We reviewed randomized controlled trials conducted in the United States from January, 1996 through December, 2011 that examined family interventions for adult mental health conditions. We identified 51 articles (39 trials) evaluating 21 different family interventions. Findings for behavioral couple or family therapy (BCT/BFT) and community reinforcement and training (CRAFT) for substance use disorders were each pooled separately for examination in meta-analyses. Findings suggest BCT/BFT reduced substance use (small-to-moderate effects) and improved relationship adjustment (large effects) compared to individually-oriented treatments. CRAFT increased treatment initiation three-fold but did not improve substance use or family functioning over alternative family interventions. Family focused therapy for bipolar disorder improved symptoms over less intensive treatments with mixed findings when compared to equally intensive treatments. For both bipolar disorder and schizophrenia spectrum disorders, the few trials meeting our search criteria and heterogeneity among trials precluded generating broader conclusions regarding which family interventions are most effective for US populations. Overall, trials were limited in their methodological quality, and many interventions were evaluated in one trial. Future research is needed to replicate findings for these single trials, examine relationship distress as a moderator of outcome, and examine BCT/BFT among dual substance using couples and outside the research group frequently represented.
Bibliographical noteFunding Information:
This research was supported by the Minneapolis Evidence-based Synthesis Program (ESP) Center located at Minneapolis VA Health Care System, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (VA-ESP Project # 09-009 ; 2012). Portions of this manuscript are reviewed in a larger technical report available online: http://vaww.hsrd.research.va.gov/publications/esp/family-interventions.cfm . The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs. We would like to thank the members of our technical expert panel for their feedback and comments throughout this project.
Copyright 2013 Elsevier B.V., All rights reserved.
- Couple therapy
- Family therapy
- Mental health
- Systematic review