Objective: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. Method: Randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, six weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms. Results: Using intent-to-treat, patients in ABFT demonstrated significantly greater rates of change on selfreported suicidal ideation at post-treatment and benefits were maintained at follow-up, with a strong overall effect size (ES = .97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation posttreatment (87%; 95% CI, 74.6-99.6) than patients in EUC (51.7%; 95% CI, 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI, 52.6-87.4; EUC 34.6%; 95% CI, 15.6-54.2), with a strong effect size (OR = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Conclusions: ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and test the proposed mechanism of change.

Current reformulations of the tension reduction hypothesis posit that only a subset of vulnerable individuals are at risk for drinking in response to negative affect. To further specify this model, this study examined the types of mood and social contexts under which affect and alcohol use are associated. Participants were 74 college students who completed repeated assessments of mood, alcohol use, friendship quality, and social support. A complex pattern of findings supported the moderating influences of gender, friendship factors, and the timing of behavior (i.e., weekends vs. weekdays) on the relation between affect and alcohol use. Young adults with less intimate and supportive friendships, as compared with their peers, showed risk for greater drinking following relative elevations in sadness and hostility. Such drinking episodes, in turn, predicted subsequent elevations in these same negative moods the following week. Gender differences in such a cyclical pattern of affect and alcohol use were found to vary across differing emotional experiences. Recommendations for a more refined theory of affect and alcohol use are discussed.

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Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents' suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12-to 18-years-old (49% were African American) were randomized to ABFT (n ¼ 66) or FE-NST (n ¼ 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F 1,127 ¼ 181, p ¼ .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t 127 ¼ 12.61, p < .0001; effect size, d ¼ 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t 127 ¼ 10.88, p < .0001; effect size, d ¼ 1.93). Response rates (ie, !50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.