***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Clinical ly derived hypotheses regarding treatment engagement of families of low-income , HIV-positive , African American mothers are tested using univariate and multivariate logistic regression models . Predictors are baseline family relational factors ( family support , mother 's desire for involvement with family , and family hassles ) and mother 's history of substance dependence . The study examines a sub sample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy ( SET ) . SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS . Participants in the sub sample were r and omly assigned to SET and attended at least two therapy sessions . Findings reveal that family relational factors predicted family treatment engagement ( family support , p < .004 ; mother 's desire for involvement with family , p < .008 ; family hassles , p < .027 ) . Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother 's own treatment engagement ( p < .016 ) . History of substance dependence was neither associated with family treatment engagement nor family support . Post hoc analyses revealed that family hassles ( p < .003 ) and mother 's desire for involvement with family ( p < .018 ) were differentially related to family treatment engagement in low- versus high-support families . Implication s for clinical practice and future research are discussed Family-oriented approaches and consequent conjoint marital sessions have been widely accepted as ingredients of comprehensive treatment and rehabilitation of chronic pain patients . However , no controlled trials have been conducted to confirm the effectiveness of couple therapy in these patients . We examined 63 chronic low back pain ( CLBP ) patients identified in primary health care centres . They were r and omly allocated to a couple therapy group ( n = 33 ) and to a control group without couple therapy ( n = 30 ) . The therapy consisted of five monthly sessions and was attended by two family therapists . All patients attended an initial examination and a 12-month follow-up examination . Effects on self-reported pain , disability , and some clinical measures , as well as on the use of medical services were evaluated . The study groups did not differ significantly in any of the outcome measures . Hence , we conclude that couple therapy has no significant effect on disability in CLBP patients BACKGROUND Family therapy is sometimes used as adjunctive treatment to pharmacotherapy to help patients recover from mood episodes of bipolar I disorder . However , the efficacy of this practice is not known . METHODS Ninety-two patients meeting criteria for a current bipolar I mood episode were r and omly assigned to family therapy plus pharmacotherapy , multifamily psychoeducational group therapy plus pharmacotherapy , or pharmacotherapy alone . Time to recovery was analyzed with survival analysis . RESULTS The proportion of subjects within each treatment group who recovered did not significantly differ , nor did time to recovery . LIMITATIONS The analyses did not include other outcomes such as psychosocial functioning , prophylaxis against recurrences of mood episodes , or compliance with pharmacotherapy . CONCLUSIONS Neither adjunctive family therapy nor adjunctive multifamily psychoeducational group therapy significantly improves the rate of recovery from mood episodes of bipolar I disorder , compared to treatment with pharmacotherapy alone BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia BACKGROUND Relapse of depression is associated with a criticising attitude of the patient 's partner . AIMS To compare the relative efficacy and cost of  couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner . METHOD A r and omised controlled trial of antidepressant drugs v. couple therapy .  The subjects were 77 people meeting criteria for depression living with a critical partner . RESULTS Drop-outs were 56.8 % [ corrected ] from drug treatment and 15 % from couple therapy . Subjects ' depression improved in both groups , but couple therapy showed a significant advantage , according to the Beck Depression Inventory , both at the end of treatment and after a second year off treatment . Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments . CONCLUSIONS For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious , if not more so , both in the treatment and maintenance phases . It is no more expensive overall Background : Family-based interventions have been shown to be effective in the treatment of depression , but they have seldom been studied in hospitalized depressed patients . This study assesses the value of the additional use of single-family or multi-family group therapy within this patient population . Methods : Eighty-three patients were r and omly assigned to : ( 1 ) the treatment programme as usual ( n = 23 ) , ( 2 ) treatment as usual combined with single-family therapy ( n = 25 ) or ( 3 ) treatment as usual combined with multi-family group therapy ( n = 35 ) . Follow-up assessment s were made at 3 months and 15 months . Results : Multi-family group and single-family therapy conditions showed significantly higher rates of treatment responders than the group receiving the usual treatment ( 49 , 24 and 9 % , respectively ) , and higher rates of patients no longer using antidepressant medication ( 26 , 16 and 0 % , respectively ) at 15 months . Partners taking part in the family treatments were significantly more likely to notice the improvements in the emotional health of the patient early on compared to those in the treatment as usual condition . Conclusions : This study suggests that single-family and multi-family therapy may benefit hospitalized patients with major depression , and may help the partners of the patients to become aware of the patient ’s improvement more quickly OBJECTIVE There is a clear need for psychosocial treatments to supplement pharmacotherapy for bipolar disorder . In this study , the efficacy of 2 forms of adjunctive family intervention were compared to pharmacotherapy alone . In addition to evaluating overall differences between treatments , a chief goal was to examine whether family impairment levels moderated the effects of family intervention on outcome . METHOD Ninety-two patients diagnosed with bipolar I disorder ( according to DSM-III-R ) were r and omly assigned to receive ( 1 ) pharmaco-therapy alone , ( 2 ) family therapy + pharmacotherapy , or ( 3 ) multi-family psychoeducational group + pharmacotherapy . Treatments and assessment s continued for up to 28 months . Primary outcome measures were number of episodes per year and percentage of time symptomatic throughout the entire follow-up period . The study was conducted from September 1992 through March 1999 . RESULTS No significant main effects were found for treatment condition . Thus , for the total sample , the addition of a family intervention did not improve outcome . However , there were significant treatment condition by family impairment interactions ( p < .05 ) . In patients from families with high levels of impairment , the addition of a family intervention ( family therapy or psycho-educational group ) result ed in a significantly improved course of illness , particularly the number of depressive episodes ( p < .01 ) and proportion of time spent in a depressive episode ( p < .01 ) . These effects were relatively large ( Cohen d = 0.7 - 1.0 ) , with patients receiving either family intervention having roughly half the number of depressive episodes and amount of time spent depressed as those receiving pharmaco-therapy alone . In contrast , for patients from low-impairment families , the addition of a family intervention did not improve course of illness . CONCLUSIONS Our findings build on previous literature suggesting the importance of treatment matching within the mood disorders and suggest that the utility of adding family interventions for bipolar patients and their families may depend upon the family 's level of impairment OBJECTIVES This study compared the efficacy of three treatment conditions in preventing recurrence of  bipolar I mood episodes  and hospitalization for such episodes : individual family therapy plus pharmacotherapy , multifamily group therapy plus pharmacotherapy , and pharmacotherapy alone . METHODS Patients with bipolar I disorder were enrolled if they met criteria for an active mood episode and were living with or in regular contact with relatives or significant others . Subjects were r and omly assigned to individual family therapy plus pharmacotherapy , multifamily group therapy plus pharmacotherapy , or pharmacotherapy alone , which were provided on an outpatient basis . Individual family therapy involved one therapist meeting with a single patient and the patient 's family members , with the content of each session and number of sessions determined by the therapist and family . Multifamily group psychotherapy involved two therapists meeting together for six sessions with multiple patients and their respective family members , with the content of each session preset . All subjects were prescribed a mood stabilizer , and other medications were used as needed . Subjects were assessed monthly for up to 28 months . Following recovery from the index mood episode , subjects were assessed for recurrence of a mood episode and for hospitalization for such episodes . RESULTS Of a total of 92 subjects that were enrolled in the study , 53 ( 58 % ) recovered from their intake mood episode . The analyses in this report focus upon these 53 subjects , 42 ( 79 % ) of whom entered the study during an episode of mania . Of the 53 subjects who recovered from their intake mood episode , the proportion of subjects within each treatment group who suffered a recurrence by month 28 did not differ significantly between the three treatment conditions . However , only 5 % of the subjects receiving adjunctive multifamily group therapy required hospitalization , compared to 31 % of the subjects receiving adjunctive individual family therapy and 38 % of those receiving pharmacotherapy alone , a significant difference . Time to recurrence and time to hospitalization did not differ significantly between the three treatment groups . CONCLUSION For patients with bipolar I disorder , adjunctive multifamily group therapy may confer significant advantages in preventing hospitalization for a mood episode OBJECTIVE Previous research has suggested that support services supplementing methadone maintenance programs vary in their cost-effectiveness . This study examined the cost-effectiveness of varying levels of supplementary support services to determine whether the relative cost-effectiveness of alternative levels of support is sustained over time . METHOD A group of 100 methadone-maintained opiate users were r and omly assigned to three treatment groups receiving different levels of support services during a 24-week clinical trial . One group received methadone treatment with a minimum of counseling , the second received methadone plus more intensive counseling , and the third received methadone plus enhanced counseling , medical , and psychosocial services . The results at the end of the trial period have been published elsewhere . This article reports the results of an analysis at a 6-month follow-up . RESULTS The follow-up analysis reaffirmed the preliminary findings that the methadone plus counseling level provided the most cost-effective implementation of the treatment program . At 12 months , the annual cost per abstinent client was $ 16,485 , $ 9,804 , and $ 11,818 for the low , intermediate , and high levels of support , respectively . Abstinence rates were highest , but modestly so , for the group receiving the high-intensity , high-cost methadone with enhanced services intervention . CONCLUSIONS This study suggests that large amounts of support to methadone-maintained clients are not cost-effective , but it also demonstrates that moderate amounts of support are better than minimal amounts . As funding for these programs is reduced , these findings suggest a floor below which supplementary support should not fall Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not BACKGROUND Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders . The present study compares improvements in work ability in two short-term therapies and one long-term therapy . METHODS In the Helsinki Psychotherapy Study , 326 out patients with depressive or anxiety disorder were r and omly assigned to long-term and short-term psychodynamic psychotherapy , and solution-focused therapy . The patients were followed for 3 years from the start of treatment . Primary outcome measures were the Work Ability Index ( WAI ) , the Work-subscale ( SAS-Work ) 
    Output:
    
Systemic therapy may also be efficacious for anxiety disorders .
There is a sound evidence -base for the efficacy of systemic therapy  for adult index patients with mental disorders in at least five diagnostic groups