Guy Diamond

• University of Pennsylvania

This chapter explores attachment-based family therapy (ABFT), focusing on its theoretical foundations, clinical model, and training process. Rooted in Bowlby’s attachment theory, ABFT emphasizes the importance of secure attachments in child development and mental health. The therapy is organized into five main tasks: reframing, alliance building wi...

Introduction Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are particularly at risk for suicidal ideation; however, little clinical research is focused on treating this population. Attachment‐based family therapy (ABFT) is among the few empirically supported youth suicide treatments adapted for LGBQ adolescents. The purpose of this exp...

Binge-spectrum eating disorders (EDs; bulimia nervosa, binge eating disorder) often develop during adolescence and are associated with serious psychological and physical consequences. Current treatments for adolescents are highly behavioral in nature and while efficacious, many patients do not reach remission indicating that current treatments fail...

Objective: The present study tested the validity and clinical utility of adolescents' reports of two distinct modes of processing during the recall of a suicidal episode in the Suicide Narrative Interview (SNI). Recall Intensity (RI) items were designed to capture a tendency to become immersed in thoughts and feelings during the interview, while M...

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,...

In middle childhood, the first manifestations of mental health problems can emerge and become a precursor of mental health issues in adolescence. Given that weak parent–child attachment can contribute to this distress, it is possible that strengthening the attachment bond could reduce risk trajectory. Unfortunately, evidence‐based attachment‐focuse...

Limited research has examined factors distinguishing between patterns of adolescent suicidal thoughts and behaviors. The current study examined demographic, school, family, and mental health differences across patterns identified by Romanelli and colleagues (2022): history of thoughts only, plans with thoughts, attempt with thoughts and/or plans, a...

Externalizing problems are common in children ages 6–14, can have lifelong consequences, and may pose a particular risk when combined with other risk factors and symptoms (like depression and anxiety). Schools are uniquely positioned to assess and address these types of behavioral health concerns, but many school-based assessments do not focus on m...

Suicide is a major, preventable public health problem. The general factor of psychopathology ("p" factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale...

Background: Almost a third of college students experience significant mental health concerns, but many do not receive adequate services. This study investigated barriers to mental health services among college students screened in a student health center primary care service. Method: Students (N = 1662) presenting for primary care completed mental...

Close relationships are consequential for youth depressive symptoms and suicide risk, but nuanced research examining intersecting factors is needed to improve identification and intervention. This study examines a clinical, residential sample of 939 adolescents and young adults ages 10 to 23 years old (M = 15.84, SD = 1.53; 97.7% white, 99.5% non-H...

Introduction: Suicide is a serious mental health concern and the second leading cause of death for adolescents in the United States. Suicide risk is a complex interaction of social, psychological, and physiological factors. Previous research has identified family functioning as being related to adolescent suicide risk, but it is not well studied i...

Background: Those with serious mental illness (SMI) experience poor health outcomes which may be addressed by the integration of mental health and primary care services. This integration could be enhanced by the inclusion of consumers in the planning process. Aims: This study sought to bring the voice of the consumer with SMI to assist with the...

Purpose Autistic youth face higher risks for experiencing mental health crises. To develop and test a county-level social network measure of care coordination between police departments and other systems that support autistic youth experiencing suicidal crisis. Design/methodology/approach To measure the structure of care coordination for autistic...

Anxiety and depressive symptoms are common, comorbid, and consequential for adolescents. Attachment theory suggests that styles of relationships with parents, developed from patterns of interactions over time, contribute to risk for these internalizing symptoms. This may be especially relevant for high-risk, clinically severe adolescents. However,...

Suicide and depression are serious public health issues for adolescents. To increase the effectiveness of interventions for youth depression and suicide, research on the mechanisms of change within existing interventions is an area of increasing interest. Using outcomes data from a large randomized controlled trial and observational coding of thera...

The purpose of this study was to (1) examine the psychometric properties of the Behavioral Health Screen Depression Subscale (BHS-DS), including internal consistency, factor structure, convergent and discriminant validity, and (2) identify cut-off scores on the BHS-DS to distinguish patients with depression risk and their level of severity among an...

Schools have the unique opportunity to identify and refer youth at risk for suicide. School-based gatekeeper training programs aim to improve staff’s ability to talk to students about mental health concerns and refer them for an assessment. Unfortunately, progress in evaluating the available programs has been limited. In fact, the popular and widel...

Although treatments for youth at risk for suicide have been successful, they are not similarly effective for everyone. Anxiety may interfere with adolescents' ability to engage with therapy and explain why some adolescents do not respond as well as others to treatment. The current study tested whether an anxiety diagnosis predicted treatment outcom...

Suicide ideation and behavior are pervasive public health issues. Given that positive interpersonal relationships can be a protective factor against suicide risk, we conducted a systematic review to examine peer‐reviewed publications from 2010 to 2019 that included empirical data, tested an intervention with at least some family component, and incl...

In a sample of suicidal adolescents (N = 117), we sought to identify how adolescents' attachment to their parents related to a key mechanism of suicide from the Interpersonal Theory of Suicide (IPTS). We tested both attachment-anxiety and attachment-avoidance, to both mother- and father-figures as correlates of the IPTS construct, perceived burdens...

Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults. Attachment-based family therapy (ABFT) is one of the few suicide treatment models that has been tested with this population. The challenge remains in how to implement ABFT into the ecology of LGBTQ+ service settings. Aims: In this study, we tested the fe...

Attachment-based family therapy (ABFT; G. S. Diamond et al., 2014) is an empirically supported treatment designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security. This therapy is grounded in attachment and emotional processing theory and provides an interpersonal, process-oriented, tr...

Objective: Despite considerable evidence that supports perceived burdensomeness (PB) and thwarted belongingness (TB) as risk factors for suicidal ideation (SI), far less is known about the direction of effects between these constructs in treatments for suicidal adolescents. The present study examined bidirectional relations between PB, TB, and ado...

Objectives: This study evaluates the relationship between substance use and impairment and current suicidal thoughts or behaviors in adolescent patients screened in a pediatric emergency department (ED). Methods: Data were collected between June 2013 and February 2018 from adolescent patients who presented to a single, urban, pediatric ED. Adole...

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerab...

In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video reco...

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components have been incorporated into most youth su...

The COVID‐19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment‐based family th...

Productieve emotionele verwerking (productive emotional processing) wordt beschouwd als een cruciaal verandermechanisme binnen de attachment-based family therapy (ABFT). In dit artikel bestuderen we het effect van ABFT-interventies die gericht zijn op productieve emotionele verwerking van primaire adaptieve emoties. De studie heeft betrekking op ee...

Objective: This study examined proposed sequential pathways through which suicidal adolescents are thought to shift from secondary global distress and rejecting anger to primary adaptive hurt, grief and assertive anger in the context of attachment-based family therapy (ABFT). Method: Participants were 39 suicidal adolescents who had received 16 wee...

Objectives The current study examined parent-adolescent discrepancies in reports of family functioning and their relation to attachment styles, depressive symptomatology, and suicidal ideation in a diverse sample of adolescents (49.7% African American, 15.5% Hispanic/Latino, 28.7% White, 81.9% female). Methods Participants were 129 adolescents (ag...

Objective: Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents’ treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents’ likelihood of benefiting from treatment. The current study t...

Objective: Suicide is a leading cause of death in adolescence. The mechanisms of adolescent suicidality, however, are not fully understood. Although the Interpersonal-Psychological Theory of Suicide, as assessed by the Interpersonal Needs Questionnaire-15 (INQ), may be a promising framework, systematic study of its utility during adolescence is la...

Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk pro...

This paper describes the implementation of an evidence‐based family therapy program in an inpatient young adult psychiatric unit. This unit was initially organised on a cognitive behaviour therapy framework but this did not sufficiently meet the young adults’ developmental demands. The unit leadership team decided to implement attachment‐based fami...

Assessing firearm access among adolescents with behavioral health risk factors is important for the primary prevention of suicide and interpersonal violence. We describe self-reported firearm access and the associated behavioral risk factors and demographic characteristics in a cross-sectional study conducted in the emergency department of an urban...

The current contribution describes the implementation of an evidence-based family therapy program in an inpatient young adult psychiatric unit. This unit was initially organized based on a cognitive behaviour therapy framework, but this framework did not sufficiently meet the young adults’ developmental demands. The unit leadership team decided to...

Children of parents with depression are at increased risk for developing psychopathology. The purpose of the current longitudinal study was to examine the dynamic relations between parents’ depressive symptoms and children’s cognitions, specifically their attributions for the causes of life events. Participants were 227 parent–child dyads with one...

Objectives Although research has identified interpersonal difficulties as risk factors for adolescent suicidality, parent and peer relationships are often assessed as discrete risk domains. Methods The current study uses a social network approach to assess individual differences in the degree to which a clinical sample of 129 adolescents being tre...

Objective: Although several treatments have been shown to be effective in treatment of youth suicidal thoughts and behaviors (STBs), there is a pressing need to account for the substantial variation in adolescents' response to and outcomes from these treatments. Method: Secondary analyses of data from a 16-week randomized trial of Attachment-Bas...

Productive emotional processing is considered a key change mechanism in attachment‐based family therapy (ABFT). This study examined the impact of attachment‐based family therapy therapist interventions aimed to promote productive emotional processing of primary adaptive emotions in a sample of 30 depressed and suicidal adolescents who had participa...

Background: Adolescent suicidality is a growing public health concern. Although evidence supports a link between anxiety and suicidality, little is known about risk associated with specific anxiety disorders. Aims: This study examined the prevalence of anxiety disorders in a sample of adolescents with depression and suicidal ideation and the associ...

Objective: To evaluate the efficacy of Attachment-based Family Therapy (ABFT) compared to a Family Enhanced Non-Directive Supportive Therapy (FE-NST) for reducing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 suicidal adolescents, between the ages of 12 to 18, 49% of whom were African-American,...

Objective: Little is known about the extent to which previous weeks' stressful events spill over and influence adolescents' abilities to derive insight from treatment sessions. Even less is known about factors that moderate clients' vulnerabilities to these spillover effects. The current study examined the spillover of negative interpersonal event...

Although therapeutic alliance is a robust predictor of treatment outcomes in child and adolescent psychotherapy, less is known about relational factors, such as youth’s attachment, to mothers and fathers. The current study investigated anxious or avoidant attachment to mothers or fathers as predictors of early formation of the therapeutic alliance...

Attachment-based family therapy is an empirically supported, manualized treatment spanning over 15 years of research and clinical practice. Increasingly, research and clinical evidence emphasize the modification of family therapy models to meet the needs of diverse clients. Best practices require culturally-sensitive therapists to attend to issues...

Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are highly prevalent in youngsters involved in Child Welfare System (CWS) services. Little research investigates, however, why these CWS youngsters are at risk. We explored whether trust in caregiver support and communication about experiences with primary care...

Attachment-Based Family Therapy (ABFT) is an evidence-based model designed to treat depressed and suicidal adolescents. ABFT works with adolescent psychopathology in the context of family relationships by addressing ruptures in the parent–child relationship and restoring parents’ caregiving capacities and adolescents trust in attachment security. T...

The Flemish Child Welfare System (CWS) is in great need of a shared empirically informed clinical strategy for working with depressed adolescents and their families. Many evidence-based practices (EBP) exist, but little is known as to whether they can be successfully imported in the CWS. Therefore, the current study explores implementation of one E...

Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmt...

Suicide is the primary cause of death in Australia for youth between the ages of 15 and 24. This is common worldwide as well. Unfortunately, very few treatments have been developed, tested, and successful for treating this difficult clinical problem. Attachment-Based Family Therapy (ABFT) is one of the therapies demonstrating a significant decrease...

In Australia the movement toward evidence based practice was supported by the first National Mental Health Strategy. For mental health clinicians the shift from evaluating process to outcome measurement also brought greater focus on specific disorders and targeted interventions, raising questions about the efficacy and effectiveness of treatment. T...

Objective: To determine whether prenatal diagnosis of congenital heart disease (CHD) increases maternal stress. Study design: Self-report instruments were administered to mothers carrying a fetus with CHD. Domains included: (1) traumatic stress (Impact of Events Scale-Revised); (2) depression (Beck Depression Index II); and (3) anxiety (State-Tr...

Several studies have earned Attachment Based Family Therapy (ABFT) the designation of a promising empirically supported treatment for adolescents with depression. This study evaluated the feasibility of importing ABFT into a hospital-based outpatient clinic in Norway. This article documents the challenges of initiating and conducting research in a...

This study examined whether Attachment-Based Family Therapy (ABFT) was associated with decreases in maternal psychological control and increases in maternal psychological autonomy granting, and whether such changes were associated with changes in adolescents' attachment schema and psychological symptoms. Eighteen suicidal adolescents and their moth...

Der klinisch-stationäre Aufenthalt ist für Jugendliche, die einen Suizidversuch unternommen haben, heutzutage meist kurz und konzentriert sich eher auf Stabilisierung als auf Behandlung. Leider ist die Teilnahme von suizidalen Jugendlichen an der ambulanten Nachsorge gering und notorisch unzuverlässig. Deshalb könnten Studien zur Beteiligung, Verwe...

To determine primary care providers' rates of screening for suicide and mental health problems in adolescents and the factors that promote or discourage this practice. Overall, 671 medical professionals (ie, pediatricians, family physicians, nurse practitioners, physician assistants) completed an electronic survey. The 53 items focused on (1) attit...

The objective of this paper is to adapt attachment-based family therapy (ABFT) for use with suicidal lesbian, gay, and bisexual (LGB) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population. In Phase I, a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth....

Extensive research demonstrates the negative impact of maternal depression on their offspring. Unfortunately, few studies have been explored in African American families. This study examined emotional and behavioral functioning among children of African American mothers with depression. African American mothers (n = 63), with a past year diagnosis...

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolesce...

This study examined whether improvement in parents’ depression was linked with changes in their children’s depressive symptoms and functioning. Participants were 223 parents and children ranging in age from 7 to 17 years old (M = 12.13, SD = 2.31); 126 parents were in treatment for depression and 97 parents were nondepressed. Children were evaluate...

To determine the adoption rate of the Web-based Behavioral Health Screening-Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this system's effect on identification and assessment of psychiatric problems. Descriptive design to evaluate the feasibility of a clinical innovation. The ED of an urban...

Dieser Artikel beschreibt die theoretischen Grundlagen und die praktische Vorgehensweise der Attachment Based Family Therapy. Zunächst geben wir einen Überblick, wie die Bindungstheorie, das Konzept der Emotionsregulation und die Auflösung von Traumata unseren erfahrungsbasierten Behandlungsansatz beeinflussen. Anschließend werden die Ziele und der...

Better understanding of effective parent-adolescent communication regarding tobacco use could inform smoking cessation intervention. Semistructured interviews related to communication about smoking were conducted with 15 depressed adolescent smokers and their parents, primarily from urban areas. This study, conducted in 2006-2008, was funded by the...

Pediatric emergency department (PED) providers are strategically positioned to identify adolescents with depression. Our objectives were to describe health care providers' perspectives on adolescent depression and the role of depression screening in the PED. We conducted semistructured interviews with 41 health care providers from an urban, academi...

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 scre...

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...

To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method....

This paper reviews epidemiology, psychiatric comorbidities, risk factors, warning signs, screening measures, and issues related to screening for suicide risk in the pediatric emergency department and acute care settings. For the first time in over a decade, rates of adolescent suicide are increasing. A recent review found physician gatekeeper train...

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy...

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this de...

Objective: The purpose of the current study to assist in understanding the prevalence and clinical correlates of psychiatric distress in adolescents seeking outpatient services for marijuana abuse or dependency.Methods: In a multi-site randomized clinical trial, 600 adolescents and their parents were assessed at intake using the Global Appraisals o...

Attrition is one of the most vexing problems for the effective delivery of behavioral health services. Most prior studies focus on patient demographics and psychopathology factors predicting dropout. We examined patient and therapist post-treatment reports of barriers to attending treatment. Six hundred adolescents and their therapists completed th...

The association of early alliance to treatment attendance and longitudinal outcomes were examined in 356 adolescents participating in a randomized clinical trial targeting cannabis use. Both patient and therapist views of alliance were examined, and outcomes were evaluated over 12 months after numerous other sources of variance were controlled. Pat...

This paper considers whether victimization moderates adolescents' outcomes in substance abuse treatment. Adolescents (N=975) in outpatient and residential settings were assessed at intake, three, six, nine, and 12 months. Differential outcomes by gender and degree of victimization were analyzed. Dependent variables were marijuana use and substance-...

Parents, referral sources, and even therapists wonder whether the gender and racial match between therapists and patients contributes to poorer alliances and treatment dropout. Six hundred adolescent substance abusers and their therapists from a large randomized clinical trial were grouped according to matches and mismatches on both gender and race...

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...

Abstract The authors studied the impact of relational reframes on parents' problem constructions and the reciprocal impact of parents' problem constructions on therapists' use of the relational reframe in five early sessions of attachment-based family therapy for depressed adolescents. Across all five sessions, relational reframes led parents to co...

This longitudinal study examined the relationships among the working alliance, treatment satisfaction, and posttreatment use among adolescents in treatment for substance abuse. Adolescents (N = 600) from the Cannabis Youth Treatment study (M. L. Dennis et al., 2002) completed measures of working alliance and treatment satisfaction as well as substa...

The goals of these two studies were to assess the acceptability and feasibility as well as to gather preliminary efficacy data on a modified combination cognitive behavioral (CBT) and attachment based family therapy (ABFT) for adolescents (ages 12-18), with the primary diagnosis of generalized (GAD), social phobia (SP), and separation (SAD) anxiety...

To evaluate the agreement between adolescent self-reported cannabis use, "on-site" qualitative urine screening, and quantitative laboratory testing. A cross-sectional study of intake and follow-up data from 248 adolescents entering substance abuse treatment for cannabis use disorders (abuse or dependence). This is part of the multi-site cooperative...

To design a treatment manual and adherence measure for attachment-based family therapy (ABFT) for adolescent depression and to collect pilot data on the treatment's efficacy. Over a period of 2 years, 32 adolescents meeting criteria for major depressive disorder (MDD) were randomly assigned to 12 weeks of ABFT or a 6-week, minimal-contact, waitlist...

Over fifteen years ago I heard Mary Main speak at the International Infancy conference in Los Angeles, where she first presented data on the predictable relation between parents' narrative accounts of their early attachment experiences on the AAI, and the attachment behaviors infants display toward that parent in the Ainsworth Strange Situation. Sh...

In this chapter, the authors present a framework for conceptualizing and conducting a family-based programmatic process research agenda. This framework builds on the innovative epistemological and methodological contributions of discovery-oriented research, particularly task analysis (L. N. Rice and L. S. Greenberg, 1984). Although researchers usua...