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

Abstract

Background: Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict. Objective: To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual. Methods: Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out crossvalidation. Results: Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain. Conclusion: The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn.

Updates in treatment of depression in children and adolescents

“…However, response to IPT was more favourable than response to enhanced TAU in those exposed to two or more types of maltreatment. One RCT (60 participating families) examined the moderating influence of parent–adolescent conflict on the response to Attachment-Based Family Therapy [27]. Although there was a trend for greater mother–adolescent conflict to predict a better response to treatment, the findings were inconclusive.…”

Attachment-Based Family Therapy to Improve Family Functioning in Adolescent Binge-Spectrum Eating Disorders: An Initial Evaluation Via Case Series Design

“…This model is a structured, empirically-supported emotion-focused family treatment originally designed for adolescent depression and suicidality. Data suggest ABFT can reduce negative family factors that fuel adolescent self-destructive behavior and this reduction in negative family factors mediates treatment outcome (G. S. Diamond et al, 2014; G. S. Diamond et al, 2019; G. S. Diamond et al, 2002; Ewing et al, 2015; Rognli et al, 2020). ABFT posits that family high conflict and low warmth can maintain and/or exacerbate psychological symptoms or maladaptive behaviors (Ewing et al, 2015).…”

“…S. Diamond et al, 2019;G. S. Diamond et al, 2002;Ewing et al, 2015;Rognli et al, 2020). ABFT posits that family high conflict and low warmth can maintain and/or exacerbate psychological symptoms or maladaptive behaviors (Ewing et al, 2015).…”