The DOI matches its Crossref record; 46 of the 46 references it cites were found in a registry or an index.
A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal
Open accessAbstract
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; F 1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t 127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t 127 = 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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“Based on previous trials [21, 23], we estimate a 35% dropout rate.”
From The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial (2024) · cites this paper as [23]
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“Several studies have demonstrated the effectiveness of ABFT for adolescents and young adults at risk for suicide [26–28].”
From Evaluating attachment-based family therapy in residential treatment in the United States: does adolescents' increased attachment security to caregivers lead to decreases in depressive symptoms? (2024) · cites this paper as [27]
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“However, effectiveness studies have shown mixed results on suicidal ideation [21, 23, 28, 29].”
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“For example, two randomized controlled clinical trials in the United States were conducted with samples in which a large percentage of teens (74% in the first trial and 49% in the second trial) identified as Black/African American (48, 62, 63), a group in the United States that has been historically marginalized and very likely to contend with race/ethnicity-related stress and trauma.”
From Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety (2023) · cites this paper as [48]
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“Including ABFT in the treatment of adolescent anxiety may be particularly beneficial for adolescents from historically marginalized communities, as ABFT was originally developed with these populations in mind (48–50).”
From Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety (2023) · cites this paper as [48]
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Citations
Cites
Everitt, B. S. (2001) · Psychology Press eBooks · doi:10.4324/9781410605542-11 · Cited by 6,877
Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients
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“nonsuicidal self-injury as indicated by the ColumbiaSuicide Severity Rating Scale (C-SSRS).(18) At intake, 41.”
BackgroundMethodJacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.67.3.300 · Cited by 853
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“The methodology of Jacobson et al.(29) was used to assess reliable change.”
MethodBrent, D. A. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830210125017 · Cited by 753 · cited 3×
“In a study of adolescents with major depressive disorder, cognitivebehavioral therapy (CBT) proved more effective than systemic behavior family therapy or NST in decreasing depressive symptoms.(5,11) However, Brent et al.”
BackgroundHow central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.
Flückiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012) · Journal of Counseling Psychology · doi:10.1037/a0025749 · Cited by 576 · cited 1×
“Second, the 2 treatments were delivered in a highly regarded children’s hospital and university, which engenders the kind of institutional alliance that has often been associated with better outcomes.(43) Testing these treatments in real-world clinical settings might be needed to evaluate their true clinical value.”
BackgroundOugrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.10.009 · Cited by 508 · cited 3×
“This compares favorably to a meta-analysis that failed to find significant decreases in suicide attempts when active interventions were compared with TAU.33,34 In the Treatment Study of Adolescent Suicide Attempters (TASA),35 consisting of medication plus CBT plus family, 12% of participants made an attempt within 6 m…”
ResultPrinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S. L., & Spirito, A. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.1.92 · Cited by 435 · cited 1×
“These criteria establish a common clinical presentation and increased risk for suicide attempts.(13,14) Seventh, this study incorporated a diverse racial and ethnic sample, providing a test of the generalizability of treatment effects across race and social class.”
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Suicide Protective Factors: Utilizing SHORES in School Counseling
Stutey, D. M., Cureton, J. L., Severn, K., & Fink, M. (2021) · The Professional Counselor · doi:10.15241/dms.11.1.16 · Cited by 5
“Diamond et al. (2019) noted that “when adolescents view parents as sensitive, safe, and available, they are more likely to turn to parents for support that can buffer against common triggers for depressive feelings and suicide ideation” (p. 722).”
BackgroundGoodwill, J. R. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100480 · Cited by 3
Rognli, E. W., Waraan, L., Czajkowski, N., & Aalberg, M. (2021) · Scandinavian Journal of Child and Adolescent Psychiatry and Psychology · doi:10.21307/sjcapp-2021-004 · Cited by 4
Manasse, S. M., Russon, J., Lampe, E. W., King, A., Abber, S. R., Trainor, C. M., Gillikin, L. M., Levy, S. A., & Diamond, G. S. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231187433 · Cited by 5
“Data suggest ABFT can reduce negative family factors that fuel adolescent self-destructive behavior and this reduction in negative family factors mediates treatment outcome (G. S. Diamond et al., 2014; G. S. Diamond et al., 2019; G. S. Diamond et al., 2002; Ewing et al., 2015; Rognli et al., 2020).”
BackgroundSelf-citationLaBerge, A., Paruk, J. K., Rapanos, A., & Cavanagh, C. (2024) · Criminal Justice and Behavior · doi:10.1177/00938548241262493 · Cited by 3
“Positive adult–youth relationships are a key component of many SDV prevention strategies, which often include helping suicidal youth identify supportive adults inside and outside of the family they can turn to in moments of crisis (Diamond et al., 2019; Pisani et al., 2013).”
Editorial: Better Treatments and the Importance of Publishing Negative Clinical Trials
Novins, D. K., & McCauley, E. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.05.002 · Cited by 3
Perinatal Suicidal Ideation and Couple Therapy
Hales-Ho, S., & Timm, T. M. (2023) · American Journal of Family Therapy · doi:10.1080/01926187.2023.2198150 · Cited by 2
“A randomized controlled trial was conducted to evaluate effectiveness of ABFT compared to another approach, family enhanced nondirective support therapy, on decreasing adolescent SI and depressive symptoms (Diamond et al., 2019).”
BackgroundMethodBockting, C., Bosmans, G., Bergers, N., Gavan, L., Hiligsmann, M., de Beurs, D., Molenberghs, G., Wijnen, B., Lokkerbol, J., & van der Spek, N. (2024) · Trials · doi:10.1186/s13063-024-08499-7 · Cited by 1
A Systematic Review of Treatments for Depression for Young Black Girls and Women
Shariff, S., Mundy, E., Hutcherson, R., Stults, A., Reynolds, I., & Graves, S. L. (2025) · Mental Health Science · doi:10.1002/mhs2.70037 · Cited by 1
Esposito, E. C., Patel, K. K., Hull, S., Johnson, C. N., Patel, M. A., & Glenn, C. R. (2026) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2026.2613368 · Cited by 1
“Further, a follow-up publication to Diamond et al. (2019) RCT (cited in Glenn et al., 2019 as “Diamond et al., 2018”) did not find significant moderation by SM status (45% SM) on reduction in adolescent SI during treatment for youth randomized to either attachment-based family therapy or…”
Attachment Theory: Novel Clinical and Molecular Insights
Kaswan, Z. A. M., Giuliano, L., & Kaffman, A. (2026) · Biomolecules · doi:10.3390/biom16030452 · Cited by 2
“…ELA-related risk comes from attachment-based RCTs [21–24, 31 , 41– 43 Additional RCTs indicate that attachment-informed interventions aimed at enhancing caregiver sensitivity reduce psychiatric symptoms and improve executive function, cognitive performance, and overall well-being [21,31,41–43 , 46–”
Anatomy of the Relational Reframe in Attachment‐Based Family Therapy
Santens, T., Chu‐Chun, C., Levy, S., Diamond, G., & Bosmans, G. (2026) · Family Process · doi:10.1111/famp.70155 · Cited by 1
“After training, we randomly divided all 47 Task 1 tapes from the Diamond et al. (2019) study among the student coders, with at least three students coding the same tape.”
Self-citationSullivan, S. R., Mitchell, E. L., Liotta, L., Chennapragada, L., Osterberg, T. J., Szeszko, J. R., Khazanov, G. K., Slattery, S., & Goodman, M. S. (2026) · Archives of Suicide Research · doi:10.1080/13811118.2026.2654645 · Cited by 1
“…children and/or adolescents as the primary participant (Adrian et al., 2024; Asarnow et al., 2011; 2015; 2017; Brent et al., 2000; Czyz et al., 2019; Diamond et al., 2019; Esposito-Smythers et al., 2019; Foster et al., 2024b; Kruesi et al., 1999; Miller et al., 2020; Wharff et al., 2012; 2019).”
InfluentialTreatment Approaches with Suicidal Adolescents
Spirito, A., Webb, M. A., Wolff, J. C., & Esposito-Smythers, C. L. (2021) · Springer eBooks · doi:10.1007/978-3-030-41319-4_21-1 · Cited by 1
Depression in Children and Adolescents
Fenley, A. R., Darling, L. N., Schild, J. S., & Langer, D. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00083-2 · Cited by 2
Psychocorrection of adolescents with suicidal behavior with the CBT-SP method
Semenova, N. B. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212203198 · Cited by 1
Cottrell, D. J., Wright-Hughes, A. M., Farrin, A. J., Walwyn, R. E. A., Mughal, F., Truscott, A., Diggins, E., Irving, D., Fonagy, P., Ougrin, D., et al. (2023) · Health Technology Assessment · doi:10.3310/gtnt6331 · Cited by 1
Integrating Immigration-Related Discrimination in Suicide Prevention for Latine Youth
Rosario‐Williams, B., Torres-Hernandez, K., Caicedo, I. P., & Álvarez, K. (2025) · Journal of Health Service Psychology · doi:10.1007/s42843-025-00140-8 · Cited by 1
“And while some interventions have included a large representation of African American families, such as Attachment based-family therapy (Diamond et al., 2019) and Multisys-temic Therapy (Huey et al., 2004), their relevance to Latine youth and families remains unclear.”
Effective treatments for suicidal youth
Brent, D. A. (2021) · doi:10.1093/med/9780198834441.003.0069 · Cited by 1
Editorial: Identifying Predictors of Treatment Response Trajectories of Suicidal Adolescents
Kennard, B. D., & Zullo, L. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.03.012
Novins, D. K., Althoff, R. R., Cortese, S., Drury, S. S., Frazier, J. A., Henderson, S. W., McCauley, E., & White, T. J. H. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.11.007
Tsvieli, N., Nir‐Gottlieb, O., Lifshitz, C. C., Diamond, G. S., Kobak, R., & Diamond, G. M. (2021) · Gezinstherapie Wereldwijd · doi:10.1007/s12440-021-00143-z
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Psychotherapy for Suicide Prevention
Calati, R., Mansi, W., Rignanese, M., Pierro, R. D., López‐Castromán, J., Madeddu, F., & Courtet, P. (2022) · Springer eBooks · doi:10.1007/978-3-030-41319-4_70-1
Baumann, S. (2022) · Familiendynamik · doi:10.21706/fd-48-1-56
Zisk, A., Abbott, C. H., Ewing, E. S. K., Fitter, M., Diamond, G. S., & Kobak, R. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000829
Self-citationSiena, M. T., & Alianan, A. S. (2023) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12649
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Borisonik, E. V. (2023) · Counseling Psychology and Psychotherapy · doi:10.17759/cpp.2023310205
Manasse, S. M., Russon, J., Lampe, E. W., King, A., Abber, S. R., Trainor, C. M., Gillikin, L. M., Levy, S. A., & Diamond, G. S. (2024) · Gezinstherapie Wereldwijd · doi:10.1007/s12440-024-00230-x
“…suggereren dat ABFT tot vermindering kan leiden van negatieve gezinsfactoren die zelfdestructief gedrag van adolescenten aanwakkeren, en dat die vermindering van negatieve gezinsfactoren de behandeluitkomst medieert (G.S. Diamond et al. 2014; 2019; 2002; Ewing et al. 2015; Rognli et al. 2020).”
Self-citationPeng, Y., Shek, D. T. L., Chen, D., Li, X., Zhao, L., & Jiang, L. (2024) · Research Square · doi:10.21203/rs.3.rs-5264701/v1
Simes, D. (2024) · Queensland University of Technology · doi:10.5204/thesis.eprints.254566
Martínez, A. D., Kloft, S., Fernandez, P., Dezyani, P., Ricci, A., Hernández, D. J., & Cunningham, K. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1481904 · Cited by 3
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Ozoani, C. A., & Vazquez, M. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5243836
Cognitive and other therapies for suicidal individuals
Chesin, M. S., Finnie, G., & Stanley, B. (2021) · doi:10.1093/med/9780198834441.003.0058_update_001
Effective treatments for suicidal youth
Brent, D. A. (2021) · doi:10.1093/med/9780198834441.003.0069_update_001
Coming Out as a Period of Increased Vulnerability to Suicide Risk Among Sexual Minorities
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Cottrell, D. J., Walwyn, R. E. A., Farrin, A. J., Irving, D., Fonagy, P., Ougrin, D., Stahl, D. R., Wright, J., & Wright-Hughes, A. M. (2024) · Health Technology Assessment · doi:10.3310/kkbb1164
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Attachment-Based Family Therapy
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“Even in randomized trials and systematic reviews involving adolescents, differences between active treatment conditions are often small, time-limited, or statistically non-significant (Diamond et al., 2019; Mehlum et al., 2016; Ougrin et al., 2015).”
Bergers, N., Ewing, E. S. K., Vader, D. T., Santens, T., Levy, S., van der Spek, N., Bockting, C., Diamond, G., & Bosmans, G. (2026) · Journal of Marital and Family Therapy · doi:10.1111/jmft.70153
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“These interventions can help strengthen the parent-young people relationship and enhance the sense of trust between parents and children [109].”
Scarth, B., Dudeney, E., Thomas, J., King, K., Mancini, V. O., Buist, A., Wereta, S., Aikman, P. J., Fortune, S. A., & Hetrick, S. E. (2026) · Research Square · doi:10.21203/rs.3.rs-10734971/v2
Metadata
- Authors
- Diamond, G. S., Kobak, R. R., Krauthamer Ewing, E. S., Levy, S. A., Herres, J. L., Russon, J. M., & Gallop, R. J.
- Affiliations
- Drexel University (US)
- University of Delaware (US)
- The College of New Jersey (US)
- Virginia Tech (US)
- West Chester University (US)
- Corresponding author
- Diamond, Guy S.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 58
- Issue
- 7
- Pages
- 721-731
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6491252
- OpenAlex
- W2898714608
- Cited by
- 147
- References
- 45
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 13 · 2023: 24 · 2022: 15 · 2021: 41 · 2020: 9 · 2019: 11
- FWCI
- 17.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- VTechWorks (Virginia Tech) (submittedVersion, public-domain)
- Funders
- National Institute of Mental Health (5R01MH091059-03)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- attachment-based family therapy, suicidal adolescents, suicidal ideation, depressive symptoms, family therapy, treatment efficacy, regression to the mean, African American adolescents
- MeSH terms
- Adolescent, Child, Depression, Family Therapy, Female, Humans, Male, Object Attachment, Pennsylvania, Suicide, Attempted, Reactive Attachment Disorder, Self Report, Suicidal Ideation
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