Effectiveness of Cognitive–Behavioral Family Therapy: A Systematic Review of Randomized Controlled Trials

Abstract

Cognitive–behavioral family therapy (CBFT) is used for a wide range of psychological and physical problems in integration with different treatment protocols. Effectiveness of CBFT research studies on the control group are limited in literature, even though this treatment is used frequently. Although various studies highlighted the effectiveness of CBFT, no systematic reviews were conducted. The study aims to review randomized controlled trials on CBFT. The study used keywords to identify 402 related articles in commonly used psychology databases (ULAKBİM, American Psychological Association, Psychology Database, Web of Science, Medline, and Scopus). The PRISMA diagram was used for analysis. Studies assessed with control groups were included without a historical limitation. The articles were screened according to inclusion and exclusion criteria. Fourteen articles were evaluated in terms of sample characteristics, content, application methods, characteristics of control and comparison groups, assessment tools, and findings. The results indicated that CBFT is especially more effective than individual CBT, psychoeducation or waitlist for various issues, such as anxiety disorders, obsessive compulsive disorders, pediatric bipolar disorder, substance use disorder, anorexia nervosa and chronic physical problems. The study inferred that CBFT can be used to improve mutual interaction between mental or physical problems with family. In other words, CBFT can be used to improve the effect of disorders experienced by one member on the family and the effect of the family on the disorders. In this manner, the risk of relapse can be reduced in the treatment of certain disorders. Therefore, the study suggests that CBFT should be used increasingly and that this field warrants further research.

Keywords

• Cognitive–behavioral family therapy
• effectiveness
• systematic review

Bilişsel-Davranışçı Aile Terapisinin Etkililiği: Randomize Kontrollü Çalışmaların Sistematik Bir İncelemesi

Öz

Bilişsel davranışçı aile terapisi (BDAT) psikolojik veya fizyolojik sorunların tedavisinde oldukça geniş bir spektrumda kullanılmaktadır. BDAT ayrıca birçok farklı terapi modeline entegre edilerek uygulanabilmektedir. Literatür incelendiğinde BDAT’nin sık kullanılmış olmasıyla birlikte, kontrol gruplu etkililik çalışmalarının sayıca az olduğu görülmüştür. Bu makalede, söz konusu aile terapisi yaklaşımına dair yapılmış olan etkililik çalışmaları sistematik bir biçimde gözden geçirilerek, literatürde eksik olduğu düşünülen bu noktaya dair bir katkı sunulması amaçlanmaktadır. Söz konusu sistematik çalışma kapsamında belirlenmiş olan anahtar kelimeler, psikoloji alanında en çok kullanılan veritabanlarında (ULAKBİM, American Psychological Association, Psychology Database, Web of Science, Medline, and Scopus) taratılmış ve 402 araştırmaya ulaşılmıştır. Bulguların analiz sürecinde ise PRISMA diyagramı yöntemi kullanılmıştır. Çalışmanın içleme ve dışlama kriterleri göz önünde bulundurularak yapılan elemeler sonucunda ulaşılan 14 çalışma; örneklem özellikleri, BDAT’nin içeriği ve uygulama biçimleri, kontrol veya karşılaştırma gruplarının özellikleri, kullanılan ölçüm araçları ve bulguları açısından değerlendirilmiştir. Yapılan bu değerlendirme sonucunda ise BDAT’nin kaygı bozukluklarından, kronik fiziksel rahatsızlıklara kadar geniş bir yelpazede özellikle bireysel BDT ve psikoeğitim uygulamalarına veya bekleme listesine göre daha etkili olduğu görülmektedir. BDAT’nin etkililiği göz önünde bulundurularak, yaşanılan ruhsal veya fiziksel sorunlar ile aile arasındaki karşılıklı etkileşimin BDAT ile düzenlenebildiği ifade edilebilir. Bu noktada BDAT’nin kullanımının daha da yaygınlaştırılması ve bu bağlamda daha çok araştırma yapılması gerektiği düşünülmektedir.

Anahtar Kelimeler

• Bilişsel davranışçı aile terapisi
• etkililik
• sistematik derleme

Kaynakça

1. Ball J, Mitchell P (2004) A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients. Eat Disord, 12:303–314.
2. Baruah U, Pandian RD, Narayanaswamy JC, Bada Math SB, Kandavel T, Reddy YCJ (2018) A randomized controlled study of brief family-based intervention in obsessive compulsive disorder. J Affect Disord, 225:137–146.
3. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E (2010) Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry, 197:350-356.
4. Beck J S (1995) Cognitive Therapy: Basics and Beyond. New York, Guilford Press.
5. Bodden D H, Bögels S M, Nauta M H, De Haan E, Ringrose J, Appelboom C et al. (2008) Child versus family cognitive–behavioral therapy in clinically anxious youth: An efficacy and partial effectiveness study. J Am Acad Child Adolesc Psychiatry, 47:1384–1394.
6. Butler AC, Chapman JE, Forman EM, Beck AT (2006) The empirical status of cognitive–behavioral therapy: A review of meta-analyses. Clin Psychol Rev, 26:17–31.
7. Canavarro MC, Dattilio F M (2011) Family therapy and medical issues. Contemp Fam Ther, 33:87-90.
8. Chalder T, Deary V, Husain K, Walwyn R (2010) Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: A randomized controlled treatment trial. Psychol Med, 40:1269-1279.

9. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ (2016) How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence. World Psychiatry, 15:245–258.
10. Danthi N, Wu CO, Shi P, Lauer M (2014) Percentile ranking and citation impact of a large cohort of National Heart, Lung, and Blood Institute–funded cardiovascular R01 grants. Circ Res, 114:600-606.
11. Dattilio FM (1998) Finding the fit between cognitive–behavioral and family therapy. Family Therapy Networker, 22:63–73.
12. Dattilio FM (2001) Cognitive–behavior family therapy: Contemporary myths and misconceptions. Contemp Fam Ther, 23:3-18.
13. Dattilio FM (2005) The restructuring of family schemas: A cognitive–behavior perspective. J Marital Fam Ther, 31:15-30.
14. Dattilio FM (2010) Cognitive-Behavioral Therapy with Couples and Families. New York, Guilford Press.
15. Dattilio FM (2021) Cognitive-behavioral techniques and family system therapy. Counseling Psychology and Psychotherapy, 29:58-68.
16. Eaves S H, Sheperis C J, Blanchard T, Baylot L, Doggett R A (2005) Teaching time-out and job card grounding procedures to parents: A primer for family counselors. Fam J, 13:252-258.
17. Efe C, Türkçapar H (2013) Bilişsel aile terapileri. Türkiye Klinikleri J. Psychiatry-Special Topics, 6:38-43.
18. Epstein N (2007) Evlilik Çatışması. Bilişsel terapi Uygulamaları (Çeviri Ed. H Hacak, M Macit, F Özpilavc). İstanbul, Litera Yayıncılık.
19. Faulkner RA, Klock K, Gale JE (2002) Qualitative research in family therapy: Publication trends from 1980 to 1999. J Marital Fam Ther, 28:69-74.
20. Friedberg RD (2006) A cognitive–behavioral approach to family therapy. J Contemp Psychother, 36:159-165.
21. Gladding S T (2017) Aile Terapisi Tarihi, Kuram ve Uygulamaları (Çeviri Ed. İ Keklik, İ Yıldırım). Ankara, Türk Psikolojik ve Danışmanlık Derneği.
22. Gottman J M, Krokoff L J (1989) Marital interaction and satisfaction: A longitudinal view. J Consult Clin Psychol, 57:47-52.
23. de Groot J, Cobham V, Leong J, McDermott B (2007) Individual versus group family-focused cognitive–behaviour therapy for childhood anxiety: Pilot randomized controlled trial. Aust N Z J Psychiatry, 41:990-997.
24. İkizoğlu G (2019) Bilişsel davranışçı kuramda çift terapisi. Türkiye Bütüncül Psikoterapi Dergisi, 2:59-69.
25. James I A, Barton S (2004) Changing core beliefs with the continuum technique. Behav Cogn Psychother, 32:431-442.
26. Kendall PC, Hudson JL, Gosch E, Flannery-Schroeder E, Suveg C (2008) Cognitive–behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. J Consult Clin Psychol, 76:282-297.
27. Kolko D J, Brent DA, Baugher M, Bridge J, Birmaher B (2000) Cognitive and family therapies for adolescent depression: Treatment specificity, mediation, and moderation. J Consult Clin Psychol, 68:603-614.
28. Latimer WW, Winters KC, D’Zurilla T, Nichols M (2003) Integrated family and cognitive–behavioral therapy for adolescent substance abusers: A stage I efficacy study. Drug Alcohol Depend, 71:303-317.
29. Liddle HA, Dakof GA, Turner RM, Henderson CE, Greenbaum PE (2008) Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103:1660-1670.
30. Lloyd S, Chalder T, Rimes KA (2012) Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: Long-term follow-up of an RCT. Behav Res Ther, 50:719-725.
31. MacPherson HA, Weinstein SM, Henry DB, West AE (2016) Mediators in the randomized trial of child- and family-focused cognitive–behavioral therapy for pediatric bipolar disorder. Behav Res Ther, 85:60-71.
32. Meichenbaum D (1974) Self-instructional strategy training: A cognitive prothesis for the aged. Hum Dev, 17:273-280.
33. Nichols MP (2013) Aile Terapisi: Kavramlar ve Yöntemler (Çeviri Ed. O Gündüz). İstanbul, Kaknüs Yayınları.
34. Özcan Ö, Çelik GG (2017) Bilişsel Davranışçı Terapi. Türkiye Klinikleri J. Child Psychiatry-Special Topics, 3:115-120.
35. Page M J, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. (2021) Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement. J Clin Epidemiol, 134:103-112.
36. Palermo TM, Wilson AC, Peters M, Lewandowski A, Somhegyi H (2009) Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146:205-213.
37. Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G et al. (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med, 32:763-782.
38. Premack D (1965) Reinforcement theory. In Nebraska Symposium on Motivation, 13:123-180.
39. Sanders MR, McFarland M (2000) Treatment of depressed mothers with disruptive children: A controlled evaluation of cognitive behavioral family intervention. Behav Ther, 31:89-112.
40. Spillane-Grieco E (2000) Cognitive-behavioral family therapy with a family in high-conflict divorce: A case study. Clin Soc Work J, 28:105-119.
41. Stewart K E, Sumantry D, Malivoire BL (2020) Family and couple integrated cognitive-behavioural therapy for adults with OCD: A meta-analysis. J Affect Disord, 277:159-168.
42. Storch EA, Geffken GR, Merlo LJ, Mann G, Duke D, Munson M et al. (2007) Family-based cognitive-behavioral therapy for pediatric obsessive–compulsive disorder: Comparison of intensive and weekly approaches. J Am Acad Child Adolesc Psychiatry, 46:469-478.
43. Thibaut JW, Kelley HH (1959) Power and dependence. Social Psychology of Groups, 7:100-125.
44. Türkçapar MH, Kahraman MS, Sargın AE (2015) Bir teknik sokratik sorgulama ile yönlendirilmiş keşif. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 1:47-53.
45. Weinstein SM, Cruz RA, Isaia AR, Peters AT, West AE (2017) Child -and family-focused cognitive behavioral therapy for pediatric bipolar disorder: Applications for suicide prevention. Suicide Life Threat Behav, 48:797-811.
46. Wetchler JL, Piercy FP (1986) The marital/family life of the family therapist: Stressors and enhancers. Am J Fam Ther, 14:99-108.
47. Wood JJ, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M (2006) Family cognitive behavioral therapy for child anxiety disorders. J Am Acad Child Adolesc Psychiatry, 45:314-321.
48. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) Declaración de la Iniciativa STROBE (strengthening the reporting of observational studies in epidemiology): Directrices para la comunicación de estudios observacionales. Rev Esp Salud Publica, 82:251-259.
49. Zarei M, Roohafza H (2018) Examining the effect of cognitive-behavioral family therapy on social stigma in family with children suffering from sickle cells in Manujan in 2016. Electronic Journal of General Medicine, 15:em34.