Browsing by Author "Zisk, Abigail"
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Item Family communication and treatment benefit in a comparative efficacy trial for depressed and suicidal adolescents(University of Delaware, 2018) Zisk, AbigailAlthough parent and adolescent reports of the family environment have been found to moderate depressed and suicidal adolescents’ response to treatment, much less is known about how observations of family interactions moderate treatment response. The current study examined baseline parent-adolescent communication using the Goal-Corrected Partnership in Adolescence Coding System (GPACS; Lyons-Ruth, Hennighausen, & Holmes, 2005) along with parent and adolescent reports of family environment. These pre-treatment family variables were tested as potential moderators of treatment response in a comparative efficacy trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced Non-Directive Supportive Therapy (FE-NST). One hundred and twenty-nine adolescents (82.9% female) were randomized to the two sixteen-week treatments. Adolescents who engaged in less cooperative and validating interactions with their parents reported greater reductions in depressive symptoms than adolescents who engaged in more cooperative and validating interactions with their parents. Rates of change in depressive symptoms were not moderated by treatment condition or by parent and adolescent reports of family conflict and cohesion. Implications for using observational assessments to identify adolescents most likely to benefit from ABFT and FE-NST are discussed.Item Immersive and reflective processing of a suicidal episode: implications for assessment and treatment of adolescents(University of Delaware, 2021) Zisk, AbigailThe following studies assessed and tested individual differences in two modes of processing, Recall Intensity (RI) and Meaning Making (MM), during the Suicide Narrative Interview (SNI). RI was viewed as a vulnerability to become immersed in suicidal thoughts and feelings, while MM was viewed as a protective capacity for developing new perspectives and understandings by reflecting on suicidal thoughts and feelings. Three studies tested the validity and clinical utility of RI and MM in a sixteen-week randomized clinical trial (RCT) for depressed and suicidal adolescents. Study 1 examined the convergent, divergent, and concurrent validity of pretreatment MM and RI. Results generally supported expectations, with baseline MM associated with protective factors that reduce suicidality and baseline RI associated with elevated scores across several suicide risk factors and more pre-treatment suicidal ideation. Study 2 used baseline MM and RI to predict adolescents’ treatment response. Findings indicated that adolescents with higher levels of MM and lower levels of RI experienced the greatest symptom reductions during treatment. Study 3 examined whether MM and RI changed from the beginning to end of treatment and whether initial gains in therapeutic alliance (TA) or reductions in suicidal ideation mediated change in RI and MM. Initial improvements in TA predicted increases in both MM and RI, while initial reductions in suicidal ideation predicted declines in RI but had no effect on MM. These studies support MM and RI as two distinct modes of processing suicidal thoughts and feelings and highlight RI as an indicator of risk and MM as a potential protective factor in assessing and treating adolescent suicidality. ☐ Keywords: adolescence, suicide, meaning making, suicide narrative, treatment responseItem Immersive and Reflective Recall of a Suicidal Episode: Implications for Assessing and Treating Suicidal Adolescents(Journal of Consulting and Clinical Psychology, 2023) Zisk, Abigail; Abbott, Caroline H.; Ewing, E. Stephanie Krauthamer; Fitter, Megan Haley; Diamond, Guy S.; Kobak, RogerObjective: 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 Meaning Making (MM) items were designed to assess more distant and reflective processing. Method: The construct and predictive validity of pretreatment MM and RI was tested in a 16-week randomized clinical trial (RCT) for depressed and suicidal adolescents (N = 113, Mage = 14.95, 84.1% female, 51.8% Black/African American). Adolescents rated MM and RI immediately following the SNI during a baseline assessment. Results: Baseline MM was associated with protective factors related to reduced suicidality, and RI was associated with several risk factors for suicidal symptoms. Adolescents who reported high MM and low RI reported greater reductions in both suicidal ideation and depressive symptoms during the RCT. Conclusions: The results support MM and RI as two distinct modes of how adolescents process memories of suicidal episodes and highlight the potential clinical utility of RI and MM in assessing and treating suicidal adolescents. What is the public health significance of this article? Identifying both risk and protective factors for adolescent suicidality is imperative for effective assessment and treatment. The present study extends prior research by testing the validity of Meaning Making (MM) and Recall Intensity (RI) as two modes of processing while recalling a past suicidal episode. Results support MM as a protective factor and RI as a risk factor and demonstrate that attachment-based family therapy and family-enhanced nondirective supportive therapy were particularly effective in reducing suicidal ideation and depression in teens reporting high MM and low RI at the start of treatment.