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

Abstract

BackgroundTo investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.MethodsForty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.ResultsFrom pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.ConclusionsThe adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.Trial registrationThis study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593–31/5).

A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury

“…Effective treatments for NSSI, such as the Dialectical Behavior Therapy for Adolescents (DBT-A) 43–45 or the Emotion Regulation Individual Therapy for Adolescents (ERITA) [ 47 , 48 ], target emotion regulation and interpersonal functioning, especially within the family, and offer the possibility of including the family or parents in the adolescent’s treatment. Breaking a vicious cycle of interactions between adolescents and parents characterized by frustration and criticism and reestablishing more functional family interactional patterns can reduce high expressed emotion [ 49 ]. Given that adolescents who engage in NSSI reported fewer positive aspects in the mother–child relationship than NC adolescents, interventions should not focus merely on reducing the negative relational aspects but also on enhancing the positive aspects of the relationship.…”

A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption

“…The study was conducted in line with research ethics based on Declaration of Helsinki [ 22 ] regarding human experimentation and Swedish Research Council ethical principles. More detailed information on the study design, procedure, and outcomes has been presented elsewhere [ 17 ]. Health outcomes were collected at baseline, post treatment, as well as 6- and 12-month follow-ups.…”

“…Intensive contextual therapy, ICT [ 16 ] was developed in Uppsala county council in collaboration with the local policymakers and clinicians, where the main purpose was to fill the gap between in- and outpatient treatment and prevent residential care and long-term hospitalization. Preliminary results indicate that ICT reduces the need for inpatient and institutional care [ 17 ]. The adolescents also reported a significant reduction of self-harm, internalizing- and externalizing behavior symptoms, and a rise in general functioning in terms of school adjustment [ 17 ].…”

“…Preliminary results indicate that ICT reduces the need for inpatient and institutional care [ 17 ]. The adolescents also reported a significant reduction of self-harm, internalizing- and externalizing behavior symptoms, and a rise in general functioning in terms of school adjustment [ 17 ].…”

Lived experiences of parents providing care to young people who self-harm: a protocol for a meta-aggregative synthesis of qualitative studies

“…36 Therefore, many evidence-based interventions targeting youth SH have involved parents in the therapeutic process. [37][38][39][40] The National Institute for Health and Care Excellence also states in its current clinical practice guideline regarding SH that the involvement of the family, carers or significant others should be encouraged in the treatment of SH behaviours. 1 Therefore, it is essential to gain an overall understanding of parents' experiences, thoughts, perspectives and needs when they are providing care to their self-harming child.…”