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Anxiety-Related Difficulties in Goal-Directed Behavior Predict Worse Treatment Outcome Among Adolescents Treated for Suicidal Ideation and Depressive Symptoms
Journal article   Open access   Peer reviewed

Anxiety-Related Difficulties in Goal-Directed Behavior Predict Worse Treatment Outcome Among Adolescents Treated for Suicidal Ideation and Depressive Symptoms

Joanna Herres, Kiera M. James, Nadia Bounoua, E. Stephanie Krauthamer Ewing, Roger Kobak and Guy S. Diamond
Psychotherapy (Chicago, Ill.), v 58(4), pp 523-532
01 Dec 2021
PMID: 34881927
url
https://doi.org/10.1037/pst0000391View
Accepted (AM)Open Access (Publisher-Specific) Open

Abstract

Psychology Psychology, Clinical Social Sciences
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 outcome among a sample of adolescents with suicidal ideation and depressive symptoms participating in either attachment-based family therapy or family-enhanced nondirective supportive therapy (N = 129; M-age = 14.87, SD = 1.68; 81.9% female). The data set that the current study used had a high representation of Black/African American adolescents (48.8% of sample), which is valuable, as few studies have included adequate representation of this population. A significant indirect effect (.88; 95% confidence interval [.01, 2.64]) showed that across both treatment conditions, participants who met criteria for an anxiety disorder had greater difficulties engaging in goal-directed behavior midtreatment, and these difficulties, in turn, predicted more posttreatment suicidal ideation. The effect of anxiety on treatment outcome via difficulties with goal-directed behavior was nonspecific to the treatment condition. However, attachment-based family therapy was superior to family-enhanced nondirective supportive therapy in improving this aspect of emotion regulation among adolescents who did not have anxiety. In addition, difficulties with goal-directed behavior on treatment outcome were worse for adolescents' who reported greater attachment avoidance to their parents. Future research should test whether targeting goal-directed behavior and attachment avoidance would result in better treatment outcome for adolescents with suicidal ideation and anxiety. Clinical Impact Statement Question: This study tested applied clinical questions about the psychotherapy process. Findings: Findings suggest that suicidal youth with anxiety experience worse treatment outcome if they are unable to engage in goal-directed behavior when distressed. Meaning: Key implications include the role of goal-directed behavior in the treatment of suicidal adolescents with anxiety. Next Steps: Future research should test the incremental validity of therapy modules that target emotion regulation for suicidal adolescents with anxiety.

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Collaboration types
Domestic collaboration
Web of Science research areas
Psychology, Clinical
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