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A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa
Background
Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.
Methods
The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.
Results
Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52;
p
= 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.
Conclusions
This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.
Trial Registration
Current Controlled Trials
ISRCTN11275465
; Registered 29 January 2007 (retrospectively registered)
Journal Article
A six-week group program of emotion focused family therapy for parents of children with mental health challenges: protocol for a randomized controlled trial
Background
Children with mental health difficulties are at increased risk of many adverse psychological, academic, and social outcomes. Emotion regulation is a key transdiagnostic factor in the development and maintenance of mental health challenges. Parents and the family system (e.g., parental functioning, parenting, parent-child relationship) play a central role in children’s development of emotion regulation and, in turn, their mental health. Therefore, continued efforts are needed to understand the effectiveness of emotion-focused treatments for child mental health difficulties, particularly those that include a family-based approach. Emotion Focused Family Therapy (EFFT) is an intervention for parents of children with mental health difficulties that teaches parents advanced skills to support their child’s emotional development, potentially leading to improvements in the psychological functioning of the affected child as well as the family. Despite this, EFFT’s efficacy has yet to be tested empirically via a randomized controlled trial.
Methods
A six-week group modality of EFFT was developed based on the standard manualized version of a two-day group modality of EFFT. Efficacy of the six-week group modality of EFFT will be tested in a randomized controlled trial among parents of children aged 7 to 15 with anxiety, depression, or behavioral challenges. Parents will be randomized to the intervention condition or waitlist control condition. Online questionnaires and in-lab assessments will be conducted at pre-treatment, post-treatment, 4-month follow-up and 1-year follow-up. Intervention effects on primary (parent psychological symptoms, child psychological symptoms, parent emotion regulation, child emotion regulation, parent-child co-regulation) and secondary (parental emotion socialization, parent emotion blocks, parental self-efficacy, perceived parental stress, treatment satisfaction, treatment fidelity) outcomes will be analyzed by linear mixed models.
Discussion
The study protocol describes the randomized controlled trial of EFFT, a parent group intervention for parents of children with anxiety, depression, and behavioral challenges. Findings contribute to the understanding of the efficacy of EFFT as a time-limited, transdiagnostic intervention for the treatment of child mental health challenges with potential positive impacts on parent and family functioning.
Trial registration [2a]
ClinicalTrials.gov: NCT05603000. Prospectively registered October 13, 2022.
Protocol version [3]
Version 1.1 November 2023.
Journal Article
Accumulating Evidence for Parent-Child Interaction Therapy in the Prevention of Child Maltreatment
In a randomized controlled trial, the effectiveness of Parent-Child Interaction Therapy (PCIT) and correlates of maltreatment outcomes were examined. Mothers (N = 150) had a history or were at high risk of maltreating their children. After 12 weeks and compared to waitlist, PCIT mothers were observed to have improved parent-child interactions and reported better child behavior and decreased stress. At PCIT completion, improvements continued and mothers reported less child abuse potential and had improved maternal sensitivity. Also, PCIT completers were less likely to be notified to child welfare than noncompleters. Finally, those families not notified post-PCIT showed greater reductions in child abuse potential and improvements in observed sensitivity during treatment. Implications for theory and practice are discussed.
Journal Article
Multiple-family group intervention programming to improve mental health of adolescents living with HIV/AIDS in Ghana: An implementation science study protocol
Adolescents living with HIV/AIDS in sub-Saharan Africa face a disproportionate burden of mental health challenges and suboptimal antiretroviral therapy (ART) adherence, which can have significant consequences for their overall health and well-being. While multiple family group therapy (MFGT) has shown promise in improving outcomes for ALHIV in other settings, the intervention is yet to be wholly adapted and evaluated in the Ghanaian context. This study aims to adapt, pilot, and evaluate a multiple family group therapy (MFGT) intervention to improve mental health and ART adherence among adolescents living with HIV/AIDS in Ghana.
A total of 80 ALHIV (aged 10-19 years at enrollment) will be recruited from two HIV clinics and each clinic will be randomized to one of two study conditions (MFGT group and control group). The study will be conducted in three phases: 1) Adaptation Phase - Qualitative data collection through focus group discussions and in-depth interviews with key stakeholders (adolescents, caregivers, community leaders and healthcare providers) to inform the adaptation of the MFGT intervention for the Ghanaian context; 2) Pilot Implementation Phase - Quantitative assessments (PHQ-9, GAD-7, Wilson's 3-item adherence scale, FAD, Berger HIV Stigma Scale) and qualitative data collection (focus groups, interviews) to evaluate the feasibility, acceptability, and preliminary effectiveness of the adapted MFGT intervention; and 3) Evaluation Phase - Continuation of the quantitative and qualitative data collection, as well as a cost-effectiveness analysis, to assess the long-term impact, sustainability, and scalability of the MFGT intervention.
The study will provide valuable insights into the feasibility, acceptability, and effectiveness of the adapted MFGT intervention in improving mental health and ART adherence among adolescents living with HIV/AIDS in Ghana. The findings will inform the development of culturally relevant and sustainable strategies to support this vulnerable population, with potential implications for similar interventions in other sub-Saharan African contexts.
The study has obtained necessary ethical approvals from the Ghana Health Service Ethics Review Committee and relevant health authorities, and will follow international research guidelines. Findings will be disseminated through peer-reviewed publications, conference presentations, and clinical trial registry, with an emphasis on open-access formats to maximize accessibility.
(NCT06701942).
24 November, 2024.
Journal Article
Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial
Background
Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT’s effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304–1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents.
Methods
The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables.
Results
Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm.
Conclusions
It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population.
Trial registration
NCT02771691
; Trial Registration Date: 25/04/2016.
Journal Article