Jun 04, 2013


Systemic behavior family therapy is a treatment for depression that combines approaches from other family therapies to treat dysfunctional families of adolescents.  Strategies used in treatment include optimizing engagement with therapy, focusing on communication and problem solving skills, and identifying dysfunctional behavior patterns.  An experimental evaluation of the program found that for participants in systemic behavior family therapy, the reduction of therapist-rated depressive symptoms was slower than those in cognitive-behavioral therapy, and also the decrease of self-reported depressive symptoms was marginally slower than those in cognitive-behavioral therapy.  Participants in cognitive-behavioral therapy were also more likely than those in systemic behavior family therapy to have achieved remission, and those in the cognitive-behavioral therapy condition achieved remission sooner than those in systemic behavior family treatment.  There were no differences between the groups on suicidality or functional impairment.


Target Population: Depressed adolescents and their families

This therapy program utilizes a combination of two treatment approaches that have been used effectively to treat dysfunctional families of adolescents with depression.  In the first phase, the therapist clarifies what concerns have made the family come into treatment and then offers reframing statements that help optimize identification of dysfunctional behavior patterns and engagement in therapy.  With the second phase, family members focus on problem-solving skills, communication, and altering family interactional patterns.  The therapy program also provides education about depression, parenting, and developmental issues.  Skill building and positive practice during sessions and at home are also emphasized.  Patients receive 12 to 16 sessions of therapy provided over the course of 12 to 16 weeks.


Evaluated population: A total of 107 adolescents and youth (13 to 18 years old) with major depressive disorder in the Pittsburgh area were evaluated.  The majority of the sample was Caucasian (83 percent) and female (76 percent).

Approach: Researchers randomly assigned participants to one of three groups: systemic behavior family therapy (N=35), cognitive behavioral therapy (N=37), or nondirective supportive treatment (N=35).  All treatments involved 12 to 16 weekly sessions, plus 2 to 4 monthly booster sessions.  In all three groups parents received a psychoeducational manual about affective illness and its treatment and were given up to one hour to discuss their questions and concerns.  Cognitive behavioral therapy is described here [INSERT LINK TO CBT WRITE UP].  Nondirective supportive treatment served as a control treatment because it involved the same amount of contact with a skilled professional who provided support and used reflective listening to help the patient identify and express feeling, and discuss options for addressing personal problems, but therapists in this condition did not give advice, set limits, or teach specific skills.

Data were collected at baseline, at 6 weeks, and at the end of treatment (or after 12 to 16 weeks for those who did not complete the treatment) on depression, suicidality, and functional impairment.  Depressive symptoms were also assessed during every treatment session.

Results: Systemic behavior family therapy reduced therapist-rated depressive symptoms at a slower rate than cognitive-behavioral therapy.  In addition, systemic behavior family therapy decreased self-reported depressive symptoms at a marginally slower rate than those in cognitive-behavioral therapy.  Participants in the cognitive-behavioral therapy treatment also had higher rates of achieving remission (no major depression, and depressive symptoms lower than a certain threshold for at least three consecutive weeks and sustained through the rest of the treatment) than those in both of the other conditions.  Those in the cognitive-behavioral therapy condition reduced their symptoms to below that threshold for three consecutive weeks, sooner than those in systemic behavior family treatment.

There were no differences between the groups on suicidality or functional impairment.



Brent, D.A., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Roth, C., Iyengar, S., & Johnson, B.A. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry, 54, 877-885.

KEYWORDS: Adolescents (12-17), Youth (16+), Males and Females (Co-Ed), Clinic/Provider-Based, Counseling/Therapy, Parent or Family Component, Family Therapy, Depression/Mood Disorders

Program information last updated 10/17/12