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Examined the role of positive striving and evaluative concerns, two dimensions of perfectionism, on goal setting behavior subsequent to success and failure feedback. Ninety-six female undergraduates completed the Multidimensional Perfectionism Scale and Center for Epidemiological Studies—Depression Scale and then participated in 5 trials of a computer game. Participants were randomized to a success or failure feedback condition. After controlling for baseline depressive symptoms, participants high in positive striving and low in evaluative concerns gradually increased their goal setting over time, regardless of type of feedback. In contrast, participants high in evaluative concerns and low in positive striving increased their goal setting after success feedback and decreased their goal setting after failure feedback. These patterns became more pronounced over time.

To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents.This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms.Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9).ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study).Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097.

Objective To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. Method This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms. Results Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6–99.6) than patients in EUC (51.7%; 95% CI=32.4–54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI=52.6–87.4; EUC 34.6%; 95% CI=15.6–54.2; odds ratio=4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9). Conclusions ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study). Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097.

This study presents the development and psychometric properties of a five-item version of the revised Vanderbilt Therapeutic Alliance Scale (VTAS-R Short Form). A total of 255 alliance ratings, derived from therapy sessions from 86 cases of family therapy for substance-abusing adolescents, were used to generate two separate subsamples. The first subsample was used to develop the five-item form and the second subsample to estimate the measure's reliability and concurrent and predictive validity. The VTAS-R Short Form evidenced high internal consistency, was highly correlated with the full-length VTAS-R, and predicted treatment completion and adolescents' days of cannabis use at 3 months follow-up. The findings suggest that the VTAS-R Short Form is a reliable and valid alternative to the full-length form.

The primary aim of this study was to estimate the prevalence of drug and alcohol use among the Bedouin of the Negev. A representative sample of 821 adults and 440 adolescents were surveyed using the Arabic version of the Israeli National Epidemiological Questionnaire. Almost 14% of adult Bedouins used alcohol and 11.1% used illicit drugs during the past year, with rates higher among individuals living in government settlements than those living in unrecognized traditional villages. Among adolescents, 21.9% used alcohol and 20.4% used drugs over the past year, with rates higher for high school students than for school attritters. Drug use was positively associated with being male, having a tolerant attitude toward drug use, the perception that drugs were not dangerous, being secular, low family cohesion and either low or high family adaptability. These data suggest that drug use is prevalent among the Bedouin of the Negev, particularly among adolescents, who report using drugs such as narcotics, cocaine, and hallucinogens at rates 3 to 8 times greater than Israeli Jewish secular students. School-based and family-based prevention and treatment programs may be most effective for this population.

Adolescents with substance use disorders (SUDs) smoke cigarettes more than youth in the general population. Little is known about changes in smoking patterns during and after outpatient SUD treatment. We examined whether receiving SUD treatment had a differential impact on cigarette smoking behaviors of mild (10 cigarettes per day [CPD]), moderate (10-19 CPD), and heavy (or=20 CPD) smokers (smoked onor=60 days in the past 90). Our sample included 378 adolescents from the Cannabis Youth Treatment study, who were assessed at intake, and after 3, 6, 9, and 12 months. Results indicate that after controlling for the effect of changes in cannabis use, mild smokers decreased days of smoking during treatment and follow-up, whereas moderate and heavy smokers demonstrated a small decrease over treatment, and no change over follow-up. Heavy smokers demonstrated a slight decrease in CPD during the treatment phase. These results suggest that, whereas cigarette smoking may decrease for mild smokers while in SUD treatment, the addition of specialized smoking interventions may be necessary to effect change in cigarette smoking for moderate and heavy smokers.

In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent alliance predicted adolescents' substance abuse and dependency symptoms at posttreatment, as well as days of cannabis use at 3-month follow-up. The association between adolescent alliance and substance abuse and dependency symptoms at posttreatment was moderated by the strength of the parent alliance. Results reveal the unique and interactive effects of the 2 alliances on treatment outcome and emphasize the need for a systemic and well-articulated approach to developing and maintaining the multiple alliances inherent to family therapy.