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1.
J Consult Clin Psychol ; 87(11): 1056-1067, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556651

RESUMO

OBJECTIVE: We evaluated whether initiating the Family Check-Up (FCU) during early childhood prevented a severe form of psychopathology in adolescence-co-occurring internalizing and externalizing problems-and whether effects operated indirectly through early childhood maternal depression and parents' positive behavior support. METHOD: Participants were drawn from a randomized controlled trial of the FCU (50.2% FCU; 49.5% girls; 46.6% Caucasian, and 27.6% Black; 13.4% Hispanic/Latino). At Ages 2 and 3, mothers self-reported depression, and primary caregivers' (PCs') positive behavior support was coded by trained observers. PCs, alternate caregivers (ACs), and teachers reported on 14-year-olds' problem behaviors. Latent profile analyses (LPAs) identified problem behavior groups for each reporter, which were outcomes in multinomial logistic regressions (PC, n = 672; AC, n = 652; teacher, n = 667). RESULTS: LPAs identified a low-problem, internalizing-only, externalizing-only, and co-occurring-problem group for each reporter. For PC- and AC-reported outcomes, the FCU predicted a lower likelihood that adolescents belonged to the co-occurring group relative to the low-problem, externalizing-only (p < .05), and internalizing-only (p < .05 for PC, p < 0.10 for AC) groups; these effects operated through maternal depression (p < .05). For teacher-reported outcomes, the FCU predicted a lower likelihood that adolescents belonged to the co-occurring group relative to the low-problem, internalizing-only, and externalizing-only (p < 0.05) groups; effects operated through positive behavior support (p < 0.05). CONCLUSIONS: Early delivery of the FCU indirectly prevented adolescents' co-occurring internalizing/externalizing problems in both home and school contexts by improving the quality of the early home environment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comportamento do Adolescente/psicologia , Transtornos do Comportamento Infantil/prevenção & controle , Transtornos do Comportamento Infantil/psicologia , Transtorno Depressivo/psicologia , Terapia Familiar/métodos , Pais/psicologia , Adolescente , Pré-Escolar , Feminino , Humanos , Masculino , Mães/psicologia , Autorrelato
2.
J Consult Clin Psychol ; 87(11): 1043-1055, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556652

RESUMO

OBJECTIVE: To examine changes in quality of life (QoL) in adolescents receiving family problem-solving therapy (F-PST) following traumatic brain injury (TBI). METHOD: Adolescents hospitalized for moderate-to-severe TBI were randomized to 1 of 3 ten-session, 6-month long treatments: face-to-face F-PST (n = 34), therapist-guided online F-PST (n = 56), and self-guided online F-PST (n = 60). Participants included 96 boys and 54 girls, of whom 124 were White and 6 were Hispanic. Outcomes were assessed pretreatment and 6 and 9 months later. Adolescents and parents rated adolescent QoL and TBI-related symptoms on the PedsQL and Health and Behavior Inventory (HBI), respectively. We used mixed modeling to examine changes over time and moderators of treatment efficacy. RESULTS: Therapist- and self-guided online groups demonstrated improvements in parent-proxy QoL from baseline to 9 months, Cohen's d = 0.75; p = .004 and Cohen's d = 1.30; p < .001, respectively. The face-to-face group had poorer parent-proxy QoL at 6 months (M = 62, SE = 3.4) than either the therapist- (M = 70.9, SE = 2.8) or self-guided online group (M = 71.1, SE = 2.6). There were no changes or group differences in self-reported QoL over time. Similar findings were observed on the HBI. Differential treatment effects on parent-proxy outcomes were found in boys versus girls and in those from single versus 2-parent households. Improvements in parent-proxy HBI ratings mediated QoL improvements. CONCLUSIONS: Both online treatments, but not face-to-face F-PST, were associated with clinical improvements, raising questions about our current delivery paradigm. Individual and family moderators of treatment efficacy underscore the potential of personalized treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Terapia Familiar/métodos , Resolução de Problemas , Psicoterapia/métodos , Qualidade de Vida/psicologia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pais , Autorrelato , Resultado do Tratamento , Adulto Jovem
3.
J Fam Psychol ; 33(7): 775-787, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31169393

RESUMO

This study examined changes in mothers' and fathers' rejection and psychological control during parent-child interactions after cognitive-behavioral therapy (CBT) for children's anxiety disorders. We studied whether family CBT reduced rejection (vs. warmth) and psychological control (vs. autonomy-granting) more than child CBT, and whether parents own anxiety disorders resulted in smaller decreases in these parenting behaviors. Participants were 128 clinically referred children and adolescents (52 boys; Mage = 12.4, SDage = 2.7) with anxiety disorders and their parents, randomly assigned to either family CBT (n = 64) or child CBT (n = 64). The Anxiety Disorders Interview Schedule was used to assess children's and parents' anxiety disorders. Before and after treatment, parents' rejection and psychological control toward their child was rated during conflict and anxiety discussions of mother-child dyads, father-child dyads, and mother-father-child triads. As expected, during dyadic and triadic interactions, mothers' and fathers' rejection toward their child decreased after child and family CBT. Unexpectedly, during triadic conflict interactions, mothers, after child CBT and family CBT, as well as fathers, after child CBT, displayed increased psychological control. During triadic anxiety interactions, only mothers, after child CBT, showed increased psychological control. Changes in parenting did not depend on whether or not parents had anxiety disorders themselves. Thus, CBT for anxiety-disordered children can successfully reduce parents' rejection. The unexpected findings of increased psychological control after treatment, particularly by mothers in the presence of the father, suggests potential benefits of mothers' psychological control with anxious children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Conflito Familiar/psicologia , Terapia Familiar/métodos , Relações Pais-Filho , Adolescente , Transtornos de Ansiedade/psicologia , Criança , Feminino , Humanos , Masculino , Pais/psicologia
4.
Int J Eat Disord ; 52(8): 950-955, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150141

RESUMO

OBJECTIVE: We tested the feasibility, acceptability, and preliminary effect sizes on outcome measures of Reconnecting for Recovery (R4R) Multifamily Therapy Group for young adults with anorexia nervosa (AN). METHOD: Ten participants (mean age = 23 years, SD = 3.6) meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for a restrictive eating disorder (AN or other specified feeding and eating disorder) and 14 family members received 16 R4R outpatient sessions over 26 weeks. Feasibility and acceptability were evaluated by recruitment and retention rates and patient/family member suitability scores. Outcomes were determined utilizing the Eating Disorder Examination (EDE), weight (body mass index), and Difficulties in Emotion Regulation Scale. RESULTS: All participants and 12 family members were retained, and the majority found R4R acceptable. EDE global score and lack of emotional awareness improved significantly from baseline (BL) to end-of-treatment (EOT) and BL to 6-month follow-up (6MFU) with moderate to large effect sizes (0.47-1.41). Limited access to emotion regulation strategies (LAERS) improved significantly from BL to 6MFU (moderate effect size; 0.57). Improvements in LAERS from BL to EOT (0.32) and weight from BL to EOT and BL to 6MFU were not significant (effect sizes 0.16-0.22). DISCUSSION: Findings provide preliminary evidence that R4R is feasible, acceptable, and produces clinically significant changes in targeted outcomes.


Assuntos
Anorexia Nervosa/terapia , Terapia Familiar/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Anorexia Nervosa/psicologia , Conscientização , Índice de Massa Corporal , Peso Corporal , Emoções , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/psicologia , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
5.
J Behav Addict ; 8(2): 201-212, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31146552

RESUMO

BACKGROUND AND AIMS: Clinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person's family environment and the parent-adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy). METHODS: This article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD. RESULTS: The article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person's family. DISCUSSION AND CONCLUSIONS: Basic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.


Assuntos
Comportamento Aditivo/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia Familiar/métodos , Pais/psicologia , Jogos de Vídeo/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Adulto , Comportamento Aditivo/psicologia , Humanos , Internet
6.
Prax Kinderpsychol Kinderpsychiatr ; 68(5): 419-437, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31250723

RESUMO

Family Psychiatry - The Attachment-Focused, Systemic-Oriented, Integrative Concept of the Family Therapy Centre (FaTC), an Acute Multi-Family Day Clinic Up to three quarters of the children of mentally ill parents develop a mental disorder during their lifetime. The transmission occurs essentially through dysfunctional interaction and disturbed attachment. Parent-child interaction is characterized by a vicious circle of escalating symptoms in the child and increasing helplessness in the parents. For this family psychiatric approaches are helpful, which address the interaction in addition to the individual disorders. The Family Therapy Centre (FaTC) Neckargemünd offers family psychiatric, integrated therapy for parents and children in an acute day clinic multi-family setting. The basic therapeutic principles are attachment orientation, mentalisation and systemic perspective with a multi-family therapy approach. Typical family psychiatric case constellations are presented, for which the concept seems particularly helpful: (1) Early childhood regulatory disorders in interaction with mentally ill parents, (2) mother with PTSD and expansive-aggressive preschool child and (3) adolescents with separation anxiety and depressive-anxious mother. The previous experiences are reflected by a moderated focus group of the entire FaTC team. The FaTC concept was evaluated as very helpful. It was positively judged that the family system is visibly present on site (and not only virtually). The focus is on interaction, therefore causal therapy can be offered rather than symptomatic treatment. Limitations of the concept are therapy of severely aggressive adolescents or parents who do not want to participate. The concept of the FaTC is currently being scientifically evaluated.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Familiar/métodos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Relações Pais-Filho , Pais/psicologia , Psiquiatria/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Familiar/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Psiquiatria/organização & administração
7.
Trials ; 20(1): 249, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039797

RESUMO

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.


Assuntos
Comportamento do Adolescente , Anorexia Nervosa/terapia , Relações Familiares , Terapia Familiar/métodos , Comportamento Alimentar , Adolescente , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/economia , Anorexia Nervosa/psicologia , Índice de Massa Corporal , Análise Custo-Benefício , Terapia Familiar/economia , Feminino , França , Custos de Cuidados de Saúde , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 253-270, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044679

RESUMO

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.


Assuntos
Coerção , Centros Comunitários de Saúde Mental , Terapia Familiar/métodos , Tratamento Psiquiátrico Involuntário/métodos , Transtornos Mentais/terapia , Pais/psicologia , Psicoterapia/métodos , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Ansiedade de Separação , Criança , Filho de Pais Incapacitados/psicologia , Terapia Familiar/ética , Humanos , Tratamento Psiquiátrico Involuntário/ética , Transtornos Mentais/psicologia , Cooperação do Paciente/psicologia , Psicoterapia/ética
9.
J Fam Psychol ; 33(7): 753-763, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31045402

RESUMO

This study examined the prospective associations among maternal substance use, depressive symptoms, and children's behavioral problems in a family systems therapy (ecologically based family therapy [EBFT]) condition and an individual treatment condition. Participants included 183 mothers with a substance use disorder who had at least 1 biological child in their care. Mothers were randomly assigned to the EBFT condition (n = 123) or an individual treatment condition (n = 60). Maternal substance use, depressive symptoms, and child behavioral problems were assessed at baseline and at 3, 6, and 12 months postbaseline. Autoregressive cross-lagged models were estimated to compare whether the cross-lagged paths among the 3 variables differed from zero in each treatment condition. Findings revealed that for individual treatment, strong reciprocal relationships were observed between maternal substance use and maternal depressive symptoms, and between maternal substance use and child behavioral problems. Conversely, in the EBFT group, fewer reciprocal relationships were observed, and instead, maternal depressive symptoms predicted more future child behavioral problems. These findings suggest an interruption in the dysfunctional reciprocal transmission of problem behaviors between mothers and children over time in the family therapy condition. The findings provide evidence for the effectiveness of family systems therapy, EBFT, in interrupting the dysfunctional family dynamics that contribute to maternal substance using behaviors and child behavioral problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos do Comportamento Infantil/terapia , Transtorno Depressivo/terapia , Terapia Familiar/métodos , Relações Mãe-Filho/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Criança , Transtornos do Comportamento Infantil/complicações , Transtornos do Comportamento Infantil/psicologia , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Mães/psicologia , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento , Adulto Jovem
10.
Cochrane Database Syst Rev ; 5: CD004780, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31041816

RESUMO

BACKGROUND: Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES: To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS: Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS: We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS: There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.


Assuntos
Anorexia Nervosa/terapia , Terapia Familiar/métodos , Psicoterapia/métodos , Adolescente , Adulto , Peso Corporal , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
11.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31126971

RESUMO

BACKGROUND: Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity. METHODS: In this randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI ≥85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed. RESULTS: Participants were primarily African American (77%), had a family income of <25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (P = .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found. CONCLUSIONS: In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.


Assuntos
Terapia Comportamental/métodos , Índice de Massa Corporal , Terapia Familiar/métodos , Obesidade Pediátrica/economia , Pobreza/economia , População Urbana , Adolescente , Adulto , Criança , Exercício/fisiologia , Exercício/psicologia , Feminino , Humanos , Masculino , Obesidade Pediátrica/psicologia , Obesidade Pediátrica/terapia , Pobreza/psicologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-30965678

RESUMO

Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent⁻child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural⁻strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants' gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural⁻strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems.


Assuntos
Comportamento do Adolescente , Terapia Familiar/métodos , Transtornos Mentais/terapia , Adolescente , Adulto , Criança , Pai/psicologia , Feminino , Humanos , Masculino , Serviços de Saúde Mental , Mães/psicologia , Resultado do Tratamento
13.
Behav Ther ; 50(2): 340-352, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824250

RESUMO

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.


Assuntos
Comportamento Infantil/psicologia , Emoções , Terapia Familiar/métodos , Relações Pais-Filho , Pais/psicologia , Percepção , Austrália/epidemiologia , Criança , Comportamento Infantil/fisiologia , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Educação Infantil/psicologia , Educação Infantil/tendências , Pré-Escolar , Emoções/fisiologia , Terapia Familiar/tendências , Feminino , Humanos , Masculino , Poder Familiar/psicologia , Poder Familiar/tendências , Percepção/fisiologia , Inquéritos e Questionários , Resultado do Tratamento
14.
Diabetes Educ ; 45(3): 272-286, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30895881

RESUMO

PURPOSE: The purpose of the study is to test the effects of a culturally tailored family-based self-management education and social support intervention on family social capital with Mexican American (MA) adults with type 2 diabetes (T2DM) and their family member. METHODS: Using a 2-group, experimental repeated-measures design, 157 dyads were randomly assigned to an intervention (group education and social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, immediately postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated-measures analyses of variance with interaction contrasts were used to test the hypotheses regarding the differential effects on family social capital. RESULTS: Social capital outcomes included social integration, social support, and family efficacy. Social integration scores, high for family members and friends and low for community engagement, did not change over time for participants or family members. Participants perceived high support from family for physical activity with an immediate increase postintervention and moderate sabotage for healthy eating with no change over time. A sustained intervention effect was noted for family efficacy for general health and total family efficacy in participants and family members. CONCLUSIONS: This family-based culturally tailored intervention demonstrated the potential to improve social capital, specifically social support for physical activity and family efficacy for diabetes management for MA adults with T2DM. Ongoing research that examines the family as a critical context in which T2DM self-management occurs and that targets strategies for sustained family social capital outcomes for T2DM is needed.


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Terapia Familiar/métodos , Americanos Mexicanos/psicologia , Autogestão/educação , Capital Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/etnologia , Exercício/psicologia , Família/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Resultado do Tratamento , Adulto Jovem
15.
Cochrane Database Syst Rev ; 3: CD012287, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30888061

RESUMO

BACKGROUND: Alcohol use in young people is a risk factor for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents. OBJECTIVES: To assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age).Specifically, on these outcomes, the review aimed:• to assess the effectiveness of universal family-based prevention programmes for all children up to 18 years ('universal interventions');• to assess the effectiveness of selective family-based prevention programmes for children up to 18 years at elevated risk of alcohol use or problem drinking ('selective interventions'); and• to assess the effectiveness of indicated family-based prevention programmes for children up to 18 years who are currently consuming alcohol, or who have initiated use or regular use ('indicated interventions'). SEARCH METHODS: We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE (Ovid 1966 to June 2018), Embase (1988 to June 2018), Education Resource Information Center (ERIC; EBSCOhost; 1966 to June 2018), PsycINFO (Ovid 1806 to June 2018), and Google Scholar. We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster RCTs (C-RCTs) involving the parents of school-aged children who were part of the general population with no known risk factors (universal interventions), were at elevated risk of alcohol use or problem drinking (selective interventions), or were already consuming alcohol (indicated interventions). Psychosocial or educational interventions involving parents with or without involvement of children were compared with no intervention, or with alternate (e.g. child only) interventions, allowing experimental isolation of parent components. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 46 studies (39,822 participants), with 27 classified as universal, 12 as selective, and seven as indicated. We performed meta-analyses according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity.Upon comparing any family intervention to no intervention/standard care, we found no intervention effect on the prevalence (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) -0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low-quality evidence) or frequency (SMD -0.31, 95% CI -0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low-quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD -0.14, 95% CI -0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low-quality evidence).When comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD -0.39, 95% CI -0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low-quality evidence) or frequency (SMD -0.16, 95% CI -0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low-quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta-analysis.In general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. AUTHORS' CONCLUSIONS: The results of this review indicate that there are no clear benefits of family-based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Saúde da Família , Terapia Familiar , Avaliação de Programas e Projetos de Saúde , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Criança , Pré-Escolar , Terapia Familiar/métodos , Humanos , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
J Psychiatr Ment Health Nurs ; 26(3-4): 101-107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30825400

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: The admission of a loved one for first episode psychosis can cause considerable distress and confusion for family members. Psychoeducation can enhance family members' knowledge of the disease process and their role in supporting recovery. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: There is limited research on psychoeducation processes within adult inpatient settings. A Practitioner Narrative found that basic assessment questions can help guide the psychoeducation process. The Stress Vulnerability and Phases of Psychosis Models are valuable and efficient educational tools in answering many typical questions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychoeducation sessions should be offered routinely in the early stage of a first episode psychosis, but must be individualized to family needs and concerns. The psychoeducation structure also provides an opportunity for family members to "tell their story" to process the events leading up to a first admission and their emotional reactions to the service user's illness. Abstract Aim To clarify how initial psychoeducation, while typically brief, can best be targeted to the needs of families during the acute treatment phase of a first episode of psychosis, when there is often significant distress and confusion. Method Over 6 months of conducting inpatient psychoeducation meetings, with families of individuals experiencing first-episode psychosis, a senior mental health nurse-as a practice development undertaking-kept a record of needs/issues expressed by families. Thesis The most frequent needs of families during a first episode of psychosis were: 1. Opportunity to discuss events leading to admission; 2. Space to share feelings and fears; 3. Have practical information concerning current care; 4. Education regarding the nature of psychotic symptoms and 5. Information about recovery. Implications for Practice Family members of individuals experiencing a first episode of psychosis often require an opportunity to process the events leading up to the admission, and their emotional reactions to the individual's illness and admission. The psychoeducation process can be individualized and targeted to the needs of families, with active listening to the family's stories. Psychoeducational frameworks that were useful for explaining issues raised were the Stress Vulnerability Model and the Phases of Psychosis.


Assuntos
Terapia Familiar/métodos , Educação em Saúde/métodos , Enfermagem Psiquiátrica/métodos , Transtornos Psicóticos/terapia , Doença Aguda , Adulto , Humanos
17.
Rehabil Psychol ; 64(3): 298-306, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30816734

RESUMO

PURPOSE: Technological advances have made the delivery of psychological interventions via web-based platforms increasingly feasible. In recent years, there has been growth in the delivery of psychological interventions through web-based modalities, that is, telepsychology. Although there is evidence supporting the usability and feasibility of telepsychology for a range of populations, there is limited literature on clinician perceptions delivering telepsychology, particularly to pediatric rehabilitation populations. In this mixed-methods study, we report on clinician perspectives and experiences delivering telepsychology to children/families impacted by pediatric traumatic brain injury. METHOD: Seventeen clinicians (psychologists and advanced psychology doctoral students) who delivered telepsychology interventions to children/families impacted by pediatric brain injuries completed surveys and interviews. RESULTS: Overall, clinicians reported that telepsychology was equivalent to face-to-face treatment in many regards (e.g., therapeutic alliance, weekly progress, child/family engagement, and establishing rapport). Clinicians reported a number of advantages of telepsychology over face-to-face interventions for this pediatric population including greater ease of scheduling, increased understanding of the family and home environments, and less caregiver stigma of behavioral health care. Disadvantages of telepsychology included difficulties reading nonverbal cues, logistical/technological issues, and greater disruptions during sessions. CONCLUSIONS: Findings provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for both pediatric rehabilitation populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Atitude do Pessoal de Saúde , Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/reabilitação , Terapia Familiar/métodos , Telemedicina/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem
18.
Implement Sci ; 14(1): 25, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30866967

RESUMO

BACKGROUND: This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care. METHODS/DESIGN: Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes. DISCUSSION: Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.


Assuntos
Terapia Familiar/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Ensaios Clínicos como Assunto , Análise por Conglomerados , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Terapia Familiar/educação , Retroalimentação , Pessoal de Saúde/educação , Humanos , Ciência da Implementação , Capacitação em Serviço , Estudos Multicêntricos como Assunto , Psicoterapia/educação , Psicoterapia/normas , Melhoria de Qualidade , Tamanho da Amostra , Materiais de Ensino
19.
BMC Public Health ; 19(1): 307, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871596

RESUMO

BACKGROUND: Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population. METHODS: The study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months. DISCUSSION: We expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only. TRIAL REGISTRATION: Clinical trials.gov ID: NCT03281057 . Registration date: September 13th, 2017.


Assuntos
Alcoolismo/terapia , Terapia Familiar/métodos , Reforço Social , Grupos de Autoajuda , Adulto , Alcoolismo/psicologia , Dinamarca , Feminino , Seguimentos , Humanos , Masculino , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/organização & administração , Resultado do Tratamento
20.
Eur Eat Disord Rev ; 27(3): 283-294, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30761665

RESUMO

OBJECTIVE: Early response, as indicated by early weight gain, in family-based treatment (FBT) for adolescent anorexia nervosa (AN) predicts remission at end of treatment. However, little is known about what factors contribute to early response. Further, no previous studies have examined early response to separated forms of FBT. METHOD: Data from a randomised clinical trial of conjoint FBT and separated FBT (parent-focused treatment, PFT) were analysed to examine the timing and amount of early weight gain that predicted remission and identify factors associated with early response. RESULTS: Weight gain of at least 2.80 kg in FBT (N = 55) and 2.28 kg in PFT (N = 51), by Session 5, were the best predictors of remission at end of treatment. Early response in FBT was predicted by greater paternal therapeutic alliance and lower paternal criticism. Early response in PFT was predicted by less severe eating-disorder symptoms and negative affect at baseline, lower maternal criticism, and greater adolescent therapeutic alliance. CONCLUSIONS: The results confirm that early weight gain is an important prognostic indicator in both conjoint FBT and PFT and suggest that addressing negative emotion, parental criticism, and therapeutic alliance early in treatment could improve remission rates.


Assuntos
Anorexia Nervosa/terapia , Terapia Familiar/métodos , Ganho de Peso , Adolescente , Criança , Feminino , Humanos , Masculino , Modelos Teóricos , Pais/psicologia , Aliança Terapêutica , Fatores de Tempo , Resultado do Tratamento
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