Efficacy of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics

Abstract

Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent's quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship.Objective: To study the efficacy of ABFT compared with Treatment as Usual (TAU) delivered within child-and adolescent mental health services (CAMHS) to adolescents with MDD.Method: Sixty adolescents, aged 13-18 years, with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were clinician-rated (Hamilton Depression Scale, HAMD) and self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles.Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher's exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X 2 [2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority of adolescents were still in the clinical range after 16 weeks of treatment. Treatment of Depression in AdolescentsConclusion: In this sample of adolescents treated for MDD in community mental health clinics, ABFT was not associated with more favorable outcomes than TAU in terms of remission rates on clinician rated and self-reported depressive symptoms. Remission and response rates were low in both groups, suggesting a need for continued improvement of the treatment methods.Trial Registration:Clinicaltrials.gov identifier: NCT01830088

Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment-Based Family Therapy for adolescent depression

“…A larger Norwegian randomised controlled trial comparing 16 weeks of ABFT to treatment as usual (TAU) for adolescent depression (clinicaltrials.gov identifier NCT01830088) was conducted to follow up on these findings. Contrary to the primary hypothesis of the trial, ABFT was not found to be superior to treatment as usual ( 22 ). While the findings from these recent trials do not provide evidence that ABFT on average is more effective than treatment as usual or other active comparisons in treating adolescent depression or suicidal ideation, ABFT is a treatment where moderation of effectiveness by parent-adolescent conflict is highly plausible.…”

“…Our findings have considerable uncertainty, and the predicted differences in treatment outcome related to parent-adolescent conflict are clinically meaningful ( 47 ) only in the higher and lower quantiles of the distribution of parent-adolescent conflict. This is not surprising, given the overall small average treatment effect in the trial ( 22 ). For mother-adolescent conflict, there is some evidence of a moderator effect.…”

“…Although this is speculative, such a pattern of moderation could perhaps explain the unexpected findings of the two latest trials of ABFT ( 19 , 22 ), where ABFT did not perform better than active comparisons, even though previous findings have been promising ( 17 ). In developing and early testing of ABFT, the patient group has been predominantly composed of youth from disadvantaged neighbourhoods, with many families suffering from financial strain ( 48 ).…”

“…We analyse baseline and outcome data from the Norwegian two-arm randomised effectiveness trial comparing ABFT to TAU ( 22 ). Moderation is defined as an effect of treatment allocation that is conditional on a baseline variable, in this case parent-adolescent conflict ( 9 ).…”

Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD

“…In a recent study, designed to examine the effectiveness of ABFT compared to Treatment as usual (TAU) in reducing depressive symptoms, we found no differences between the two treatment options ( Waraan et al, 2020 ). Neither ABFT nor TAU was efficient in reducing depressive symptoms.…”