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Seidel DH, Markes M, Grouven U, Messow CM, Sieben W, Knelangen M, Oelkers-Ax R, Grümer S, Kölsch H, Kromp M, von Pluto Prondzinski M. Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:125. [PMID: 38355466 PMCID: PMC10868021 DOI: 10.1186/s12888-024-05556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders. METHODS We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed. RESULTS Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST. CONCLUSIONS Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
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Affiliation(s)
- David Henry Seidel
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany.
| | - Martina Markes
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Ulrich Grouven
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Claudia-Martina Messow
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Wiebke Sieben
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Marco Knelangen
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Rieke Oelkers-Ax
- Family Therapy Centre (Familientherapeutisches Zentrum gGmbH, FaTZ), Hermann-Walker-Straße 16, 69151, Neckargemünd, Germany
| | - Sebastian Grümer
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Heike Kölsch
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Mandy Kromp
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Markus von Pluto Prondzinski
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
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Kreski NT, Askari MS, Cerdá M, Chen Q, Hasin DS, Martins SS, Mauro PM, Olfson M, Keyes KM. Changing adolescent activity patterns and the correlation of self-esteem and externalizing mental health symptoms across time: results from the USA from 1991 through 2020. Psychol Med 2024; 54:169-177. [PMID: 37183659 DOI: 10.1017/s0033291723001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Common adolescent psychiatric symptoms cluster into two dominant domains: internalizing and externalizing. Both domains are linked to self-esteem, which serves as a protective factor against a wide range of internalizing and externalizing problems. This study examined trends in US adolescents' self-esteem and externalizing symptoms, and their correlation, by sex and patterns of time use. METHODS Using Monitoring the Future data (N = 338 896 adolescents, grades:8/10/12, years:1991-2020), we generated six patterns of time use using latent profile analysis with 17 behavior items (e.g. sports participation, parties, paid work). Groups were differentiated by high/low engagement in sports and either paid work or high/low peer socialization. Within each group, we mapped annual, sex-stratified means of (and correlation between) self-esteem and externalizing factors. We also examined past-decade rates of change for factor means using linear regression and mapped proportions with top-quartile levels of poor self-esteem, externalizing symptoms, or both. RESULTS We found consistent increases in poor self-esteem, decreases in externalizing symptoms, and a positive correlation between the two across nearly all activity groups. We also identified a relatively constant proportion of those with high levels of both in every group. Increases in poor self-esteem were most pronounced for female adolescents with low levels of socializing, among whom externalizing symptoms also increased. CONCLUSIONS Rising trends in poor self-esteem are consistent across time use groups, as is the existence of a group facing poor self-esteem and externalizing symptoms. Effective interventions for adolescents' poor self-esteem/co-occurring symptoms are needed broadly, but especially among female adolescents with low peer socialization.
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Affiliation(s)
- Noah T Kreski
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
| | - Melanie S Askari
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue 4-16, New York, NY 10016, USA
| | - Qixuan Chen
- Department of Biostatistics, Columbia University, Mailman School of Public Health, 722 West 168th Street, R644, New York, NY 10032, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 722 W. 168th Street, Room 228F, New York, NY 10032, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 722 W. 168th Street, Room 228F, New York, NY 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 W 168th St, R733, New York, NY 10032, USA
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Spaan P, van den Boogert F, Grootendorst-van Mil NH, Hoogendijk WJG, Roza SJ. Screening for disruptive behavior in adolescents at risk using the strengths and difficulties questionnaire. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1085-1097. [PMID: 37194384 DOI: 10.1111/jora.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/05/2022] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Abstract
Disruptive behavior in adolescents is burdensome and may continue into adulthood if left unidentified. The strengths and difficulties questionnaire (SDQ) can screen for disruptive behavior, but its psychometric properties in high-risk samples and ability to predict delinquency warrant further investigation. In 1022 adolescents, we investigated the predictive validity (on average 1.9 years after screening) of the self-reported SDQ on disruptive behavior disorders and delinquency, measured with multi-informant questionnaires and structured interviews. We compared three scoring methods: total, subscale, and dysregulation profile scoring. In this high-risk sample, SDQ subscale scores predicted disruptive behavior outcomes best. Predictive values for the specific types of delinquency were small. Concluding, the SDQ can be used in high-risk settings for early identification of youth with disruptive behavior.
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Affiliation(s)
- Pascalle Spaan
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank van den Boogert
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sabine J Roza
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Netherlands Institute for Forensic Psychiatry and Psychology, The Hague, The Netherlands
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Cunningham PB, Gilmore J, Naar S, Preston SD, Eubanks CF, Hubig NC, McClendon J, Ghosh S, Ryan-Pettes S. Opening the Black Box of Family-Based Treatments: An Artificial Intelligence Framework to Examine Therapeutic Alliance and Therapist Empathy. Clin Child Fam Psychol Rev 2023; 26:975-993. [PMID: 37676364 PMCID: PMC10845126 DOI: 10.1007/s10567-023-00451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
The evidence-based treatment (EBT) movement has primarily focused on core intervention content or treatment fidelity and has largely ignored practitioner skills to manage interpersonal process issues that emerge during treatment, especially with difficult-to-treat adolescents (delinquent, substance-using, medical non-adherence) and those of color. A chief complaint of "real world" practitioners about manualized treatments is the lack of correspondence between following a manual and managing microsocial interpersonal processes (e.g. negative affect) that arise in treating "real world clients." Although family-based EBTs share core similarities (e.g. focus on family interactions, emphasis on practitioner engagement, family involvement), most of these treatments do not have an evidence base regarding common implementation and treatment process problems that practitioners experience in delivering particular models, especially in mid-treatment when demands on families to change their behavior is greatest in treatment - a lack that characterizes the field as a whole. Failure to effectively address common interpersonal processes with difficult-to-treat families likely undermines treatment fidelity and sustained use of EBTs, treatment outcome, and contributes to treatment dropout and treatment nonadherence. Recent advancements in wearables, sensing technologies, multivariate time-series analyses, and machine learning allow scientists to make significant advancements in the study of psychotherapy processes by looking "under the skin" of the provider-client interpersonal interactions that define therapeutic alliance, empathy, and empathic accuracy, along with the predictive validity of these therapy processes (therapeutic alliance, therapist empathy) to treatment outcome. Moreover, assessment of these processes can be extended to develop procedures for training providers to manage difficult interpersonal processes while maintaining a physiological profile that is consistent with astute skills in psychotherapeutic processes. This paper argues for opening the "black box" of therapy to advance the science of evidence-based psychotherapy by examining the clinical interior of evidence-based treatments to develop the next generation of audit- and feedback- (i.e., systemic review of professional performance) supervision systems.
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Affiliation(s)
- Phillippe B Cunningham
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Rd. Ste. 104, Charleston, SC, 29407, USA.
| | - Jordon Gilmore
- Department of Bioengineering, Clemson University, 401-3 Rhodes Research Center, Clemson, SC, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, USA
| | - Stephanie D Preston
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | - Catherine F Eubanks
- Gordon F. Derner School of Psychology, Adelphi University, One South Avenue, Garden City, NY, USA
| | - Nina Christina Hubig
- School of Computing, Clemson University, 1240 Supply Street, Charleston, SC, 29405, USA
| | - Jerome McClendon
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science & Coordinating Center for Clinical Trials (CCCT), University of Texas School of Public Health, University Texas Health Sciences , RAS W-928, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Stacy Ryan-Pettes
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798, USA
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Philipp DA, Prime H, Darwiche J. An ultra-brief systemic intervention to address child mental health symptomatology. FAMILY PROCESS 2023; 62:469-482. [PMID: 36959726 DOI: 10.1111/famp.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/08/2023]
Abstract
Drawing on decades of research in family systems, coparenting, and developmental science, we present a clinical approach to address unmet service needs in children's mental health. Specifically, we describe Lausanne Family Play - Brief Intervention (LFP-B) - a manualized family systems approach providing a caregiver-caregiver-child therapy (and sibling/s, when applicable). The LFP-B is ultra-brief, typically delivered in as few as three sessions (two assessment sessions followed by a video feedback session), with the aim of reducing children's mental health symptomatology by enhancing the coparenting relationship. We review literature on systemic family therapies and provide a rationale for including coparents and children in child mental health care. We then provide a rationale for using behavioral observations and video feedback in treatment, drawing on research in related family-based treatments (e.g., parent-child therapies). Finally, we provide an overview of the LFP-B manual and a case illustration.
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Affiliation(s)
- Diane A Philipp
- Garry Hurvitz Centre for Community Mental Health at Sickkidis, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather Prime
- Department of Psychology, York University, Toronto, Ontario, Canada
- LaMarsh Centre for Child & Youth Research, York University, Toronto, Canada
| | - Joëlle Darwiche
- Family and Development Research Center, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Hesse M, Jones S, Pedersen MM, Skov KBE, Thylstrup B, Pedersen MU. The predictive value of brief measures of externalizing behavior and internalizing problems in young people receiving substance use treatment: A secondary analysis. Addict Behav 2023; 139:107574. [PMID: 36565530 DOI: 10.1016/j.addbeh.2022.107574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identifying people at risk of poor outcomes following treatment for substance use disorders is important for developing tailored services. The aim of this study was to test whether a brief measure of internalizing and externalizing behavior could identify young adults at high risk of psychiatric care episodes and criminal offending up to four years after enrolment in treatment for substance use disorder. METHODS Clients aged 15-25 years from a randomized multicenter study were included (N = 457). At baseline, all completed the YouthMap12 screener, a measure of internalizing symptoms (IP6) and externalizing problems (EP6). We used accelerated failure time regression to assess time to psychiatric care and criminal offending, adjusting for baseline occurrence, gender, age, treatment group, and uptake area. Youden's J was used to assess optimal cut-points for risk of events. RESULTS The IP6 was associated with shorter time to psychiatric care following treatment enrolment (beta = -0.71, 95% confidence interval [CI] = -0.94 to -0.48; adjusted beta = -0.45, 95% CI = -0.66 to -0.25). The EP6 was associated with shorter time to criminal offending, coefficient = -0.32, 95% CI = -0.44 to -0.19; adjusted coefficient = -0.18, 95% CI = -0.30 to -0.06). Optimal cut-points were two or more for the IP6 and three or more for the EP6. CONCLUSIONS The IP6 and the EP6, two simple and easily administered instruments, can identify young adults who are at an increased risk of future criminal offending or in need of psychiatric care. The findings lend support to using the 12-item YouthMap, as it identifies relevant risks, is compatible with local service delivery needs, and is theoretically and empirically supported.
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Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, School of Business and Social Sciences, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Sheila Jones
- Department of Social Work, School of Health and Welfare, Dalarna University, Sweden.
| | | | | | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, School of Business and Social Sciences, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Mads Uffe Pedersen
- Department of Social Work, School of Health and Welfare, Dalarna University, Sweden.
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Mestre JM, Taubner S, Mota CP, Rangel Henriques M, Saliba A, Heinonen E, Ramos S, Moreno-Peral P, Volkert J, Adler A, Barkauskiene R, Conejo-Cerón S, Di Giacomo D, Ioannou Y, Mucha Vieira F, Røssberg JI, Sales CMD, Schmidt SJ, Stepisnik Perdih T, Ulberg R, Protić S. Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review. Front Psychiatry 2022; 12:730921. [PMID: 35095586 PMCID: PMC8795767 DOI: 10.3389/fpsyt.2021.730921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). METHODS A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. RESULTS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent-adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. CONCLUSIONS Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. ETHICS AND DISSEMINATION Ethical approval was not required. PROSPERO registration number: CRD42021231835.
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Affiliation(s)
- José M. Mestre
- Instituto para el Desarrollo Social y Sostenible (INDESS), Universidad de Cádiz, Cadiz, Spain
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Catarina Pinheiro Mota
- Department of Education and Psychology, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Margarida Rangel Henriques
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Andrea Saliba
- Department of Psychiatry, University of Malta and Mental Health Services Malta, Valletta, Malta
| | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sara Ramos
- Instituto para el Desarrollo Social y Sostenible (INDESS), Universidad de Cádiz, Cadiz, Spain
| | | | - Jana Volkert
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Asta Adler
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | | | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Yianna Ioannou
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Filipa Mucha Vieira
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Célia M. D. Sales
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Stefanie J. Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Randi Ulberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Sonja Protić
- Institute of Criminological and Sociological Research, Belgrade, Serbia
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Hilzinger R, Duarte J, Hench B, Hunger C, Schweitzer J, Krause M, Fischersworring M. Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy. PLoS One 2021; 16:e0250094. [PMID: 33974658 PMCID: PMC8112648 DOI: 10.1371/journal.pone.0250094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder. METHOD Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel. FINDINGS Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective. DISCUSSION Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.
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Affiliation(s)
- Rebecca Hilzinger
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Javiera Duarte
- Center of Studies in Clinical Psychology and Psychotherapy, Universidad Diego Portales, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Barbara Hench
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Hunger
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mariane Krause
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
- Faculty of Social Science -School of Psychology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Martina Fischersworring
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
- Faculty of Medicine- Postgraduate School, University of Chile, Santiago, Chile
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Blanchard MA, Heeren A. Why we should move from reductionism and embrace a network approach to parental burnout. New Dir Child Adolesc Dev 2020; 2020:159-168. [PMID: 33084239 DOI: 10.1002/cad.20377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Network science has allowed varied scientific fields to investigate and visualize complex relations between many variables, and psychology research has begun to adopt a network perspective. In this paper, we consider how leaving behind reductionist approaches and instead embracing a network perspective can advance the field of parental burnout. Although research into parental burnout is in its early stages, we argue that a network approach to parental burnout could set the scene for radically new vistas in parental burnout research. We claim that such an approach can allow simultaneous investigations (and clear visualizations) of many variables related to parental burnout and their interactions, integrates smoothly with prior family systems theories, and prioritizes dynamic research questions. We likewise discuss potential future clinical applications, such as interventions targeting central nodes and treatment personalized to a specific family's network system. We also review practical considerations, limitations, and future directions for researchers interested in applying a network approach to parental burnout research.
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Affiliation(s)
| | - Alexandre Heeren
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience, UCLouvain, Louvain-la-Neuve, Belgium
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Lebow JL. Editorial: The Systemic in Couple and Family Research and Couple and Family Therapy. FAMILY PROCESS 2020; 59:3-9. [PMID: 32119753 DOI: 10.1111/famp.12529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Jay L Lebow
- Family Institute at Northwestern, Evanston, IL
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12
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“Fighting Tooth and Nail”: Barriers to Accessing Adolescent Mental Health Treatment from Mothers Perspectives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:935-945. [DOI: 10.1007/s10488-020-01026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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13
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van der Pol TM, van Domburgh L, van Widenfelt BM, Hurlburt MS, Garland AF, Vermeiren RRJM. Common elements of evidence-based systemic treatments for adolescents with disruptive behaviour problems. Lancet Psychiatry 2019; 6:862-868. [PMID: 31255602 DOI: 10.1016/s2215-0366(19)30085-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
A growing number of evidence-based systemic treatments for adolescents with disruptive behaviour problems exist. However, it is not clear to what extent these treatments have unique and common elements. Identification of common elements in the different treatments would be beneficial for the further understanding and development of family-based interventions, training of therapists, and research. Therefore, the aim of this Review was to identify common elements of evidence-based systemic treatments for adolescents with disruptive behaviour. Several common elements of systemic treatments were identified, showing a strong overlap between the interventions. Investigation of these common mechanisms and techniques could potentially build strong universal systemic treatment and training modules for a broad spectrum of adolescents with problem behaviours.
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Affiliation(s)
- Thimo M van der Pol
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, Netherlands.
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Brigit M van Widenfelt
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands
| | - Michael S Hurlburt
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ann F Garland
- Department of School, Family and Mental Health Professions, University of San Diego, San Diego, CA, USA
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands
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14
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Jiménez L, Hidalgo V, Baena S, León A, Lorence B. Effectiveness of Structural⁻Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and Their Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071255. [PMID: 30965678 PMCID: PMC6479931 DOI: 10.3390/ijerph16071255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022]
Abstract
Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent⁻child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural⁻strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants' gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural⁻strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems.
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Key Words
- Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent–child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural–strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants’ gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural–strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems.
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Affiliation(s)
- Lucía Jiménez
- Faculty of Psychology, University of Seville, Camilo José Cela s/n, 41018 Seville, Spain.
| | - Victoria Hidalgo
- Faculty of Psychology, University of Seville, Camilo José Cela s/n, 41018 Seville, Spain.
| | - Sofía Baena
- Faculty of Psychology, University of Seville, Camilo José Cela s/n, 41018 Seville, Spain.
| | - Antonio León
- Child and Adolescent Mental Health Unit, Virgen Macarena Hospital, C/ Dr. Fedriani, 3, 41009 Seville, Spain.
| | - Bárbara Lorence
- Faculty of Psychology, University of Seville, Camilo José Cela s/n, 41018 Seville, Spain.
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15
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Schindler A. Attachment and Substance Use Disorders-Theoretical Models, Empirical Evidence, and Implications for Treatment. Front Psychiatry 2019; 10:727. [PMID: 31681039 PMCID: PMC6803532 DOI: 10.3389/fpsyt.2019.00727] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/10/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). Based on attachment theory, substance abuse can be understood as "self-medication," as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD and, on the other hand, a negative impact of substance abuse on attachment security. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups. Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results: All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment, results mainly point toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful-avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood. Discussion: The last decades have seen a substantial growth in studies on attachment and SUDs. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to the understanding and treatment of SUDs in a significant way. But to do so, a lot of open questions have to be answered. We will need more carefully designed longitudinal studies, more studies connecting psychological data with brain processes, and more clinical trials.
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Affiliation(s)
- Andreas Schindler
- Department for Personality and Stress Disorders, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Weyers L, Zemp M, Alpers GW. Impaired Interparental Relationships in Families of Children With Attention-Deficit/Hyperactivity Disorder (ADHD). ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1027/2151-2604/a000354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Abstract. Research on attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has traditionally focused on the genetic and neurobiological aspects of the disorder, but the role of family relationships has been much less systematically examined. There is growing evidence that the quality of interparental relationships and a child’s ADHD symptoms are reciprocally related. Because the literature appears to be inconsistent, this meta-analysis aims to summarize previous research and assess whether there are robust differences in the quality of interparental relationships between parents of children with ADHD and parents of healthy children. This meta-analysis of 15 studies with 43 effect sizes revealed a small but significant difference ( d = .24), which indicates that parents of a child with ADHD report poorer relationship quality than parents of healthy children. This effect was moderated by the child’s age and did not depend on whether the child had a comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). The causality of this relationship has yet to be determined.
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Affiliation(s)
- Lena Weyers
- Department of Psychology, University of Mannheim, Germany
| | - Martina Zemp
- Department of Psychology, University of Mannheim, Germany
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17
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Lebow JL. Editorial: Research on Rarely Researched Family Therapies. FAMILY PROCESS 2018; 57:849-854. [PMID: 30536752 DOI: 10.1111/famp.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jay L Lebow
- Family Process and Family Institute at Northwestern, Evanston, IL
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18
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Multidimensional family therapy in adolescents with a cannabis use disorder: long-term effects on delinquency in a randomized controlled trial. Child Adolesc Psychiatry Ment Health 2018; 12:44. [PMID: 30140308 PMCID: PMC6098634 DOI: 10.1186/s13034-018-0248-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/24/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Substance 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. METHODS 109 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). RESULTS While 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. CONCLUSIONS Across 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.
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19
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van der Pol TM, Henderson CE, Hendriks V, Schaub MP, Rigter H. Multidimensional Family Therapy Reduces Self-Reported Criminality Among Adolescents With a Cannabis Use Disorder. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:1573-1588. [PMID: 28076983 DOI: 10.1177/0306624x16687536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Multidimensional family therapy (MDFT) is an established treatment program for youth displaying multiproblem behavior. We examined whether MDFT decreased criminal offending among cannabis abusing adolescents, as compared with individual psychotherapy (IP). In a Western European randomized controlled trial comparing MDFT with IP, a sample of 169 adolescents with a cannabis disorder completed self-reports on criminal offending. Half indicated they had committed one or more criminal offenses in the 90 days before the baseline assessment. Follow-up assessments were at 6 and 12 months after randomization. The proportion of adolescents reporting nondelinquency increased during the study period, most so in the MDFT condition. In addition, MDFT lowered the number of violent offenses more than IP. This difference was not seen for property crimes. In cannabis abusing adolescents, MDFT is an effective treatment to prevent and reduce criminal offending. MDFT outperforms IP for violent crimes.
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Affiliation(s)
- Thimo M van der Pol
- 1 Curium, Leiden University Medical Center, The Netherlands
- 2 VU University Medical Center, Amsterdam, The Netherlands
| | | | - Vincent Hendriks
- 1 Curium, Leiden University Medical Center, The Netherlands
- 4 Parnassia Addiction Research Centre, The Hague, The Netherlands
| | | | - Henk Rigter
- 1 Curium, Leiden University Medical Center, The Netherlands
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20
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Hendriks AM, Bartels M, Colins OF, Finkenauer C. Childhood aggression: A synthesis of reviews and meta-analyses to reveal patterns and opportunities for prevention and intervention strategies. Neurosci Biobehav Rev 2018; 91:278-291. [PMID: 29580961 DOI: 10.1016/j.neubiorev.2018.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 01/27/2023]
Abstract
This study provides a synthesis of meta-analyses and systematic reviews on non-pharmacological treatments for childhood aggression. Treatments referred to universal prevention, selective prevention, indicated prevention, or intervention (Mrazek and Haggerty, 1994). Seventy-two meta-analyses and systematic reviews met the inclusion criteria. We describe their characteristics, effect sizes across types of treatments, and the effects of various moderators. For universal and selective prevention, effects were mostly absent or small; for indicated prevention and interventions, effects were mostly small or medium. Only two moderators had a positive effect on treatment effectiveness, namely pre-test levels of aggression and parental involvement. These results identified similarities between indicated prevention and intervention treatments, on the one hand, and universal prevention and selective prevention, on the other. Our findings suggest that research distinguishing between targets of treatments (i.e., factors associated with childhood aggression vs. present aggressive behaviors) would be promising. Moreover, to further increase effectiveness of treatments for childhood aggression, individual differences warrant scientific attention.
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Affiliation(s)
- A M Hendriks
- Department of Biological Psychology, Vrije Universiteit Amsterdam, van den Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - M Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, van den Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - O F Colins
- Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands.
| | - C Finkenauer
- Department of Biological Psychology, Vrije Universiteit Amsterdam, van den Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Interdisciplinary Social Sciences: Youth Studies, Utrecht University, Faculty of Social and Behavioural Sciences, Martinus J. Langeveld Building, Heidelberglaan 1, 3584 CH Utrecht, The Netherlands.
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21
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Oruche UM, Robb SL, Aalsma M, Pescosolido B, Brown-Podgorski B, Draucker CB. Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors. Arch Psychiatr Nurs 2017; 31:596-601. [PMID: 29179827 DOI: 10.1016/j.apnu.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/13/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Abstract
This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.
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Affiliation(s)
- Ukamaka M Oruche
- School of Nursing, Indiana University-Purdue University Indianapolis, United States.
| | - Sheri L Robb
- School of Nursing, Indiana University-Purdue University Indianapolis, United States
| | - Matt Aalsma
- Section of Adolescents Health and Medicine, School of Medicine, Indiana University, United States
| | | | - Brittany Brown-Podgorski
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, United States
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22
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Rickerby ML, DerMarderosian D, Nassau J, Houck C. Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness: Fostering Shifts in Family Illness Beliefs and Relationships. Child Adolesc Psychiatr Clin N Am 2017; 26:733-759. [PMID: 28916011 DOI: 10.1016/j.chc.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The heuristic model of family-based integrated care (FBIC) was developed from 1998 to 2016 in the context of the development of the Hasbro Children's Partial Hospital Program (HCPHP) along with the development of a family therapy training program for Brown University child psychiatry and triple board residents. The clinical experience of the HCPHP team in treating more than 2000 patients and families in combination with the authors' experience in training residents for diverse practice settings highlights the usefulness of the FBIC paradigm for interdisciplinary family-based treatment for a broad range of illnesses and levels of care.
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Affiliation(s)
- Michelle L Rickerby
- The Hasbro Children's Partial Hospital Program, The Alpert School of Medicine of Brown University, 593 Eddy Street, Providence, RI 02906, USA.
| | - Diane DerMarderosian
- The Hasbro Children's Partial Hospital Program, The Alpert School of Medicine of Brown University, 593 Eddy Street, Providence, RI 02906, USA
| | - Jack Nassau
- The Hasbro Children's Partial Hospital Program, The Alpert School of Medicine of Brown University, 593 Eddy Street, Providence, RI 02906, USA
| | - Christopher Houck
- The Hasbro Children's Partial Hospital Program, The Alpert School of Medicine of Brown University, 593 Eddy Street, Providence, RI 02906, USA
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23
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McPherson KE, Kerr S, Casey B, Marshall J. Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives. JOURNAL OF MARITAL AND FAMILY THERAPY 2017; 43:717-732. [PMID: 28276073 DOI: 10.1111/jmft.12221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings.
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24
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Hartnett D, Carr A, Hamilton E, O'Reilly G. The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta-Analysis. FAMILY PROCESS 2017; 55:287-304. [PMID: 27731494 DOI: 10.1111/famp.12195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta-analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well-defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta-analyses were as follows: random assignment FFT versus CTL (k = 3, d = 0.48, p < .01); random assignment FFT versus TAU (k = 3, d = .20, ns); random assignment FFT versus ALT (k = 5, d = .35, p < .05); nonrandom assignment FFT versus CTL (k = 2, d = .90, ns); nonrandom assignment FFT versus TAU (k = 2, d = .08, ns); and nonrandom assignment FFT versus ALT (k = 3, d = .75, p < .001). These results provide support for the effectiveness of FFT compared with untreated controls and well-defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.
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Affiliation(s)
- Dan Hartnett
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Alan Carr
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Elena Hamilton
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Gary O'Reilly
- School of Psychology, University College Dublin, Dublin, Ireland
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25
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Karam EA, Sterrett EM, Kiaer L. The Integration of Family and Group Therapy as an Alternative to Juvenile Incarceration: A Quasi-Experimental Evaluation Using Parenting with Love and Limits. FAMILY PROCESS 2017; 56:331-347. [PMID: 26510974 DOI: 10.1111/famp.12187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The current study employed a quasi-experimental design using both intent-to-treat and protocol adherence analysis of 155 moderate- to high-risk juvenile offenders to evaluate the effectiveness of Parenting with Love and Limits® (PLL), an integrative group and family therapy approach. Youth completing PLL had significantly lower rates of recidivism than the comparison group. Parents also reported statistically significant improvements in youth behavior. Lengths of service were also significantly shorter for the treatment sample than the matched comparison group by an average of 4 months. This study contributes to the literature by suggesting that intensive community-based combined family and group treatment is effective in curbing recidivism among high-risk juveniles.
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26
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Lebow JL. Editorial: The Expanding World of Couple and Family Therapy. FAMILY PROCESS 2017; 56:281-284. [PMID: 28591460 DOI: 10.1111/famp.12295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jay L Lebow
- Family Process and Family Institute at Northwestern, Evanston, IL
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27
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van der Pol TM, Hoeve M, Noom MJ, Stams GJJM, Doreleijers TAH, van Domburgh L, Vermeiren RRJM. Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis. J Child Psychol Psychiatry 2017; 58:532-545. [PMID: 28121012 DOI: 10.1111/jcpp.12685] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior. METHOD 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Thimo M van der Pol
- Department of Child and Adolescent Psychiatry, Curium - Leiden University Medical Centre, Leiden, The Netherlands.,Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Machteld Hoeve
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc J Noom
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert Jan J M Stams
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo A H Doreleijers
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium - Leiden University Medical Centre, Leiden, The Netherlands.,Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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28
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Shi J, Wang L, Yao Y, Zhan C, Su N, Zhao X. Systemic Therapy for Youth at Clinical High Risk for Psychosis: A Pilot Study. Front Psychiatry 2017; 8:211. [PMID: 29104547 PMCID: PMC5655006 DOI: 10.3389/fpsyt.2017.00211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/05/2017] [Indexed: 12/01/2022] Open
Abstract
Psychosocial intervention trials for youth at clinical high risk (CHR) for psychosis have shown promising effects on treating psychotic symptoms but have not focused on psychosocial functional outcomes, and those studies have been conducted among help-seeking patients; there is a lack of research on non-clinical young CHR individuals. Systemic therapy (ST) is grounded in systemic-constructivist and psychosocial resilience theories. It has a number of advantages that makes it attractive for use with CHR individuals in non-clinical context. The present study evaluated the effect of ST for students at CHR on reducing symptoms and enhancing psychosocial function. This was a single-blind randomized controlled trial for CHR young people comparing ST to supportive therapy with a 6-month treatment. Psychotic and depressive symptoms (DS) as well as self-esteem and social support (SS) were assessed at pre- and posttreatment. 26 CHR individuals were randomly divided into intervention group (n = 13) and control group (n = 13). There were no significant differences in severity of symptoms, level of SS and self-esteem at baseline between the two groups (P > 0.05). At posttreatment, significant improvements in positive and DS as well as SS and self-esteem were observed in the ST group (P < 0.05); in the control group, these improvements were not significant (P > 0.05). The findings indicated that systemic intervention for university students at CHR for psychosis may have a positive effect on symptoms and self-esteem as well as SS in short term. More long-term research is needed to further evaluate this intervention.
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Affiliation(s)
- Jingyu Shi
- East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lu Wang
- East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuhong Yao
- Students Counseling Center, Tongji University, Shanghai, China
| | - Chenyu Zhan
- East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Na Su
- School of Medicine, Tongji University, Shanghai, China
| | - Xudong Zhao
- East Hospital, School of Medicine, Tongji University, Shanghai, China
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Bakker MJ, Greven CU, Buitelaar JK, Glennon JC. Practitioner Review: Psychological treatments for children and adolescents with conduct disorder problems - a systematic review and meta-analysis. J Child Psychol Psychiatry 2017; 58:4-18. [PMID: 27501434 DOI: 10.1111/jcpp.12590] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND This meta-analysis evaluates the efficacy of nonpharmacological treatments for conduct disorder (CD) problems in children and adolescents, based on child, parent and teacher report. METHODS PubMed, PsycINFO and EMBASE were searched for peer-reviewed articles published between January 1970 and March 2015. Main inclusion criteria were nonpharmacological treatment, participants younger than 18 years, clinical CD problems/diagnosis, randomized controlled trials and inclusion of at least one CD problem-related outcome. Treatment efficacy is expressed in effect sizes (ESs) calculated for each rater (parent, teacher, self and blinded observer). RESULTS Of 1,549 articles retrieved, 17 (published between June 2004 and January 2014) describing 19 interventions met the inclusion criteria. All studies used psychological treatments; only three studies included a blinded observer to rate CD problems. Most studies were of very poor to fair quality. ESs were significant but small for parent-reported outcomes (0.36, 95% CI = 0.27-0.47), teacher-reported outcomes (0.26, 95% CI = 0.12-0.49) and blinded observer outcomes (0.26, 95% CI = 0.06-0.47), and they were nonsignificant for self-reported outcomes (-0.01, 95% CI = -0.25 to 0.23). Comorbidity, gender, age, number of sessions, duration, intervention type, setting, medication use or dropout percentage did not influence the effect of treatment. CONCLUSIONS Psychological treatments have a small effect in reducing parent-, teacher- and observer-rated CD problems in children and adolescents with clinical CD problems/diagnosis. There is not enough evidence to support one specific psychological treatment over another. Future studies should investigate the influence of participant characteristics (e.g. age of CD onset), use more homogeneous outcome measures and allow better evaluation of study quality. Many reports failed to provide detailed information to allow optimization of psychological treatment strategies.
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Affiliation(s)
- M J Bakker
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - C U Greven
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands.,Medical Research Council Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - J C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
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McCart MR, Sheidow AJ. Evidence-Based Psychosocial Treatments for Adolescents With Disruptive Behavior. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:529-563. [PMID: 27152911 PMCID: PMC5055452 DOI: 10.1080/15374416.2016.1146990] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article updates the earlier reviews of evidence-based psychosocial treatments for disruptive behavior in adolescents (Brestan & Eyberg, 1998; Eyberg, Nelson, & Boggs, 2008), focusing primarily on the treatment literature published from 2007 to 2014. Studies were identified through an extensive literature search and evaluated using Journal of Clinical Child and Adolescent Psychology (JCCAP) level of support criteria, which classify studies as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on existing evidence. The JCCAP criteria have undergone modest changes in recent years. Thus, in addition to evaluating new studies from 2007 to 2014 for this update, all adolescent-focused articles that had been included in the 1998 and 2008 reviews were reexamined. In total, 86 empirical papers published over a 48-year period and covering 50 unique treatment protocols were identified and coded. Two multicomponent treatments that integrate strategies from family, behavioral, and cognitive-behavioral therapy met criteria as well-established. Summaries are provided for those treatments, as well as for two additional multicomponent treatments and two cognitive-behavioral treatments that met criteria as probably efficacious. Treatments designated as possibly efficacious, experimental, or of questionable efficacy are listed. In addition, moderator/mediator research is summarized. Results indicate that since the prior reviews, there has been a noteworthy expansion of research on treatments for adolescent disruptive behavior, particularly treatments that are multicomponent in nature. Despite these advances, more research is needed to address key gaps in the field. Implications of the findings for future science and clinical practice are discussed.
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Goorden M, Schawo SJ, Bouwmans-Frijters CA, van der Schee E, Hendriks VM, Hakkaart-van Roijen L. The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review. BMC Psychiatry 2016; 16:237. [PMID: 27412612 PMCID: PMC4944475 DOI: 10.1186/s12888-016-0949-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/23/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family therapy and family-based treatment has been commonly applied in children and adolescents in mental health care and has been proven to be effective. There is an increased interest in economic evaluations of these, often expensive, interventions. The aim of this systematic review is to summarize and evaluate the evidence on cost-effectiveness of family/family-based therapy for externalizing disorders, substance use disorders and delinquency. METHODS A systematic literature search was performed in PubMed, Education Resource information Centre (ERIC), Psycinfo and Cochrane reviews including studies conducted after 1990 and before the first of August of 2013. Full economic evaluations investigating family/family-based interventions for adolescents between 10 and 20 years treated for substance use disorders, delinquency or externalizing disorders were included. RESULTS Seven hundred thirty-one articles met the search criteria and 51 studies were initially selected. The final selection resulted in the inclusion of 11 studies. The quality of these studies was assessed. Within the identified studies, there was great variation in the specific type of family/family-based interventions and disorders. According to the outcomes of the checklists, the overall quality of the economic evaluations was low. Results varied by study. Due to the variations in setting, design and outcome it was not feasible to pool results using a meta-analysis. CONCLUSIONS The quality of the identified economic evaluations of family/family-based therapy for treatment of externalizing disorders, adolescent substance use disorders and delinquency was insufficient to determine the cost-effectiveness. Although commonly applied, family/family-based therapy is costly and more research of higher quality is needed.
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Affiliation(s)
- Maartje Goorden
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Saskia J. Schawo
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Clazien A.M. Bouwmans-Frijters
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Evelien van der Schee
- Brijder Addiction Treatment, Parnassia Group, Parnassia Addiction Research Centre (PARC), P.O. Box 53002, 2505 AA The Hague, The Netherlands
| | - Vincent M. Hendriks
- Brijder Addiction Treatment, Parnassia Group, Parnassia Addiction Research Centre (PARC), P.O. Box 53002, 2505 AA The Hague, The Netherlands ,Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Leiden University, P.O. Box 37, 2300 AA Leiden, The Netherlands
| | - Leona Hakkaart-van Roijen
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Affiliation(s)
- Jay L Lebow
- Family Process and Family Institute at Northwestern, Evanston, IL
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Riedinger V, Pinquart M, Teubert D. Effects of Systemic Therapy on Mental Health of Children and Adolescents: A Meta-Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:880-894. [PMID: 26467300 DOI: 10.1080/15374416.2015.1063427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Systemic therapy is a frequently used form of psychotherapy for the treatment of mental disorders in children and adolescents. The present study reports the results of the first meta-analysis on the effects of systemic treatment of mental disorders and behavior problems in children and adolescents. Based on systematic search in electronic databases (PsycINFO, Psyndex, PubMed, ISI Web of Knowledge, CINAHL), k = 56 randomized, controlled trials met the inclusion criteria. We computed a random-effects meta-analysis. Systemic therapy showed small-to-medium effects in comparison with an untreated control group (posttest: k = 7, g = .59 standard deviation units, follow-up: k = 2, g = .27) and alternative treatment (posttest: k = 43, g = .32, follow-up: k = 38, g = .28). At follow-up, longer interventions produced larger effect sizes. No other moderator effects were identified. Although available randomized, controlled trials show convincing results, their effects refer to a limited number of systemic approaches and mental disorders, and also pertain to adolescents rather than younger children. Thus, more research is needed before more general conclusions about the effects of systemic therapy can be drawn.
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Sigmarsdóttir M, Thorlacius Ö, Guðmundsdóttir EV, DeGarmo DS. Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial. FAMILY PROCESS 2015; 54:498-517. [PMID: 25410965 DOI: 10.1111/famp.12109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Well-documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training-the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent-to-treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent-rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.
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Affiliation(s)
- Margrét Sigmarsdóttir
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- The School Administration Office, Hafnarfjördur, Iceland
- The Government Agency for Child Protection, Reykjavík, Iceland
| | | | - Edda Vikar Guðmundsdóttir
- The School Administration Office, Hafnarfjördur, Iceland
- The Government Agency for Child Protection, Reykjavík, Iceland
| | - David S DeGarmo
- Oregon Social Learning Center, Eugene, OR
- Department of Educational Methodology, Policy, and Leadership, University of Oregon, Eugene, OR
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Schindler A, Bröning S. A Review on Attachment and Adolescent Substance Abuse: Empirical Evidence and Implications for Prevention and Treatment. Subst Abus 2015; 36:304-13. [DOI: 10.1080/08897077.2014.983586] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andreas Schindler
- Department for Personality and Stress Disorders, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sonja Bröning
- German Center for Addiction Research in Childhood and Adolescence, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Family-based assessment and intervention are essential skills for child psychiatrists that are often neglected in fellowship training. The Brown Model for Family Therapy Training described here has evolved during the past 15 years. It is a model for training residents in family-based integrated care (FBIC), which has data to support postgraduate perception of positive impact on real-world practice. Effective training in FBIC has value for clinicians, families, and systems of care wanting to respond to the growing evidence in child psychiatry about the power of family environment, beliefs, and relationships in promoting child mental health.
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Affiliation(s)
- Michelle L Rickerby
- The Hasbro Children's Partial Hospital Program, 593 Eddy Street, Providence, RI 02906, USA.
| | - Thomas A Roesler
- Psychiatry and Behavioral Medicine Unit, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sandpoint Way Northeast, Seattle, WA 98105, USA
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Lebow JL. Editorial: conflicts of interest in publication about families and family therapy. FAMILY PROCESS 2015; 54:199-204. [PMID: 26058868 DOI: 10.1111/famp.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Darwiche J, de Roten Y. Couple and family treatments: study quality and level of evidence. FAMILY PROCESS 2015; 54:138-59. [PMID: 25308547 DOI: 10.1111/famp.12106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper examines the application of the guidelines for evidence-based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two-step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, "evidence-based" treatments; one was a level II, "evidence-informed treatment with promising preliminary evidence-based results"; and four were level I, "evidence-informed" treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.
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Affiliation(s)
- Joëlle Darwiche
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
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Lebow JL. Editorial: the passing of a generation. FAMILY PROCESS 2014; 53:577-579. [PMID: 25471239 DOI: 10.1111/famp.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Couple and Family Therapy Outcome Research in the Previous Decade: What Does the Evidence Tell Us? CONTEMPORARY FAMILY THERAPY 2014. [DOI: 10.1007/s10591-014-9314-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In this article, we examine the field of family therapy by drawing a distinction between two forms of practice: Whole Family Therapy (WFT), defined as treating the whole family, and Relational Family Therapy (RFT), defined as working with a subsystem of the family or an individual while retaining a systemic lens. Our thesis is that the practice of WFT has been in decline for some time and steps must be taken to keep it from becoming a defunct practice. We consider the trajectory of WFT and RFT throughout the development of family therapy through reference to the people, the literature, training, and practice patterns associated with family therapy. We remind the reader of the many benefits of WFT and suggest that today WFT is likely to be practiced in conjunction with RFT and individual therapy. Since training of family therapists today is largely located in degree-granting programs, we identify constraints to including WFT in such programs. We conclude by offering suggestions that can enhance a program's ability to train students in WFT.
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Rampage C. The role of family institutes in promoting the practice of family therapy. FAMILY PROCESS 2014; 53:489-99. [PMID: 24785549 DOI: 10.1111/famp.12074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Much of the development of family therapy as a discipline was an outcome of the clinical, training, and theory-building activities conducted at family institutes around the United States. Beginning in the 1960s, these institutes were the crucibles in which the concepts and practices of family therapy flourished. The author, a leader at one of the largest family institutes in the United States, discusses the role of family institutes in promoting the practice of family therapy, as well as the challenges of doing so.
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Affiliation(s)
- Cheryl Rampage
- The Family Institute at Northwestern University, Evanston, IL
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Liddle HA. Adapting and implementing an evidence-based treatment with justice-involved adolescents: the example of multidimensional family therapy. FAMILY PROCESS 2014; 53:516-528. [PMID: 25099536 DOI: 10.1111/famp.12094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For over four decades family therapy research and family centered evidence-based therapies for justice-involved youths have played influential roles in changing policies and services for these young people and their families. But research always reveals challenges as well as advances. To be sure, demonstration that an evidence-based therapy yields better outcomes than comparison treatments or services as usual is an accomplishment. But the extraordinary complexity embedded in that assertion feels tiny relative to what we are now learning about the so-called transfer of evidence-based treatments to real world practice settings. Today's family therapy studies continue to assess outcome with diverse samples and presenting problems, but research and funding priorities also include studying particular treatments in nonresearch settings. Does an evidence-based intervention work as well in a community clinic, with clinic personnel? How much of a treatment has to change to be accepted and implemented in a community clinic? Perhaps it is the setting and existing procedures that have to change? And, in those cases, do accommodations to the context compromise outcomes? Thankfully, technology transfer notions gave way to more systemic, dynamic, and frankly, more family therapy-like conceptions of the needed process. Implementation science became the more sensible, as well as the theoretically and empirically stronger overarching framework within which the evidence-based family based therapies now operate. Using the example of Multidimensional Family Therapy, this article discusses treatment development, refinement, and implementation of that adapted approach in a particular clinical context-a sector of the juvenile justice system-juvenile detention.
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Affiliation(s)
- Howard A Liddle
- Public Health Sciences and Psychology, University of Miami Miller School of Medicine, Miami, FL; Center for Treatment Research on Adolescent Drug Abuse, University of Miami Miller School of Medicine, Miami, FL
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Sexton TL, Datchi C. The development and evolution of family therapy research: its impact on practice, current status, and future directions. FAMILY PROCESS 2014; 53:415-433. [PMID: 24946675 DOI: 10.1111/famp.12084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Science has always been a central part of family therapy. Research by early pioneers focused on studying the efficacy of both couple and family interventions from a systemic perspective. Today we know more now than ever before about the processes of diverse families and the therapeutic outcomes of family therapy practices. Despite the acknowledged importance of family therapy research, there are still questions about its impact on "real life" practice. Despite all the flaws of each, research and practice are critical interacting elements of a dialectic relationship: High-quality practice combines reliable scientific knowledge with individual clinical judgment made by family therapists in the context of their dynamic transactions with a family or couple. Future research can help uncover the mechanisms we have yet to know and test the ones we have identified while the dynamic interaction of research and practice that can lead to further innovations and developments central to the future of family therapy.
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Affiliation(s)
- Thomas L Sexton
- Center for Adolescent and Family Studies, Indiana University, Bloomington, IN
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Lebow JL. Editorial: Whither family therapy: alive and flowering amidst the challenges. FAMILY PROCESS 2014; 53:365-370. [PMID: 25213545 DOI: 10.1111/famp.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Oruche UM, Draucker C, Alkhattab H, Knopf A, Mazurcyk J. Interventions for family members of adolescents with disruptive behavior disorders. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 27:99-108. [PMID: 24934181 PMCID: PMC4199581 DOI: 10.1111/jcap.12078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PROBLEM The family members of adolescents diagnosed with disruptive behavior disorders (DBDs) experience profound stress and burden. Despite the need for empirically supported interventions that address the challenges faced by these family members, few such interventions are available. METHODS In this qualitative descriptive study, we conducted in-depth interviews with 15 families of adolescents diagnosed with DBD. We asked the family members to identify what types of mental health services they needed and to describe the "ideal" program that would best address their concerns. FINDINGS Family members identified several intervention modalities that would fit their needs, including multifamily groups, family therapy, individual therapy, and community-based hotlines. They indicated that programs should address the following topics: family communication, conflict resolution, education about DBD, and strategies to improve interactions with child service agencies. CONCLUSIONS Clinicians should recognize that all family members may need support to manage the stressors associated with caring for or living with adolescents with DBD. When working with families, clinicians should provide information about the etiology and management of DBD, help navigate interactions with child service agencies, and employ strategies to improve family communication and functioning.
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Affiliation(s)
- Ukamaka M Oruche
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
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Haber R, Carlson RG, Braga C. Use of an anecdotal client feedback note in family therapy. FAMILY PROCESS 2014; 53:307-317. [PMID: 24702034 DOI: 10.1111/famp.12070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To attain information about divergent agendas in family therapy, as well as incorporate client feedback, we present the Client Feedback Note (CFN). The CFN elicits information about each family member's feelings, learning, dislikes, and wishes for each session. Anecdotal feedback after each session may help the therapist have better insight into the clients' perceptions and experience of the therapy and the therapist. Sensitivity to information generated by the CFN can help both therapist and client work to coconstruct a therapeutic process that is relevant to the diverse needs of the client system. This manuscript will (a) discuss literature supporting the use of client feedback in therapy; (b) present the CFN and rationale for its development; (c) discuss our experiences utilizing the CFN along with case examples that illustrate its use; and (d) identify practical applications, limitations, and potential research with using the CFN in systemic therapy.
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Affiliation(s)
- Russell Haber
- Department of Educational Studies, University of South Carolina, Columbia, SC
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