Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety

Summary & key facts

This theoretical paper suggests that adding attachment-based family therapy (ABFT) before cognitive behavioral therapy (CBT) could help teens with anxiety. CBT has strong research support but does not help all adolescents. ABFT aims to repair the parent-teen attachment and boost parenting behaviors like acceptance, validation, and support for teen autonomy. The authors propose that ABFT might make families more able and willing to do CBT tasks and that this combined approach could be more acceptable for teens from marginalized groups or less individualistic cultures. The idea is a proposal and needs empirical testing in clinical studies.

Key facts:

• Adolescent anxiety has increased in recent years, creating a need for trauma-informed and culturally responsive treatments.
• Cognitive behavioral therapy (CBT) has abundant evidence supporting its effectiveness for adolescent anxiety, but some teens do not respond to CBT.
• Attachment-based family therapy (ABFT) targets the parent-teen attachment relationship and works to increase parenting behaviors such as acceptance, validation, and promotion of teen autonomy.
• The paper proposes delivering ABFT sessions before CBT to improve the family context and to increase the adolescent’s and family’s ability and willingness to engage in CBT tasks.
• The authors suggest ABFT may be more acceptable and appropriate for adolescents from marginalized communities and from less individualistic cultures because it explicitly addresses family and contextual factors.
• This paper is theoretical and proposes a combined ABFT+CBT model; it does not present results from clinical trials and calls for empirical research to test whether the combined approach improves outcomes.

Abstract

Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen's functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent's anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent's distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family's ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone.

Topics

Attachment and Relationship Dynamics Child and Adolescent Psychosocial and Emotional Development Mental Health Treatment and Access

Categories

Clinical Psychology Psychology Social Sciences

Tags

Anxiety Behavioral therapy Clinical psychology Cognition Cognitive behavioral therapy Family therapy Medicine Psychiatry Psychological therapy Psychology Psychotherapist

Conditions & symptoms

Anxiety Anxiety or worry