategies were identified by content analysis. A total of 42 patients showed signs of mental distress, while 20 patients did not show signs of distress. There were no significant differences between the two groups in terms of sociodemographic characteristics and the severity of their physical symptoms. In the first interview question, the stressed group more frequently addressed issues related to death (35.7% versus 15.0%) and social stress (21.4% versus 0.0%). With respect to the second interview question, the nonstressed group was significantly more likely to mention strategies for consciously emphasizing positive emotions (70.0% versus 31.0%). In addition, higher scores on the FKV scales for depressive coping and trivialization and wishful thinking were evident in the stressed group. Quality of life and mental distress should be considered in clinical care for COPD. Interventions to influence illness perception and related coping styles are important, especially with regard to the development of a realistic and optimistic perspective on life and disease burden, as well as the inclusion of group and family therapeutic interventions.

Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial.

Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act-compliant videoconferencing technology (VCT). This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST's preliminary effectiveness upon completion of outcome data collection. ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776.

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

A Video-Delivered Family Therapeutic Intervention for Perinatal Women With Clinically Significant Depressive Symptoms and Family Conflict: Indicators of Feasibility and Acceptability.

BackgroundVariation in family therapeutic intervention fidelity has an impact on outcomes. The use of video conferencing technology can strengthen therapist fidelity to family therapeutic interventions.ObjectiveThis article explores indicators of feasibility and acceptability for a video-delivered family therapeutic intervention for perinatal women with depressive symptoms and family conflict. The objectives of this article are to describe indicators of feasibility, including therapist fidelity to the intervention and technological factors that relate to implementation of the intervention, as well as indicators of acceptability for participants of the intervention.MethodsThe data included in this article are from an ongoing randomized trial of the Resilience Enhancement Skills Training (REST) video-delivered family therapeutic intervention. Participant recruitment and data collection are still underway for this clinical trial. Of the 106 participants who are currently enrolled in this study, 54 (51%) have been randomized to receive REST from May 2021 through July 2022. Currently, 2 therapists are delivering the intervention, and the training procedures for therapists are summarized herein. Therapist fidelity to the family therapeutic intervention was assessed in 67 audio recorded sessions. The training procedures were summarized for use of video conferencing technology by therapists and the 54 study participants. Knowledge of the video conferencing technology features was assessed in therapists and study participants by the number of attempts required to use the features. Participant responsiveness to the intervention was assessed by the percentage of attended sessions and percentage of complete homework assignments.ResultsTo date, both therapists have demonstrated high fidelity to the family therapeutic intervention and used all video conferencing technology features on their first attempt. The current participants required 1 to 3 attempts to use 1 or more of the video conferencing technology features. About 59% (n=32) of the current participants immediately accessed the features on the first attempt. Our results show that perinatal women attended all sessions, and their family members attended 80% of the sessions. To date, participants have completed 80% of the homework assignments.ConclusionsThese early findings describe indicators of the feasibility and acceptability of the video-delivered family therapeutic intervention for use with this high priority population. Upon completion of recruitment and data collection, a subsequent article will include a mixed methods process evaluation of the feasibility and acceptability of the video-delivered family therapeutic intervention.Trial RegistrationClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776

"The effects of family therapeutic interventions on mental health and quality of life of children with cancer: A systematic review".

The diagnosis of a childhood malignancy and the following period are very stressful for the little patient and the whole family. Depression, anxiety, and poor quality of life (QoL) are some of the negative effects of pediatric cancer to the children and their parents. Family therapeutic interventions aim to improve mental health and QoL of these children. A systematic search of the electronic database PubMed was conducted for articles that studied the effect of family therapeutic interventions on mental health and QoL of children with cancer. A total of 634 articles were evaluated, of which 10 articles met the inclusion criteria. A percentage of 70% of the studies, representing seven different types of interventions, seemed to be beneficial for the participant's mental health and QoL. The remaining three studies did not significantly improve mental health and QoL. The results of our review indicate that family psychosocial interventions are beneficial for children with cancer. These children and their families are a growing population requiring more patient-centered, time flexible interventions which may enhance family bonding and patients' positive emotions.

Investigating the Psychometric Properties of the Arabic Version of the Family Adaptability and Cohesion Evaluation Scale IV (FACES IV) in Saudi Arabia

The Family Adaptability and Cohesion Evaluation Scale IV (FACES IV) has been widely used to assess family functioning and to implement family therapeutic interventions. Cross-cultural adaptation is needed given the high sensitivity of family norms with culture. This study investigates the psychometric properties of the FACES IV in the context of Saudi culture. The sample consisted of 369 participants (270 females and 99 males) aged between 13 and 70. The results of the confirmatory factor analysis supported the FACES IV model, after some adjustments. The findings indicated that FACES IV was a reliable and valid measure that can be used in the context of Saudi Arabia. The study showed some particularities with the rigid and enmeshed dimensions and concurred with previous validation studies in suggesting that these dimensions must be investigated further with respect to different cultures.

La experiencia de formación en intervención terapéutica: reflexiones suscitadas durante el entrenamiento de la Especialización en Terapia Familiar de la Universidad Católica Luis Amigó

El presente artículo plantea reflexiones resultado de la experiencia de entrenamiento en intervención terapéutica con familias, llevada a cabo durante el primer semestre de formación como especialistas en terapia familiar de la Universidad Católica Luis Amigó. En el ejercicio se identifican asuntos significativos como la comprensión del sí mismo (self), la comunicación como posibilidad, el uso de técnicas y la experiencia de observación en las primeras sesiones con familias. Al plantear reflexiones suscitadas durante la práctica de entrenamiento, se retoman elementos conceptuales y vivenciales que articulados se consideran eje central del terapeuta familiar que busca conducir el ejercicio profesional bajo una epistemología sistémica con asiento conceptual y un verdadero proceso reflexivo.

Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis.

BackgroundFamily therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms.ObjectiveThis systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning.MethodsThis study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning.ResultsSeven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples.ConclusionAlthough a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed.Systematic review and meta-analysis protocol registrationPROSPERO, CRD42017075150.

Familienklima, elterliche Paarbeziehung und kindliche Symptombildung - Mentalisierungsbasierte Familientherapie bei kindlichem Kopfschmerz/ Family Climate, Parental Partner Relationships and Symptom Formation in Children - Mentalisation- Based Family Therapy for Childhood Headache

The emotional family climate is considered both an effective risk and protective factor for child development. Factors such as negative experiences parents made during their childhood or adolescence, which can reoccur as intergenerational transmission, a low partnership quality and a high level of conflict seem to be particularly relevant for the quality of the emotional family climate. Consequently, the relationship between partners, as the core relation within families, is particularly important for the family climate and subsequently for the development of the child. For this reason, problems in parent relationships should receive special attention in family therapeutic interventions. Mentalisation-based family therapy (MBF-T) offers promising approaches in this context. The key principles of mentalisation are introduced and the links between family and mentalisation are presented, followed by information on the history, objectives and the procedures of MBF-T. A case study of a family therapy, in which a child suffers from chronic headache, illustrates the connection and interrelation between family climate, family conflicts and the parental relationship, and it will further show the importance of mentalisation-based elements for therapeutic treatments.

Clinical Effectiveness of Family Therapeutic Interventions Embedded in General Pediatric Primary Care Settings for Parental Mental Health: A Systematic Review and Meta-analysis

The aim of this systematic review and meta-analysis was to synthesize the available evidence on embedded family therapy interventions in pediatrics and impacts on parental mental health and family functioning outcomes. The Cochrane Collaboration guidelines for systematic reviews and meta-analysis were used for this study. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The Cochrane Collaboration's Risk of Bias Tool and GRADE system were used to rate the quality of evidence of the included studies. The primary outcomes included parental distress, parental depressive symptoms, and dysfunctional parent-child interaction. Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group. Family therapy model, intervention level, delivery modality, and dosage moderated intervention impacts on parental distress. Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent-child interaction in favor of the intervention group. Family therapy interventions can be successfully embedded in general pediatric primary care, and intended outcomes are achieved in this setting. Recommendations for future research and implications for policy development are discussed.

A Meta-Analysis of Long-Term Outpatient Treatment Effects for Children and Adolescents with Conduct Problems

The present meta-analytic review explored long-term treatment effects in children and adolescents, age ranging from 2 to 17 years, treated because of conduct problems. The presumed mediators were examined. Various treatments, in all 56 studies including 2589 participants, were included. 32 studies involved an untreated control condition, whereas 24 studies did not. The overall weighted effect size (ES) in conduct problems after termination of treatment was a reduction of ES = 0.08 for a mean follow-up period of 8.9 months. Long-term changes on the presumed mediator showed a small deterioration of ES = −0.06. The moderator analysis confirmed that treatment effects in conduct problems and mediators were related. Changes in conduct problems from post-treatment to follow-up were larger in studies with cognitive behavior therapy (CBT) or a combination of behavior therapy (BT) and CBT compared to BT and family therapy. Individual treatments resulted in larger changes in aggressive behaviour as compared to group treatments or a combination of these. Treatment effects for both conduct problems and the presumed mediators seem to last, but changes were small. Few studies included teenagers and knowledge of lasting treatment effects is limited for older children including CBT treatments. More knowledge of the mediators involved in treatment is needed, in particular for cognitive and family therapeutic interventions.

Regulation of ERBB3/HER3 signaling in cancer.

ERBB3/HER3 is emerging as a molecular target for various cancers. HER3 is overexpressed and activated in a number of cancer types under the conditions of acquired resistance to other HER family therapeutic interventions such as tyrosine kinase inhibitors and antibody therapies. Regulation of the HER3 expression and signaling involves numerous HER3 interacting proteins. These proteins include PI3K, Shc, and E3 ubiquitin ligases NEDD4 and Nrdp1. Furthermore, recent identification of a number of HER3 oncogenic mutations in colon and gastric cancers elucidate the role of HER3 in cancer development. Despite the strong evidence regarding the role of HER3 in cancer, the current understanding of the regulation of HER3 expression and activation requires additional research. Moreover, the lack of biomarkers for HER3-driven cancer poses a big challenge for the clinical development of HER3 targeting antibodies. Therefore, a better understanding of HER3 regulation should improve the strategies to therapeutically target HER3 for cancer therapy.

Multidimensional Family Therapy in Theory and in Practice

This article reviews the family therapy case of an adolescent substance abuser through the lens of multidimensional family therapy (MDFT). Initially, the adolescent presented with suicidal ideation, depression, academic difficulties, and behavior problems. The family experienced chronically high levels of conflict, which related to the mother's depression, the father's harsh discipline, and the adolescent's sister's frequent suicidal threats and outbursts. Family therapeutic interventions helped to decrease family conflict and improve the adolescent's grades and behavior. In particular, conjoint work with the parents had a stabilizing effect on the family system. As predicted by MDFT, this stabilizing effect was shown to place the adolescent on a healthier developmental trajectory. Limitations of the case and implications for future research are also presented.

Pitfalls of the psychotherapy of twins with eating disorders

Scientific literature is limited on problems related to the psychotherapy of twins, especially eating disorders. This paper discusses the therapeutic difficulties encountered with two anorexic and one bulimic sets of twins. The three case reports show that the symbiotic tendency of twins is a frequent phenomenon, which may be a special resistance against change, and can serve as a factor maintaining the pathological state. In many cases, the parental behaviour strengthens the symbiosis of the twins, instead of helping the individuation. The integration of individual and family therapeutic interventions is proposed. The separation-individuation process of the twins can be stimulated by individual sessions with each of the twins, or separate sessions during family therapy (i.e., sessions with the parents and with one of the twins). In this case, the best strategy would be to have the individual and family therapies conducted by the same therapist.

Zur familientherapeutischen Arbeit mit Jugendlichen, die unter einer Borderlinepersönlichkeitsstörung leiden

This article gives an overview about the impact of pathologic family interaction for the development of severe personality disorders. Furthermore the paper will address the issue of the emotional burden of all family members; which makes family orientated interventions necessary, especially for adolescents and young adults. The difficulties and chances of family based interventions will be discussed focusing on the systemic problems of these families and the specific challenges resulting of the borderline symptoms for family therapeutic interventions. Different approaches for the treatment of families will be introduced. Especially the strategies of the Dialectical Behavioral Therapy for adolescents and families will be described. These approaches consist of the family member's spsychoeducation and practicing specific skills to improve communication, appreciationand emotional validation.

User satisfaction with services in a randomised controlled trial of adolescent anorexia nervosa

User satisfaction is a neglected outcome in adolescent anorexia nervosa especially since the relative effectiveness of different treatments is unclear. It may also affect clinical outcome. To assess young person's and parents' satisfaction with CAMHS outpatient, specialist outpatient and inpatient treatment received in a large randomised controlled trial. Quantitative and qualitative analysis of questionnaire data from 215 young people and their parents followed by focus groups to further explore emerging themes. High levels of satisfaction were reported, more amongst parents than young people and with specialist services. Both young people and carers strongly valued clinical relationships that involved being listened to and understood. They valued the expertise of specialist rather than generic CAMHS services. There were polarised views on the influence of other young people in inpatient units. Parents in particular valued support for themselves, both from professionals and other parents and felt this, and sibling support was lacking. All comprehensive CAMH services are able to provide the good generic psychotherapeutic skills that parents and young people value so highly. However, generic CAMHS struggle to provide the demanded level of expertise and more specialised individual and family therapeutic interventions.

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents

The effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated. Sixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated. The mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively. Psychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.

Moderne Behandlung der Cannabisabhängigkeit

The prevalence of cannabis use is rising also in Germany. The number of treatment seeking adolescents and adults increases simultaneously. Cannabis-related psychosocial sequels have driven controlled clinical trials of principally psychotherapeutic interventions in USA and Australia. Considering these trials brief interventions using motivational and cognitive behavioural techniques have been shown to be effective in cannabis dependent adults, adjunct to individual counselling. Regarding the specific treatment of young people, besides motivational and cognitive-behavioural also milieu and family therapeutic interventions were efficacious The only available controlled pharmacological study did not reveal any superiority of valproate. Meanwhile, also in Germany the first public studies have been started: “Realize-it (Sudbaden), “CANDIS” (Dresden), “INCA” (Bonn/Essen). Against the background of the high vulnerability of adolescents the “INCANT” project addresses the efficacy of multidimensional family therapy in the treatment of cannabis dependent adolescents and young adults. Unfortunately, no trial to date has taken account of relevant psychiatric co-morbidity. Nearly 70% of cannabis dependent adults suffer from concomittant anxiety or affective disorders, addictive diseases, personality disorders or schizophrenia. Therapeutical recommendations of these dual disorders still lean on the opinion of experts, such as collected in the AWMF-guideline: “cannabis-related disorders” ( http//www.uni-duesseldorf.de/www/AWMF/II/076-005.htm ).

Studienlage zur Behandlung der Cannabisabhängigkeit

Epidemiological studies show that the prevalence of cannabis use in Germany is approaching that of countries known for their high consumption rate, such as Australia and some parts of the USA. In these countries, the resulting cannabis-related psychosocial damage has led to mainly psychotherapeutic treatment studies (conducted in the past ten years) that will be introduced here. According to these studies, the optimal treatment of cannabis-dependent adults would be a short intervention which consists of a combination of motivational-enhancement and cognitive-behavioural elements as well as individual case-counselling (c. f. "Marihuana Treatment Project"). In parallel to a clear consume-reduction over time, these interventions were associated with abstinence rates between 15 % and 22 % also in longer follow-ups (greater than 12 months). Additionally, an approximately 50 % reduction of cannabis-related problems was described. Without any specific treatment, however, abstinence rates were found to be only between 0 % and 9 %, also without any change in prominent social problems. A similar though less obvious trend occurred in a large multisite study regarding the specific treatment of young people, in which besides motivational and cognitive-behavioural also milieu and family therapeutic interventions were tested (c. f. "Cannabis Youth Treatment"). Unfortunately, there exists no controlled treatment study up to now that considered a relevant psychiatric co-morbidity, which usually accompany cannabis-dependence. Whether the interventions above can be recommended and implemented under German conditions should be further investigated, especially considering the growing number of cannabis-consumers seeking treatment.

Behavior Modification As a Limit-Setting Task in the Family Psychotherapy of a Disruptive Boy

The use of behavior modification as a family task in the treatment of a family with a poorly disciplined child is illustrated in a single case report. The parents' initial failure to implement the behavior modification program provided data about the dynamics of the family and necessitated family therapeutic intervention before the behavior modification program could be successful. The concept of behavior modification as a family task facilitates the clinical integration of family therapy and behavior modification.