Guide to Effective Programs
for Children and Youth

Cognitive Behavioral Family Intervention

OVERVIEW

The Cognitive Behavioral Family Intervention (CBFI) is designed to reduce maternal depression as well as children’s disruptive behavior through integrating cognitive therapy strategies to treat depression and teach parenting skills. Families in CBFI receive clinical and home visits that include therapist-guided practice, role-play, feedback, and coaching to teach behavioral principles and techniques to reduce depression and increase parenting skills. Mothers were taught cognitive behavior management strategies such as identifying and interrupting dysfunctional child-related cognitions. Families were randomly assigned to contrasting treatments, in order to compare Behavioral Family Intervention (BFI) to Cognitive Behavioral Family Intervention. Thus, there is no non-treatment control group. The researchers found that both interventions reduced maternal depression and child disruptive behavior in the short term; however, the impact on clinically significant Maternal depression at the 6-month follow-up was longer for CBFI.

DESCRIPTION OF PROGRAM

Target population: Families with a clinically depressed parent and a child with significant conduct problems.

The Cognitive Behavioral Family Intervention (CBFI) is designed to reduce mother’s depression and children’s disruptive behavior through integrating cognitive therapy strategies to treat depression and teach parenting skills. Therapy consists of 12 sessions, including 8 clinic sessions and 4 feedback sessions in the mother’s homes. These sessions are completed over a 3-5 month period. During the sessions, parents gain knowledge of positive parenting techniques. Parents learn to reach agreement about appropriate and inappropriate behaviors and how to address them, including proper punishments. Other techniques regarding positive parenting include praising children, attention, and positive reinforcement. In the CBFI sessions, the treatment of the mother’s depression is integrated with parent training. The mothers are taught relaxation techniques such as deep breathing and other coping techniques to help them deal with their depression and how it relates to their children. Parenting sessions address positive approaches such as contingent praise and attention and strategies for dealing with misbehavior.

EVALUATION(S) OF PROGRAM

Evaluated population: Subjects included 47 families with mothers who were classified as depressed and at least one child who was classified as having a behavioral problem according to commonly used criteria found in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). The children were 3 to 9 years of age and showed no evidence of developmental disabilities. The families were randomly assigned to either the BFI group or the CBFI group. Thirty-seven families completed treatment and the 6-month follow-up.

Approach: The researchers collected data using home videotaping and 20-minute observation sessions. These observations were coded using the Family Observation Schedule. The Child Behavior Checklist and Parent Daily Report were also used to measure treatment outcomes. Observers included two postgraduate research assistants. Further treatment measures included the Beck Depression Inventory, the Automatic Thoughts Questionnaire, and the Parent Sense of Competence Scale.

Results: Both the BFI and CBFI interventions were effective in reducing children’s disruptive behavior (F= 37.81 p≤0.0001 for the Child Behavior Checklist). Mother’s weekly rating of child behavior also showed a reduction in disruptive actions. This was measured through observation by the therapist and self-report measures from the family at post intervention. However, there was no reliable difference in reduction of the child’s behavior between the CBFI and the BFI methods.

Researchers concluded that the study was limited by the fact that they were unable to conduct clinical diagnostic interviews at follow-up. Researchers were also unable to conduct formal reliability checks of protocol adherence. Threats to internal validity can not be ruled out. Furthermore, the possibility that improvements in child and parent functioning were due to maturation can not be ruled out.

SOURCES FOR MORE INFORMATION

References

Sanders, M. R. & McFarland, M. (2000). Treatment of depressed mother with disruptive children: A controlled evaluation of cognitive behavioral family intervention. Behavior Therapy, 31, 89-112.

Program categorized in this guide according to the following:

Evaluated participant ages: 3-9

Program components: Counseling/therapy, home visiting, and parents/family.

Measured outcomes: Social/emotional, behavior problems.

Program information last updated 09/22/06.