Attachment-Based Family Therapy (ABFT) is designed to help families strengthen their relationships, solve problems, and regulate emotions. The program consists of individual and joint meetings with depressed adolescents and their parents. ABFT was found to have significant positive impacts on rates of change in adolescents’ suicidal thoughts, clinical recovery for suicidal thoughts and depressive symptoms, and treatment retention.
DESCRIPTION OF PROGRAM
Target Population: Depressed adolescents and their families
The goal of Attachment-Based Family Therapy (ABFT) is to strengthen attachment bonds between an adolescent and his or her parent or guardian, and to facilitate family cohesion, problem-solving, emotional regulation, and organization, in order to create secure and protective relationships that can help adolescents dealing with suicidal thoughts and depression. Patients are given three months of treatment by Ph.D.- or MSW-level therapists. These providers follow a semi-structured protocol that consists of 1) the Relational Reframe Task with family members, to strengthen their relationships; 2) the Adolescent Alliance Task with the adolescent, to identify family conflicts and prepare for family discussion; 3) the Parent Alliance Task with parents, to develop love, empathy, and emotionally-focused parenting skills; 4) the Reattachment Task with all family members, to facilitate discussion, problem-solving, and relationship skills development; and 5) the Competency Task, which focuses on fostering both adolescent autonomy and family connection.
EVALUATION OF PROGRAM
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial. Department of Psychiatry and Human Behavior Faculty Papers, Paper 8.
Evaluated population: Patients of the Department of Psychiatry at the Children’s Hospital of Philadelphia, between the ages of 12 and 17, were referred to this study and considered eligible after being identified as having suicidal thoughts and receiving qualifying scores on tests of suicidal ideation and depression. Other criteria for eligibility included 1) having a parent or guardian willing to participate, 2) not needing, or having recently been discharged from, psychiatric hospitalization, 3) not having psychosis, and 4) having no history of mental retardation or borderline intellectual functioning.
A total of 66 adolescents participated in the study. For both the treatment and the control groups, the mean age was slightly above 15 (15.1 treatment, 15.3 control); participants were mostly African American (71.4 percent treatment, 77.4 percent control) and female (91.4 percent treatment, 74.2 percent control); and the average annual income for participating parents was under $30,000 for slightly less than half of participants (43.8 percent treatment, 44.8 percent control).
Approach: Individual adolescents, along with their families, were randomly assigned to an ABFT treatment group (35 individuals) or an Enhanced Usual Care control group (31 individuals), in which participants were referred to other providers but were continually monitored. Participants were assessed at baseline, mid-treatment (at six-weeks), post-treatment (at 12 weeks), and at a 24-week follow-up. The primary outcomes measured were rates of change and clinical recovery for suicidal ideation and depressive symptoms.
Results: The ABFT group had a significantly higher rate of retention than the control group did. ABFT had significant positive impacts on rates of change for self- and clinician-reported suicidal ideation during the 12-week treatment period (ES = .95 self, 0.62 clinician), and on the total change on this outcome over the course of the 24-week study (ES = 0.97 self, 0.64 clinician). Similar results were found for a subsample of adolescents who had been diagnosed with clinical depression (ES = 1.00 total change). ABFT also had significant positive impacts on self- and clinician-reported clinical recovery for suicidal ideation at all time points, and for depressive symptoms at mid-treatment.
ABFT had marginally significant impacts on clinical recovery for depressive symptoms during the full treatment phase, and on rates of change for this outcome during the first six weeks of treatment.
ABFT did not have a significant impact on rates of change in suicidal ideation during the post-treatment follow-up phase. There were also no significant impacts on clinical recovery for depressive symptoms at the follow-up assessment, or on the total change for this outcome from baseline to follow-up.
SOURCES FOR MORE INFORMATION
Diamond, G.S., Wintersteen, M.B., Brown, G.K., Diamond, G.M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial. Department of Psychiatry and Human Behavior Faculty Papers, Paper 8.
Suzanne A. Levy, Ph.D.
KEYWORDS: Adolescents, Youth, Males and Females (Co-ed), Black/African-American, Urban, Clinic/Provider-based, Counseling/Therapy, Parent or Family Component, Family Therapy, Depression/Mood Disorders, Parent-Child Relationship, Other
Program information last updated on 3/10/2015.