父母冲突知觉对青少年焦虑的影响及家庭治疗效果评价

目的 探讨父母冲突知觉对青少年焦虑的影响以及家庭治疗对青少年焦虑的治疗效果,为缓解青少年焦虑情绪提供参考.方法 选取2019年1-8月在合肥市第四人民医院门诊就诊的120例青少年焦虑患者为研究对象,随机分为两组(各60例),对照组仅接受临床一般药物治疗,治疗组在临床一般药物治疗的同时接受家庭治疗.通过收集父母冲突知觉量...     

Family therapy techniques for the family physician

Since 1960, family therapy has emerged from the general field of psychotherapy as a discipline in itself. An extensive literature has been developed, much of it based on general systems theory. Family physicians have routinely recognized problem families within their practice. Skills and techniques are suggested in this article for introducing changes within a family system.     

Family therapy in the treatment of anorexia nervosa

There have been a number of enthusiastic reports advocating the use of family therapy in the treatment of anorexia nervosa. Although the authors support the role of family therapy, they caution against its exclusive use in a condition that is clearly multidetermined. Case reports illustrating some of the problems experienced with families of patients with anorexia nervosa are provided.     

Role of therapeutic alliance in family therapy for adolescent anorexia nervosa

OBJECTIVE: The purpose of this study is to examine the role of therapeutic alliance in predicting treatment dropout, response and outcome in a cohort of adolescents with anorexia nervosa (AN) and their families who were treated using a manualized form of family-based therapy (FBT). METHOD: Independent assessors scored early and late therapeutic alliances for patients and parents using the Working Alliance Inventory-Observer (WAIo). Outcomes were weights and scores on the subscales of the Eating Disorder Examination at the end of 12 months of FBT. RESULTS: Therapeutic alliance throughout treatment was strong both for adolescents and for their parents. A strong early alliance with adolescents was associated with early treatment response in terms of weight gain. A strong early alliance with parents prevented dropout, whereas a strong late parental alliance predicted their child's total weight gain at the end of treatment. CONCLUSION: Therapeutic alliance in both patients and parents treated with FBT is generally strong and likely contributes to treatment retention and treatment outcome.     

Aggressive family communication,weight gain,and improved eating attitudes during systemic family therapy for anorexia nervosa

During systemic family therapy with 15 hospitalized anorexics, family communication was evaluated, using a Family Aggression Scale developed by one of the authors. Initially members communicated aggression covertly. This finding may partially explain the common clinical observation that the families of anorexics present a strong facade of togetherness and avoid overt conflict. During therapy members shifted from covert communication of aggression to overt communication of aggression. This shift correlated with improvement in subjects' eating attitudes reflected by their EAT-26 scores. All subjects gained weight. Greater weight gain occurred in subjects whose families had low levels of covert or indirect aggression. A regression analysis showed that 86% of the variance in weight gain was predicted by two leading indicators in the middle phase of treatment. Two other factors accounted for 64% of the variance in EAT scores. The findings of this study suggest that family aggression as measured by the Family Aggression Scale is a significant index of pathology in anorexics' families and is also a clinically meaningful measure of improved conflict resolution during systemic family therapy. © 1995 by John Wiley & Sons, Inc.     

The constructive family approach to eating disorders: Critical remarks on the use of family therapy in anorexia nervosa and bulimia

The conceptualization of an eating disorder as a symptom of family dysfunctioning has become quite popular. Following the example of Minuchin and Selvini Palazzoli, many clinicians seem to prefer family therapy as the treatment of choice in anorectic patients. This movement, however, is based upon personal beliefs rather than on solid research. Family therapy should be viewed as a component to be integrated within a multidimensional approach that is guided by a constructive and positive attitude towards the family and is based upon a pragmatic but flexible “scientist-practitioner” spirit.     

The role of family therapy in the treatment of extremely severe anorexia nervosa

The authors present the case of a fifteen-year-old anorectic girl. Her lowest body weight was after admission 16.5 kg, with a height of 139 cm-s (body mass index: 8.54 kg/m2). After five-year long unsuccessful individual therapy family therapy was administered, which caused remission, ascertained by a five-year follow-up. The authors stress that in the treatment of a subgroup of anorectic patients the family therapy could be a crucial therapeutical modality.     

Family medicine and family therapy: comparative development, methods, and roles

Family medicine and family therapy have evolved separately, but the fields are now increasingly in contact with each other. Today's family physician needs a deeper grasp of their similarities and differences. This paper compares the two disciplines in terms of their (1) membership criteria for treatment, (2) considered appropriateness for treatment, (3) contractual process, and (4) evolution of membership over time. Also explored are the disciplines' notions of illness and change; their differing attitudes toward technique are analyzed as well. Family therapists and family physicians appear likely to have increased exposure to one another. As they do, common approaches may develop, and conceptual differences may present a mutual stimulus for growth and change.     

Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial

PURPOSE We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message.METHODS The study was a cluster-randomized clinical trial that included 41 primary care practices, the majority in the Midwest, using Family Healthware, a self-administered, Web-based tool that assesses familial risk for the diseases and provides personalized risk-tailored messages. Patients in the control group received an age- and sex-specific health message related to lifestyle and screening. Smoking cessation, fruit and vegetable intake, physical activity, aspirin use, blood pressure, and cholesterol and blood glucose screening were assessed at baseline and 6 months after the intervention.RESULTS Of 4,248 participants, 3,344 (78%) completed the study. Participants were white (91%), female (70%), and insured (97%), and had a mean age of 50.6 years (range 35–65 years). Intervention participants were more likely to increase daily fruit and vegetable consumption from 5 or fewer servings a day to 5 or more servings a day (OR = 1.29; 95% confidence interval [CI], 1.05–1.58) and to increase physical activity (OR = 1.47; 95% CI, 1.08–1.98) to 5 to 6 times a week for 30 minutes or more a week. The absolute differences in proportion were 3% and 4%, respectively. Intervention participants were less likely to move from not having cholesterol screening in the last 5 years to having their cholesterol measured within 5 years (OR = 0.34; 95% CI, 0.17–0.67), with an absolute difference of 15%.CONCLUSIONS Messages tailored to an individual’s familial risk for 6 common diseases modestly increased self-reported physical activity and fruit and vegetable intake but reduced the likelihood of receiving cholesterol screening.     

Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial

OBJECTIVE: The purpose of this study is to explore the predictors of dropout and remission in the treatment of adolescent anorexia nervosa (AN) using family therapy. METHOD: Data derived from a randomized clinical trial comparing short and long term family therapy for adolescents with AN were used. A rotated component analysis was employed to reduce the number of variables and to address problems of collinearity and multiple testing. Dropout was defined as participating in less than 80% of the assigned therapy. Participants were classified as remitted if they obtained an ideal body weight greater than 95% and a global eating disorder Examination score within two standard deviations of community norms at the end of 12 months. RESULTS: Co-morbid psychiatric disorder and being randomized to longer treatment predicted greater dropout. The presence of co-morbid psychiatric disorder, being older, and problematic family behaviors led to lower rates of remission. A reduction of child behavioral symptoms, a decline in problematic family behaviors, and early weight gain were all within treatment changes that increased the chance of remission. CONCLUSION: Co-morbid psychiatric disorder, family behaviors, and early response to treatment are important factors when predicting dropout and remission in family therapy for adolescent AN.     

Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr)

ObjectiveThis study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history.MethodsA total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005–7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6 month follow-up, adjusting for age, site and practice clustering.ResultsA significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's < .01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not.Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR = 1.24, p = 0.042) and actively collecting family history information at follow-up (OR = 2.67, p = 0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases.ConclusionFamily Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.     

Family physician consultation patterns indicate high risk for early-onset anorexia nervosa

OBJECTIVE: There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. METHOD: Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group comprising 19 girls with anorexia nervosa, onset under 14; (b) a clinical control group comprising 19 girls with an emotional disorder; and (c) a nonclinical group comprising 19 girls with no history of mental health problems. RESULTS: Both clinical groups had an elevated number of consultations, particularly in the 5 years before diagnosis. The index group had a significantly higher number of eating, weight, and shape consultations (especially in the year before diagnosis), whereas the clinical control group had a greater number of psychological consultations. CONCLUSION: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.     

Family functioning in anorexia nervosa: British and Italian mothers' perceptions

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did the Italian mothers. In contrast, the Italians perceived their families' behavior control methods as less healthy than did the British mothers. The findings might be explained by differences between British and Italian interpretations of the role of "family," particularly giving the British emphasis on independence and the Italian emphasis on family life. It is suggested that these culturally divergent attitudes towards family life might have different influences on anorexia nervosa. Finally, implications for family therapy are discussed, taking into account those characteristics that are more relevant for each cultural group.