Attachment-Based Family Therapy for Adolescent Self-Injury

Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents

BACKGROUND

To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.

METHODS

Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.

RESULTS

From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.

CONCLUSIONS

The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.

TRIAL REGISTRATION

This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).

Attachment, Emotion Regulation, Childhood Abuse and Assault: Examining Predictors of NSSI Among Adolescents

In this study we examined the relative risk of Non-Suicidal Self-Injury (NSSI) associated with a history of physical and sexual abuse/assault, poor attachment relationships, and poor emotion regulation among adolescents. A total of 2,637 adolescents (aged 12-15 years) completed questionnaires at 3 time-points: baseline, 12, and 24 months later. Across the study, 9.4% reported a history of NSSI. Each of past or recent abuse/assault, poor attachment relationships, and poor emotion regulation was associated with NSSI. We also observed a potential "high-risk" group among those reporting recent sexual abuse or assault. Knowledge of abuse history, recent sexual assault, attachment, and emotion regulatory ability will enable clinicians to assist adolescents in avoiding some of the more negative outcomes of these, including NSSI.

Perception of Parental Bonds and Suicide Intent Among Egyptian Adolescents

PROBLEM

Suicidal adolescents, compared to their nonsuicidal peers, tend to perceive their parents as less "caring" and more "controlling"-which characterizes the "affectionless control" parenting style. Research findings are inconsistent regarding the distinct influence of mother versus father parenting on youth suicide intent; moreover, the influence of parents' joint parenting styles on suicide intent has not been investigated.

METHODS

Using a cross-sectional design and large sample (N = 150 youth, 13-21 years old), currently hospitalized in a treatment center in Egypt for a recent suicide attempt, data were collected using the Suicide Intent Scale, Parental Bonding Instrument, and Center for Epidemiologic Studies Depression Scale.

FINDINGS

Seventy percent of youth reported high suicide intent. Mother and father parenting styles, assessed independently, were not associated with adolescent suicide intent. The joint effect of both parents' parenting style, however, was positively associated with suicide intent (Wald χ(2) = 8.79, p = .03). Suicide intent was stronger among adolescents who experienced neglectful compared with optimal parenting style (B = 1.93, Wald χ(2) = 4.28, p = .04).

CONCLUSIONS

The findings have direct implications for mental health nursing interventions, signaling the critical need to engage both parents in family-based interventions to address youth suicidal behavior.

Models of correction and prevention of self-injurious behavior

We present a review of models of correction of self-injurious and suicidal behavior. Cognitive-behavioral approach includes cognitive-behavioral therapy, acceptance-based group therapy focused on enhancing emotional regulation and rising emotional aware- ness, dialectical behavioral therapy directed at rising emotional awareness, improving in- terpersonal relationships and teaching adaptive ways of coping with emotions, functional analysis and functional communication training. Psychodynamic approach includes mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy. Model of family therapy based on theory of attachment and multilevel model of intervention are considered. We discuss general and specific aspects of prevention of self-injury in clinical and normal populations. Requirements for the development of self-injury prevention programs for schools are listed.