Department of Psychiatry and Biobehavioral Sciences, University of California, UCLA School of Medicine, 760 Westwood Plaza Rm A8-256, Los Angeles, CA 90024-1759, United States.
Department of Psychiatry and Biobehavioral Sciences, University of California, UCLA School of Medicine, 760 Westwood Plaza Rm A8-256, Los Angeles, CA 90024-1759, United States.
J Affect Disord. 2022 Mar 1;300:66-70. doi: 10.1016/j.jad.2021.12.088. Epub 2021 Dec 22.
Family-focused therapy (FFT) is associated with longer intervals between mood episodes and reductions in suicidal ideation among adolescents at risk for bipolar disorders. However, the mediating processes underlying the efficacy of FFT are not well understood. In an open trial of an 18-week FFT program, we explored the association between the therapeutic alliance of adolescents/parents with their therapists and the symptomatic outcomes of adolescents over 18 weeks.
Participants were enrolled in a treatment development trial of FFT supplemented with a mobile app. We used the System for Observing Family Therapeutic Alliances (SOFTA) to rate alliance between adolescents, parents, and therapists using videotaped FFT sessions from the beginning and end of treatment. Pearson correlations were computed between SOFTA alliance ratings and changes in Children's Depression Rating Scale, Revised (CDRS-R) scores over 18 weeks of treatment.
SOFTA ratings were obtained from sessions conducted with 17 adolescents (mean age 14.9+/-2.0 years; 41.2% female) and 22 parents. CDRS-R ratings were obtained from 16 adolescents at baseline and 18 weeks. Parents had significantly higher levels of engagement and emotional connection with therapists than their offspring. Adolescents' therapeutic engagement scores were significantly correlated with reductions in CDRS scores over 18 weeks (r(14) = -0.58, p = 0.018; N = 16).
We could not draw conclusions about the causal relationship between therapeutic alliance and improvement in depression.
Among high-risk adolescents undergoing FFT, therapeutic alliance is associated with clinical improvement over 4 months. Strategies to enhance adolescent engagement may strengthen the long-term effects of family interventions.
以家庭为中心的治疗（FFT）与双相情感障碍高危青少年情绪发作间隔时间延长和自杀意念减少有关。然而，FFT 疗效的中介过程尚不清楚。在一项为期 18 周的 FFT 方案的开放试验中，我们探讨了青少年/父母与治疗师的治疗联盟与青少年在 18 周内的症状结果之间的关系。
参与者参加了 FFT 治疗开发试验，该试验辅以移动应用程序。我们使用家庭治疗联盟观察系统（SOFTA），使用治疗开始和结束时的 FFT 录像来评估青少年、父母和治疗师之间的联盟。计算 SOFTA 联盟评分与儿童抑郁评定量表修订版（CDRS-R）评分在 18 周治疗期间的变化之间的 Pearson 相关性。
从与 17 名青少年（平均年龄 14.9+/-2.0 岁；41.2%女性）和 22 名父母进行的会议中获得了 SOFTA 评分。在基线和 18 周时从 16 名青少年获得了 CDRS-R 评分。父母与治疗师的参与度和情感联系明显高于子女。青少年的治疗参与度评分与 18 周内 CDRS 评分的降低呈显著相关（r（14）=-0.58，p=0.018；N=16）。
我们无法得出治疗联盟与抑郁改善之间存在因果关系的结论。
在接受 FFT 的高危青少年中，治疗联盟与 4 个月内的临床改善相关。增强青少年参与的策略可能会加强家庭干预的长期效果。
