Browsing by Author "Diamond, Guy S."

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    Attachment-Based Family Therapy as an Adjunct to Family-Based Treatment for Adolescent Anorexia Nervosa
    Wagner, Ingrid; Diamond, Guy S.; Levy, Suzanne; Russon, Jody M.; Litster, Richard (Wiley, 2016-06)
    Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment-Based Family Therapy (ABFT) with FBT, and argue that ABFT’s focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent–child relational ruptures.
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    Attachment-based family therapy in the age of telehealth and COVID-19
    Levy, Suzanne; Mason, Syreeta; Russon, Jody M.; Diamond, Guy S. (Wiley, 2021-03-22)
    The COVID-19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment-based family therapy (ABFT) in the context of telehealth and COVID-19. ABFT is an empirically supported treatment model designed for adolescents and young adults struggling with depression, anxiety, trauma, and suicide. ABFT is a semi-structured, process-oriented, and trauma-informed family therapy model which presents its own unique challenges and benefits in telehealth environments. We present our adaptations based on years of telehealth clinical experience and address how this model supports the impact of COVID-19 on families.
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    Attachment-Based Family Therapy: A Review of the Empirical Support
    Diamond, Guy S.; Russon, Jody M.; Levy, Suzanne (Wiley, 2016-09)
    Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.
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    Demonstrating Attachment-Based Family Therapy for Transgender and Gender Diverse Youth with Suicidal Thoughts and Behavior: A Case Study
    Russon, Jody M.; Smithee, Lauren; Simpson, Samantha; Levy, Suzanne; Diamond, Guy S. (Wiley, 2021-05-27)
    Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.
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    Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings
    Shearer, Annie; Herres, Joanna; Kodish, Tamar; Squitieri, Helen; James, Kiera; Russon, Jody M.; Atte, Tita; Diamond, Guy S. (Elsevier, 2016-07)
    Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal selfinjury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14e24 years). Methods: Data were collected using the Behavioral Health Screenda Web-based screening tool that assesses psychiatric symptoms and risk behaviorsdduring routine well visits. Results: Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions: Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.
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    Family processes: Risk, protective and treatment factors for youth at risk for suicide
    Diamond, Guy S.; Kodish, Tamar; Ewing, E. Stephanie Krauthamer; Hunt, Quintin A.; Russon, Jody M. (Elsevier, 2021-03)
    Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components that have been incorporated into most youth suicide treatments. Unfortunately, research on if and how these family processes moderate, mediate or change as a result of treatment is limited. Recommendations for future research are offered.
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    Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care
    Russon, Jody M.; Mensinger, Janell; Herres, Joanna; Shearer, Annie; Vaughan, Katherine; Wang, Shirley B.; Diamond, Guy S. (Springer, 2019-10-01)
    Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14–24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.
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    Predicting Alliance for Depressed and Suicidal Adolescents: The Role of Perceived Attachment to Mothers
    Ibrahim, Maliha; Jin, Bora; Russon, Jody M.; Diamond, Guy S.; Kobak, Roger (Informa, 2018-01-02)
    Background. Although therapeutic alliance is a robust predictor of treatment outcomes in child and adolescent psychotherapy, less is known about relational factors, such as youth’s attachment, to mothers and fathers. The current study investigated anxious or avoidant attachment to mothers or fathers as predictors of early formation of the therapeutic alliance in a high-risk sample of depressed and suicidal adolescents. Methods. Changes in adolescents’ alliance ratings between the first and fourth treatment sessions was examined in a comparative efficacy trial (N = 115) of Attachment Based Family Therapy and Family Enhanced Non-Directive Supportive Therapy for suicidal and depressed adolescents. Multilevel regression analysis accounted for nested data by therapist and treatment condition. Results. After accounting for significant random effects in our multilevel model associated with therapist to treatment condition, results revealed a significant effect of perceived insecurity to mothers leading to lower levels of therapeutic alliance at session four (β = -0.49, p < .05). Discussion. The quality of adolescents’ attachments to parents may play an important role in adolescents’ ability to form strong working relationships with a therapist. Findings suggested that adolescents with avoidant attachment styles may be more difficult to engage in treatment and could benefit from specific interventions focused on alliance-building.
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    Promoting parental acceptance of bisexuality: A case study of attachment-based family therapy
    Ibrahim, Maliha; Russon, Jody M.; Levy, Suzanne; Diamond, Guy S. (Informa, 2018-07-03)
    Attachment-based family therapy is an empirically supported, manualized treatment spanning over 15 years of research and clinical practice. Increasingly, research and clinical evidence emphasize the modification of family therapy models to meet the needs of diverse clients. Best practices require culturallysensitive therapists to attend to issues of race, gender identity, sexual orientation, ethnicity, class, and ability. The ABFT model has been evolving to address the health disparities associated with marginalization and attend to the specialized needs of diverse families. This clinical case study demonstrates how ABFT clinicians must adopt an intersectional approach to be successful in building and sustaining relational repair. Transcripts from a case with a religious, African-American family and their bisexual daughter outline the structure and sequence of ABFT. An analysis of this case illustrates the impact of intersectionality on clinical processes and mechanisms of change.
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    A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal
    Diamond, Guy S.; Kobak, R. Roger; Ewing, E. Stephanie Krauthamer; Levy, Suzanne; Herres, Joanna; Russon, Jody M.; Gallop, Robert J. (Elsevier, 2019-07-01)
    Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, ≥50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.
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    The relationship between disordered eating and sexuality amongst adolescents and young adults
    Shearer, Annie; Russon, Jody M.; Herres, Joanna; Atte, Tita; Kodish, Tamar; Diamond, Guy S. (Elsevier, 2015-12)
    Research shows that gay and bisexual males are at increased risk for disordered eating symptoms (DES); however, studies examining DES amongst lesbians and bisexual women have produced mixed findings. Furthermore, few studies have included questioning or “unsure” individuals. This study examined DES symptoms in adolescents and young adults across self-reported sexual attraction and behavior. Participants were recruited from ten primary care sites in Pennsylvania and administered the Behavioral Health Screen (BHS) – a web-based screening tool that assesses psychiatric symptoms and risk behaviors – during a routine visit. As expected, males who were attracted to other males exhibited significantly higher disordered eating scores than those only attracted to members of the opposite sex. Males who engaged in sexual activities with other males also exhibited significantly higher scores than those who only engaged in sexual activities with females. Amongst females, there were no significant differences in DES scores between females who were only attracted to females and those only attracted to males. Those who reported being attracted to both sexes, however, had significantly higher scores, on average, than those only attracted to one sex. More surprisingly, females who were unsure of who they were attracted to reported the highest DES scores of all. These findings are contrary to previous assumptions that same-sex attraction plays a protective role against eating pathology in females. Females who are unsure or attracted to both sexes may actually be at increased risk for developing DES.
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    Religion, Sexual Orientation, and Suicide Attempts Among a Sample of Suicidal Adolescents
    Shearer, Annie; Russon, Jody M.; Herres, Joanna; Wong, Amanda; Jacobs, Carrie; Diamond, Gary M.; Diamond, Guy S. (Wiley, 2018-08)
    Despite condemnation of same-sex attraction by certain religious groups, few studies have explored the relationship between religion, same-sex attraction, and suicidality. This study examined the moderating effect of same-sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two-way dichotomous (same-sex attraction, yes/ no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same-sex attraction but fewer attempts in those reporting opposite-sex attraction only.