ARTICLES
Attachment-Based Family Therapy for Depressed Adolescents: A Treatment Development Study

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ABSTRACT

Objective:

To design a treatment manual and adherence measure for attachment-based family therapy (ABFT) for adolescent depression and to collect pilot data on the treatment's efficacy.

Method:

Over a period of 2 years, 32 adolescents meeting DSM-III-R criteria for major depressive disorder (MDD) were randomly assigned to 12 weeks of ABFT or a 6-week, minimal-contact, waitlist control group. The sample was 78% female and 69% African American; 69% were from low-income, inner-city communities.

Results:

At post-treatment, 81% of the patients treated with ABFT no longer met criteria for MDD, in contrast with 47% of patients in the waitlist group. Mixed factorial analyses of variance revealed that, compared with the waitlist group, patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict. Of the 15 treated cases assessed at the follow-up, 13 patients (87%) continued to not meet criteria for MDD 6 months after treatment ended.

Conclusions:

ABFT appears to be a promising treatment and worthy of further development.

Section snippets

Sample.

Patients included in the study had a DSM-III-R primary diagnosis of major depressive disorder (MDD), were between the ages of 13 and 17 years, and had a primary caretaker willing to participate in treatment. The mean age of the 32 randomized patients was 14.9 years (SD = 1.5). Twenty-five (78%) were female, 22 (69%) were African American, and 10 (31%) were white. Patients were primarily referred by schools or parents. The majority (80%) came from single-parent families, and 69% reported less

Group Equivalence Tests

A series of χ2 and t tests was used to examine baseline differences between the groups. Analyses revealed no significant group differences on any demographic or pre-treatment severity scores. Furthermore, there were no significant outcome differences among therapists on presence of post-treatment diagnosis (χ25 = 5.90, p = .32) or pre-to-post change in adolescent BDI scores (F5,25 = 1.26, p = .33).

Change in Diagnosis.

Of the 16 initial treatment cases, 13 (81%) no longer met criteria for MDD at post-treatment,

DISCUSSION

This article presents data on the first manual-based family therapy specifically designed for treating adolescents with MDD that has been shown to be successful in comparison with a no-treatment control condition. Patients treated with ABFT showed significant decreases in rates of depression diagnosis and severity of depression and anxiety symptoms. ABFT patients also reported nearly significant decreases in hopelessness and suicidal ideation and an increase in attachment to mothers. The

REFERENCES (54)

  • TM Achenbach

    Manual for the Youth Self-Report/11–18

    (1991)
  • JP Allen et al.

    Attachment and adolescent psychosocial functioning

    Child Dev

    (1998)
  • GC Armsden et al.

    The Inventory of Parent and Peer Attachment: relationships to well-being in adolescence

    J Youth Adolesc

    (1987)
  • AT Beck et al.

    An inventory for measuring depression (BDI)

    Arch Gen Psychiatry

    (1961)
  • AT Beck et al.

    The measurement of pessimism: the Hopelessness Scale

    J Consult Clin Psychol

    (1974)
  • B Birmaher et al.

    Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder

    Arch Gen Psychiatry

    (2000)
  • BL Bloom

    A factor analysis of self-report measures of family functioning

    Fam Process

    (1985)
  • I Boszormeny-Nagy et al.

    Invisible Loyalties

    (1984)
  • J Bowlby

    Attachment

    (1969)
  • DA Brent et al.

    A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive treatments

    Arch Gen Psychiatry

    (1997)
  • EM Cummings et al.

    Toward a transactional model of relations between attachment and depression

  • LR Derogatis

    Brief Symptom Inventory: Administration, Scoring and Procedures Manual

    (1993)
  • LR Derogatis et al.

    Brief Symptom Inventory: Administration, Scoring, and Procedures Manual-I

    (1982)
  • G Diamond et al.

    Emotions, attachment, and the relational reframe: the first session

    J Syst Ther

    (1998)
  • Diamond GM, Diamond GS, Hogue AT, Liddle HA (1999), Adherence process research in family therapy. Paper presented at...
  • GM Diamond et al.

    The therapist–parent alliance in family-based therapy for adolescents

    J Clin Psychol

    (2000)
  • GS Diamond et al.

    Family therapy for the treatment of depressed adolescents

    Psychotherapy

    (1995)
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    This work was supported by funding from the National Alliance of Research on Schizophrenia and Depression, the American Suicide Foundation, and NIMH grant R21NIH52920-01AB.

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