Attachment-Based Family Therapy for Adolescents with Suicidal Ideation: A Randomized Controlled Trial

Abstract

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.

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self‐injury

“…However, the present findings do support a family‐focused approach to preventing adolescent NSSI. One such approach, Attachment Based Family Therapy (ABFT) (Diamond, Reis, Diamond, Siqueland, & Isaacs, 2002), which focuses on improving communication and support in child‐parent relationships, has been shown to be effective among adolescents at reducing both depression and suicidality (Diamond et al., 2010). As depression and suicidality are both closely related to NSSI (Wilkinson et al., 2011), the efficacy of ABFT on reducing the risk of NSSI seems theoretically promising and should be investigated with larger randomized control trials.…”

Low Emotional Trust in Mothers is Associated with Increased Suicide Attempts in Inpatient Adolescents with Depressive Symptoms

“…Support has indeed accumulated for family focused interventions for youth selfinjurious thoughts and behaviors (Glenn, Franklin, & Nock, 2015); for instance, attachmentfocused treatments (e.g., Attachment-Based Family Therapy; Diamond, Reis, Diamond, Siqueland, & Isaacs, 2002;Diamond et al, 2010) focus on strengthening rapport between adolescent and caregiver, and fostering disclosure in the context of a supportive, empathic environment in order to decrease depression and suicidality. Acute care interventions may DEPRESSION, SUICIDE, AND EMOTIONAL TRUST 14 further benefit from bolstering emotional trust between adolescent and caregiver, and identifying active barriers to self-disclosure and the belief that confidentiality will be maintained.…”

Unleashing the Power of Prevention

“…Systematic reviews of school-based suicide prevention programs indicate moderate effectiveness in reducing suicidal thoughts (Katz et al, 2013;Miller et al, 2009). Selective and indicated family-focused interventions have shown effects in reducing suicidal behaviors (Diamond et al, 2010;Huey et al, 2004).…”