Multidimensional Family Therapy Research Articles

Pandemic after pandemic: Adopting the multidimensional family therapy approach for youth drug abuse in Zimbabwe

Youth drug abuse in Zimbabwe has become a topical issue such that hardly a day passes without the mainstream media, social media, and other communication platforms mentioning drug abuse amongst youth and school children. The term new pandemic has been used to describe the drug abuse among Zimbabwe youth after the covid-19 pandemic. Several measures have been put in place by the Government of Zimbabwe to combat the ‘new pandemic’. The measures among them were criminalization of drug victims and suppliers of drugs, however, with limited success. The main objective of the study was to unpack the multidimensional factors that influence youth to indulge in drug abuse in Zimbabwe. The study adopted a qualitative desk research approach to unveil the topical problem. The study reveals the multidimensional influences of youth drug abuse and the multidimensional solutions to the problem. The study was underpinned by two theories: the bioecological and family systems theories. Research findings were that problems of youth drug abuse were a result of drugs being regarded as a business venture, rising urbanization without the corresponding industrialization, socio-economic challenges, social fabric breakdown, youth collective idleness, and unattended/unsupervised children. The study recommends that the nation should embark on a massive exercise to train adolescents, parents, families, communities, and the whole nation to deal with drug abuse among youths. Keywords: Communities; drug abuse; multidimensional family therapy; youth; Zimbabwe

Multidimensional Family Therapy for Justice-Involved Young Adults with Substance Use Disorders

The present study explored the acceptability, feasibility, fidelity, and outcomes of a young adult adaptation of multidimensional family therapy (MDFT), an evidence-based family treatment originally developed for adolescents. Participants included 22 individuals between the ages of 19 to 25 who were enrolled in a criminal drug court program. MDFT was found to be feasible and was delivered with strong fidelity to young adults and their families. Participants reported high satisfaction with MDFT, and 95% completed treatment. Analyses revealed statistically significant decreases in substance use on all indicators from baseline to the 6-month follow-up. Significant improvements were also noted in vocational functioning, including a 73% increase in full-time employment from baseline to 6-month follow-up. Criminal justice outcomes included a significant decrease in legal risk, and 86% of study participants had no rearrests from baseline through the 18-month follow-up period. The article concludes with recommendations for implementing family-based interventions with young adults, as well as future research directions in this important area.

In-session gaming as a tool in treating adolescent problematic gaming.

For some adolescent gamers, playing online games may become problematic, impairing functioning in personal, family, and other life domains. Parental and family factors are known to influence the odds that adolescents may develop problematic gaming (PG), negative parenting and conflictual family dynamics increasing the risk, whereas positive parenting and developmentally supportive family dynamics protecting against PG. This suggests that a treatment for adolescent PG should not only address the gaming behaviors and personal characteristics of the youth, but also the parental and family domains. An established research-supported treatment meeting these requirements is multidimensional family therapy (MDFT), which we adapted for use as adolescent PG treatment. We report here on one adaptation, applying in-session gaming. In-session demonstration of the "problem behavior" is feasible and informative in PG. In the opening stage of therapy, we use in-session gaming to establish an alliance between the therapist and the youth. By inviting them to play games, the therapist demonstrates that they are taken seriously, thus boosting treatment motivation. Later in treatment, gaming is introduced in family sessions, offering useful opportunities to intervene in family members' perspectives and interactional patterns revealed in vivo as the youth plays the game. These sessions can trigger strong emotions and reactions from the parents and youth and give rise to maladaptive transactions between the family members, thus offering ways to facilitate new discussions and experiences of each other. The insights gained from the game demonstration sessions aid the therapeutic process, more so than mere discussion about gaming.

Sustainment Rates and Factors for Multidimensional Family Therapy in Europe and North America

This retrospective non-experimental study examined the short-term (2-year) and longer-term (5-year and 8-year) sustainment of 137 programs in Europe and North America implementing a single evidence-based practice (EBP), Multidimensional Family Therapy (MDFT). MDFT implementation and sustainment is based on the Stages of Implementation (SIC) model outlined by Saldana and colleagues. The study had two primary objectives: (1) to examine short-term and longer-term sustainment rates of MDFT in Europe and North America, and (2) to explore potential factors that may be associated with sustainment of MDFT in particular, and the potential implications for behavioral health EBPs more generally. Results show that 90% of MDFT programs were sustained for at least 2 years, 87% of the programs sustained for at least 5 years, and 70% for at least 8 years. These findings compare favorably with the previous research on implementing and sustaining evidence-based practices. The findings support the growing consensus that not only start-up funding but also ongoing financing either through governments or third-party payors may be essential for longer-term sustainability of EBPs in both Europe and North America. This study also highlights the potential value of multi-site program networks. Future research directions are suggested, such as examination of the potential importance of the quality and nature of the EBP itself, adaptability to different organizations and clients, and providing high-quality structured and empowering training and quality assurance to sustain evidence-based behavioral health interventions. These programmatic and clinician-level factors are critical areas for further investigation into the sustainment of EBPs.

Multidimensional family therapy reduces problematic gaming in adolescents: A randomised controlled trial.

Background and aimsSocial variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapies – multidimensional family therapy (MDFT) and family therapy as usual (FTAU) – on their impact on the prevalence of IGD and IGD symptoms.MethodsEligible for this randomised controlled trial comparing MDFT (N = 12) with FTAU (N = 30) were adolescents of 12–19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Phénix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months.ResultsBoth family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child’s gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU.Discussion and ConclusionsFamily therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study.Trial registration numberISRCTN 11142726.

Residential Youth Care Combined with Systemic Interventions: Exploring Relationships between Family-Centered Care and Outcomes

ABSTRACT Family-centered care, in terms of parental involvement and family-centered staff attitude and behavior during placement in secure residential youth care, is increasingly being combined with systemic interventions. Little is known, however, about this combination of family-centered residential care and systemic interventions. This study assessed whether levels of parental involvement or family-centered staff attitude and behavior during placement predicted outcomes of systemic interventions. We first assessed the outcomes in the full sample of families receiving systemic interventions and thereafter in families receiving systemic interventions with a strong evidence base (Multidimensional Family Therapy, Multisystemic Therapy [specializing in treatment of individuals with an intellectual disability/with problem sexual behavior], Relational Family Therapy [MDFT, MST(-ID/-PSB), RGT]) and systemic interventions with a less strong evidence base (Attachment Based Family Therapy, Flexible Assertive Community Treatment [FACT], FamilyFACT, Forensic Ambulant Systemic Therapy, Systemic Therapy [ABFT, (Family)FACT, FAST, ST]). Results revealed that higher levels of parental involvement predicted less family empowerment and a longer duration of the systemic intervention. Higher levels of family-centered staff attitude and behavior predicted more parental distress, a shorter duration of the residential placement and a shorter duration of the systemic intervention. Combinations of secure residential youth care with different systemic interventions of different evidence bases resulted in different outcomes. Future research is needed to establish which components of family-centered care or systemic interventions contribute to adolescent outcomes.

Searching for change mechanisms in emotion-focused work with adolescents and parents: An example from multidimensional family therapy.

Searching for change mechanisms in emotion-focused work with adolescents and parents: An example from multidimensional family therapy.

Assessing the effect of multidimensional family therapy in adolescents on police arrests against a background of falling crime rates. A randomised controlled trial with 7-year follow-up

BackgroundEarlier, we reported that multidimensional family therapy (MDFT) and cognitive behavioural therapy (CBT) decreased criminal offending in adolescents as measured with self-report in a randomised controlled trial with 1-year follow-up. The present study tested if this effect could be confirmed using police arrest data.MethodsStudy participants were 109 adolescents who were recruited for the Dutch part of a transnational treatment trial. National police arrest records were analysed for 3 years before the adolescents entered treatment with MDFT or CBT and for 7 years after treatment entry.ResultsPolice arrest rates rose in the 3 years preceding treatment and then dropped in both treatment groups to almost zero level during the follow-up period.ConclusionsThe results suggest that MDFT and CBT both strongly and durably decreased police arrest rates. However, this conclusion remains uncertain as crime rates concurrently decreased in the general population.Trial registrationISRCTN51014277

Behavioral Treatments for Adolescent Cannabis Use Disorder: a Rationale for Cognitive Retraining.

Adolescent cannabis use represents a significant public health concern. Cannabis experimentation typically begins in adolescence and increases the odds of meeting criteria for cannabis use disorder. Cannabis use disorder is associated with numerous short- and long-term adverse consequences for adolescents, highlighting the critical need for efficacious behavioral treatments. This brief review aims to synthesize the state of the behavioral treatment literature on adolescents with cannabis use disorder and to discuss new pathways to leverage neuroscience to inform novel targets for behavioral intervention. To date, effective treatment options for adolescent cannabis use disorder that have been tested in randomized controlled trials include cognitive behavioral therapy, motivational enhancement therapy, and multidimensional family therapy. However, established behavioral treatment approaches focus on higher-order cognitive control and have only been modestly effective. There is a need to develop new pathways that translate neuroscience findings into novel targets for behavioral interventions.

Outpatient psychosocial substance use treatments for young people: An overview of reviews

BackgroundSystematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings. MethodsReviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included. Forty-three reviews met all inclusion criteriaTo appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84). ResultsAll high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy. ConclusionsMethodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

APA calls for ‘whole‐person’ approach to solve opioid epidemic

Solving the opioid epidemic requires a “whole‐person” approach that includes nonpharmacological treatment for pain, as well as ensuring that people have the employment, education and housing supports they need for long‐term recovery, the CEO of the American Psychological Association (APA) told a congressional panel, a June 18 press release stated. “Research shows that the most effective treatment of opioid use disorder requires psychosocial interventions in combination with medications,” APA CEO Arthur C. Evans Jr., Ph.D., said in prepared remarks to the House Committee on Oversight and Reform. “The three forms of treatment with the strongest evidence base for use in treating opioid use disorders are contingency management, cognitive behavioral therapy and multidimensional family therapy.” Speaking in support of the Comprehensive Addiction Resources Emergency (CARE) Act, H.R. 2569, Evans noted the APA “strongly supports the use of medication‐assisted therapy drugs in treating opioid use disorder, and we support policies to ensure that the full range of such drug therapies are available to patients and their providers.… Psychologists have been at the forefront of the shift away from responding to pain as solely a physiological condition and toward an understanding of pain as a biopsychosocial phenomenon involving the biological, psychological and social aspects of the individual's health and functioning.”

Why and how to include parents in the treatment of adolescents presenting Internet gaming disorder?

Background and aimsClinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person’s family environment and the parent–adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy).MethodsThis article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD.ResultsThe article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person’s family.Discussion and conclusionsBasic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.

Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments

Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach’s α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings.Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems.

Self-medication Hypothesis and Family Socialization Theory: Examining Independent and Common Mechanisms Responsible for Binge Drinking.

For many, binge drinking behaviors start early and become a persistent pattern of use throughout the lifespan. In an effort to strengthen understanding of etiology, this study considered the mechanisms from the self-medication hypothesis and family socialization theory. The goal was to identify whether emotional distress is a potential shared mechanism that accounts for the development of binge drinking in different developmental periods. This study used the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset to examine binge drinking across time for n=9,421 participants ranging in age from 11 to 18 (M=15.39, SD=1.62) at Wave I and ranging from 24 to 32 (M=28.09, SD=1.61) at Wave IV of the study. Using an autoregressive cross-lagged model, I examined how parent-child closeness, depressive symptoms, and binge drinking were related over three developmental periods. In examining cross-sectional and longitudinal relations, depressive symptoms were significantly related to binge drinking more often than parent-child closeness; however, results indicated the self-medication model may primarily account for concurrent drinking behaviors rather than long-term. The family socialization theory was indicated to account for some variability above and beyond the self-medication hypothesis. No indirect association between binge drinking and the parent-child relationship was detected through depressive symptoms, failing to support a shared mechanism between the two theories. The results provide support for a multifaceted assessment process for substance using clients, and support the use of Multisystemic Family Therapy, Multidimensional Family Therapy, and perhaps Attachment-Based Family Therapy.

Multidimensional family therapy in adolescents with a cannabis use disorder: long-term effects on delinquency in a randomized controlled trial

BackgroundSubstance use and delinquency are considered to be mutual risk factors. Previous studies have shown that multidimensional family therapy (MDFT) is effective in tackling both conditions on the short term. The current study examines the long-term effects of MDFT on criminal offending.Methods109 adolescents with cannabis use disorder and comorbid problem behavior were randomly assigned to either MDFT or cognitive behavioral therapy (CBT). Police arrest data were collected for 6 years: 3 years prior to and 3 years after treatment entry. Using survival analysis and repeated measure General Linear Models (rmGLM), the two treatment groups were compared on number of arrests, type of offence, and severity of offence. Moderator analyses looking at age, disruptive behavior disorders, history of crimes, family functioning, and (severe) cannabis use were conducted (rmGLM).ResultsWhile police arrest rates increased in the 3 years before treatment, the rates decreased substantially after the start of both treatments. No differences were found between the treatment groups with respect to either time to first offence from the start of the treatment or changes in frequency or severity of offending over time. A treatment effect trend favoring MDFT was found for property offending in the subgroup of adolescents with high baseline-severity of cannabis use.ConclusionsAcross a follow-up period of 3 years, MDFT and CBT were similarly effective in reducing delinquency in adolescents with a cannabis use disorder.Trial registration ISRCTN51014277, Registered 17 March 2010—Retrospectively registered, http://www.isrctn.com/ISRCTN51014277

Multidimensional Family Therapy as a community-based alternative to residential treatment for adolescents with substance use and co-occurring mental health disorders

This randomized clinical trial (RCT) compared Multidimensional Family Therapy (MDFT) with residential treatment (RT) for adolescents with co-occurring substance use and mental health disorders on substance use, delinquency, and mental health symptoms. Using an intent-to-treat design, 113 adolescents who had been referred for residential treatment were randomly assigned to either RT or MDFT in the home/community. The sample was primarily male (75%) and Hispanic (68%) with an average age of 15.4 years. Seventy-one percent of youth had at least one previous residential treatment placement. Participants were assessed at baseline and at 2, 4, 12 and 18 months post-baseline. During the early phase of treatment (baseline to 2 months), youth in both treatments showed significant reductions in substance use [substance use problems (d = 1.10), frequency of use (d = 1.36)], delinquent behaviors (d = 0.18) and externalizing symptoms (d = 0.77), and youth receiving MDFT reported significantly greater reductions in internalizing symptoms than youth receiving RT (d = 0.42). In phase 2, from 2 to 18 months after baseline, youth in MDFT maintained their early treatment decreases in substance use problems (d = 0.51), frequency of use (d = 0.24), and delinquent behaviors (d = 0.42) more effectively than youth in RT. During this period, there were no significant treatment differences in maintenance of gains for externalizing and internalizing symptoms. Results suggest that Multidimensional Family Therapy is a promising alternative to residential treatment for youth with substance use and co-occurring disorders. The results, if supported through replication, are important because they challenge the prevailing assumption that adolescents who meet criteria for residential treatment cannot be adequately managed in a non-residential setting.

Marital and family therapy.

Substance abuse is a family disease that adversely impacts both the user and the user's family. The family can act as a risk factor for the development of substance abuse among children and adults. The family can also be involved in therapy to either help the recovery process or prevent substance abuse. Marital and family therapy have been found to be effective in reducing the severity of substance use, lowering marital and family conflict, improving family communication and cohesion as well as effective parenting practices. Behavioural Couples Therapy has been found to have good empirical support for bringing about the desired changes in both substance abuse and marital relationship. While targeting entire families, the most common evidenced based family interventions are Brief Strategic Family Therapy, Multidimensional Family Therapy, Family Behaviour Therapy, Functional Family Therapy and Community Reinforcement Programme. Marital and family therapy have to be sensitive to gender and culture. Effective use of marital and family therapy requires adequate training to equip practitioners in adequately treating not only substance use disorders and family pathology, but also in treating co-morbid mental health conditions.

Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis.

Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior. The effectiveness of MDFT in reducing adolescents' substance abuse, delinquency, externalizing and internalizing psychopathology, and family malfunctioning was examined by means of a (three-level) meta-analysis, summarizing 61 effect sizes from 19 manuscripts (N=1,488 participants). Compared with other therapies, the overall effect size of MDFT was significant, albeit small in magnitude (d=0.24, p<.001), and similar across intervention outcome categories. Moderator analysis revealed that adolescents with high severity problems, including severe substance abuse and disruptive behavior disorder, benefited more from MDFT than adolescents with less severe conditions. It can be concluded that MDFT is effective for adolescents with substance abuse, delinquency, and comorbid behavior problems. Subsequently, it is important to match specific characteristics of the adolescents, such as extent of impairment, with MDFT.

Feasibility of Inpatient and Outpatient Multidimensional Family Therapy for Improving Behavioral Outcomes in Adolescents Referred to Residential Youth Care

ABSTRACTIn this study, half of a cohort of adolescents referred to a secure residential youth care institution in The Netherlands was actually placed in the center where they received well-tested Multidimensional Family Therapy (MDFT). The others were offered outpatient MDFT in a last-minute effort to avert juvenile judge accorded out-of-home placement. All adolescents had problems with their family, and virtually all of them with school. Externalizing behavior problems were prevalent. As expected, both groups of adolescents benefited from MDFT on externalizing behavior, family, and school outcome measures. MDFT was well-liked by adolescents and parents.