Lynne Siqueland

Attachment-Based Family Therapy for Depressed Adolescents: A Treatment Development Study

OBJECTIVE To design a treatment manual and adherence measure for attachment-based family therapy (ABFT) for adolescent depression and to collect pilot data on the treatments efficacy. METHOD Over a period of 2 years, 32 adolescents meeting criteria for major depressive disorder (MDD) were randomly assigned to 12 weeks of ABFT or a 6-week, minimal-contact, waitlist control group. The sample was 78% female and 69% African American; 69% were from low-income, inner-city communities. RESULTS At post-treatment, 81% of the patients treated with ABFT no longer met criteria for MDD, in contrast with 47% of patients in the waitlist group. Mixed factorial analyses of variance revealed that, compared with the waitlist group, patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict. Of the 15 treated cases assessed at the follow-up, 13 patients (87%) continued to not meet criteria for MDD 6 months after treatment ended. CONCLUSIONS ABFT appears to be a promising treatment and worthy of further development.

Anxiety Disorders in Children: Family Matters.

Accumulating evidence indicates that family/parenting behaviors are associated with the etiology of anxiety disorders in children. This article critically reviews what is known about how family/parenting behaviors have been measured in this literature and presents findings from studies examining the relation between family/parenting constructs and anxiety disorders in children. We review the role of family involvement in the treatment of anxiety disorders in children and conclude with avenues of future research.

PRETREATMENT EXPECTATIONS, INTERPERSONAL FUNCTIONING, AND SYMPTOMS IN THE PREDICTION OF THE THERAPEUTIC ALLIANCE ACROSS SUPPORTIVE-EXPRESSIVE PSYCHOTHERAPY AND COGNITIVE THERAPY

Therapeutic alliance has been a robust predictor of therapy outcome, yet little is known about which patient variables predict the development of an alliance between patient and therapist in time-limited manualized therapies. The authors evaluated pretreatment predictors of therapeutic alliance, controlling for symptom change before its assessment, using a large sample of patients treated with either supportive-expressive (SE) dynamic psychotherapy or cognitive therapy. They found that SE patients with greater pretreatment expectations of improvement formed better alliances with their therapist at Session 2, and expectations significantly predicted alliance at Session 10 for both treatment groups. Further, patients in the SE condition demonstrated a significant relation between positive expectations and growth in alliance. Women achieved better alliances at Session 10. Finally, hostile-dominant interpersonal problems significantly predicted poor alliance. Pretreatment symptom level was not significantly predictive of alliance.

Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. High levels of alliance were observed in supportive-expressive therapy (SE), cognitive therapy (CT), and individual drug counseling (IDC), and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups. In contrast to other studies, alliance was not a significant predictor of drug outcome. However, alliance did predict patient retention differentially across the 3 treatments. In SE and IDC, either higher levels of alliance were associated with increased retention or no relationship between alliance and retention was found, depending on the time alliance was measured. In CT, higher levels of alliance were associated with decreased retention.

Retention in Psychosocial Treatment of Cocaine Dependence: Predictors and Impact on Outcome

This report describes retention in treatment in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (CCTS), a multi-site trial of four psychosocial treatments for 487 cocaine dependent patients. Younger, African-American, and unemployed patients were retained in treatment for fewer days than their counterparts. African-American patients who lived with a partner were retained in treatment for less time than if they lived alone. Higher psychiatric severity kept men in treatment longer but put women at risk for dropping out sooner. Patients who completed the full treatment used drugs less often than patients who dropped out, but outcome did not differ at each month. Patients in the drug counseling condition stayed in treatment for fewer days than patients in psychotherapy, but they were more likely to be abstinent after dropout. Patients with higher psychiatric severity were more at risk for continuing to use drugs after dropout.

Predictors of dropout from psychosocial treatment of cocaine dependence.

The current study assessed demographic, drug and psychiatric predictors of dropout in the pilot/training phase of a large, multi-site psychotherapy outcome study for patients with cocaine dependence. The different predictors of dropout were assessed throughout the phases of the study: screening, intake, stabilization and assessment phase, and following randomization to treatment. Results showed that (1) younger patients were less likely to keep their intake appointment. (2) Of the patients who had an intake visit, those who did not complete high school and with more days of cocaine use in the previous month were less likely to complete an initial stabilization and assessment phase requiring 1 week of abstinence from all drugs. A survival analysis was used to examine time to dropout for the 286 patients randomized to individual treatment. (3) Again, younger age was associated with dropout after randomization. (4) Drug use variables did not predict time to dropout. (5) Presence of any current Axis I disorder was associated with later dropout from treatment. Minority treatment information seekers and treatment initiators were less likely to go on to complete the full treatment program.

Types of parental involvement in CBT with anxious youth: A preliminary meta-analysis

OBJECTIVE Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Self-help activities in cocaine dependent patients entering treatment: results from the NIDA collaborative cocaine treatment study

Although little is known about self-help attendance among cocaine dependent patients, clinicians frequently recommend this treatment. Cocaine dependent patients (519) entering a psychotherapy study were therefore surveyed regarding their recent self-help group attendance and participation. During the previous week, 34% had attended a self-help group. Of self-help attenders who actively participated 55% initiated abstinence within the next month, compared with 40% of non-attenders and 38% of non-participating attenders (P < 0.01). These findings support the potential short-term positive prognostic significance of self-help attendance and participation in cocaine dependent patients.

Cognitive Behavioral Therapy Age Effects in Child and Adolescent Anxiety: An Individual Patient Data Metaanalysis

Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap.

THERAPIST SATISFACTION WITH FOUR MANUAL-BASED TREATMENTS ON A NATIONAL MULTISITE TRIAL: AN EXPLORATORY STUDY

Lisa M. Najavits and Roger D. Weiss, Department of Psy-chiatry, Harvard Medical School, and McLean Hospital, Bel-mont, Massachusetts; Frank Ghinassi and Michael E. Thase,Department of Psychiatry, Western Psychiatric Institute andClinic, University of Pittsburgh; Amanda Van Horn, LynneSiqueland, and Lester Luborsky, Department of Psychiatry,University of Pennsylvania Medical School; Arlene Frank,Department of Psychiatry, Brookside Hospital, Nashua, NewHampshire.Arlene Frank is now at Health Enhancement Services, Inc.,Research Division, Boca Raton, Florida, and Department ofEpidemiology & Public Health, University of Miami Schoolof Medicine.The National Institute on Drug Abuse (NIDA) Collabora-tive Cocaine Treatment Study was a NIDA-funded coopera-tive agreement involving four clinical sites, a coordinatingcenter, and NIDA staff. The coordinating center at the Uni-versity of Pennsylvania included Paul Crits-Christoph, PhD(principal investigator), Lynne Siqueland, PhD (project coor-dinator), Karla Moras, PhD (assessment unit director), JesseChittams, MA (director of data management/analysis), andLarry R. Muenz, PhD (statistician). The collaborating scien-tists at the Treatment Research Branch, Division of Clinicaland Research Services at NIDA, were Jack Blaine, MD, andLisa Simon Onken, PhD. The four participating clinical siteswere University of Pennsylvania: Lester Luborsky, PhD(principal investigator), Jacques P. Barber, PhD (co–principalinvestigator), Delinda Mercer, MA (project director); Brook-side Hospital: Arlene Frank, PhD (principal investigator), Ste-phen F. Butler (co–principal investigator), Sarah Bishop, MA(project director); Harvard Medical School, McLean Hospital,and Massachusetts General Hospital: Roger D. Weiss, MD(principal investigator), David R. Gastfriend, MD (co–principal investigator), Lisa M. Najavits, PhD (project direc-tor), and Margaret Griffin (research associate); and University ofPittsburgh, Western Psychiatric Institute and Clinic: MichaelThase, MD (principal investigator), Dennis Daley, MSW (co–principal investigator), Ishan M. Salloum, MD (co–principalinvestigator), and Judy Lis, MSN (project director). The train-ing unit heads of the Cognitive Therapy Training Unit wereAaron T. Beck, MD (University of Pennsylvania), and BruceS. Liese, PhD (University of Kansas Medical Center); headsof the Supportive–Expressive Therapy Training Unit wereLester Luborsky and David Mark, PhD (University of Penn-sylvania); heads of the Individual Drug Counseling Unit wereGeorge Woody, MD (Veterans Administration, University ofPennsylvania Medical School), and Delinda Mercer, MA(University of Pennsylvania); and heads of the Group Drug