Role of Friends in Adolescent Interpersonal Relations

(BFFs Trial)

Overseen By Michelle P Brown, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of South Carolina

Disqualifiers: Age, No caregiver, No friend, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

120 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how friendships affect adolescents who have faced maltreatment (abuse or neglect) compared to those who haven't. Researchers seek to determine how these friendships influence stress management and potential mental health challenges. Participants will either discuss their stress experience with a friend or sit quietly, while researchers measure their stress responses. A debrief session will follow to discuss the experience. Teens aged 13 to 17, with or without a history of maltreatment, who can bring a best friend to the study, might be a good fit for this trial. As an unphased trial, this study offers a unique opportunity to contribute to understanding adolescent friendships and mental health.

Do I need to stop taking my current medications to join the trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems unlikely that you would need to stop, as the study focuses on friendships and stress regulation, not medication use.

What prior data suggests that this protocol is safe for adolescents?

Research shows that spending time with friends can help teenagers manage stress. One study found that friendships can lower stress levels, especially for those who have had tough childhoods. This suggests that talking with friends might be an effective way to handle stress.

In this trial, the treatment involves discussing issues with a friend. No physical risks have been associated with this activity. The focus is on understanding emotional and social support, which is generally safe. Studies on similar friendship interactions have not reported any negative effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how social support from friends can impact stress recovery in adolescents. Unlike typical stress management techniques that focus on individual coping strategies or medication, this approach investigates interpersonal interactions as a potential tool for improving emotional well-being. By using real-time psychophysiological monitoring and analyzing friend interactions, the trial aims to uncover the specific behaviors that might help reduce stress responses, potentially offering a new, accessible way to support adolescents' mental health.

What evidence suggests that this trial's debriefing treatment could be effective for stress regulation in adolescents?

Research has shown that friendships help young people manage stress more effectively. One study found a link between having good friends and better mental health, with less stress in the brain. Another study showed that supportive friends can reduce feelings of anxiety and depression. Evidence also suggests that friends can lower the body's stress reactions, potentially preventing future mental health problems. In this trial, participants in one arm will debrief with a friend after a stressful event, which may help them manage stress and improve their well-being in the future. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for adolescents aged 13-17 who have experienced maltreatment or not, with a non-offending caregiver and a best friend (not sibling/romantic partner) to participate. They must all be fluent in English. It excludes those without a non-offending caregiver, no best friend available, or not fluent in English.

Inclusion Criteria

I am between 13 and 17 years old.

Qualify as either maltreated (endorses history of maltreatment - physical abuse, sexual abuse, emotional maltreatment, or neglect and/or has substantiated record of child maltreatment per Department of Social Services [DSS] records) or non-maltreated (denies history of maltreatment and/or no substantiated record of child maltreatment per DSS records)

Parent participating in the study visit is a non-offending caregiver (no record of substantiated maltreatment against the adolescent participant)

Exclusion Criteria

No available non-offending parent or guardian/caregiver to participate in the study

I am either younger than 13 or older than 17 at my first study visit.

Participant, caregiver, or friend is not fluent in written and spoken English

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Study Visit

Participants attend an initial study visit with their caregiver and friend, complete questionnaires, undergo stress management assessment, and participate in a task with either a debrief or quiet sitting period.

1 day

1 visit (in-person)

Follow-up

Participants are monitored for changes in friendship, psychopathology, and revictimization experiences through questionnaires completed online or via mail.

6 months

1 visit (virtual or mail)

What Are the Treatments Tested in This Trial?

Interventions

• Debrief

Trial Overview The study examines how friendships affect stress regulation and future mental health in maltreated versus non-maltreated teens. Participants will complete questionnaires, stress tests, and either discuss an experience with their friend or sit quietly afterward. Outcomes are compared after six months.

How Is the Trial Designed?

Group I: Debrief Experimental Treatment 1 Intervention

Following exposure to a laboratory stressor, participants in this arm will debrief their experience with a friend for 5 minutes while their psychophysiological reactivity is recorded using an electrocardiogram (ECG). Their interaction will be audio and video recorded for later observational coding of their friend's validating and invalidating behaviors during the conversation.

Group II: No Debrief Active Control 1 Intervention

Following exposure to a laboratory stressor, participants in this arm will sit by themselves while their psychophysiological reactivity is recorded using an electrocardiogram (ECG).

Who Is Running the Clinical Trial?

University of South Carolina

Lead Sponsor

Trials

233

Recruited

122,000+

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborator

Trials

2,103

Recruited

2,760,000+

Published Research Related to This Trial

Friendship relations in adolescence are crucial for developmental functions such as independence from parents, starting romantic relationships, and identity formation, characterized by trust, communication, and intimacy.

Quality of friendships, particularly the ability to communicate personal concerns, is more important for developing social skills and coping mechanisms than simply the number of friends, with girls generally valuing these elements more than boys.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Characteristics and functions of friendship in adolescence]. Claes, M., Poirier, L.[2019]

A study of 628 adolescents found that those who engage in co-rumination, or excessive discussion of problems with friends, tend to focus more on interpersonal issues like family and peer relationships, which can increase their risk for internalizing problems.

Middle adolescents and girls were observed to co-ruminate more about interpersonal problems, suggesting that improving problem-solving skills in these areas could help reduce co-rumination and its associated risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Friends' discussions of interpersonal and noninterpersonal problems during early and middle adolescence: Associations with co-rumination. Rose, AJ., Smith, RL., Schwartz-Mette, RA., et al.[2023]

In a study involving 1,029 participants from 162 virtual networks, it was found that individuals often over-reported their peers' sexual risk behaviors while under-reporting protective behaviors, indicating a misperception of peer influences.

The research highlighted a significant concordance between perceived and actual behaviors regarding condom use and multiple partners, suggesting that understanding these perceptions is crucial for addressing sexual risk behaviors among youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Actual versus perceived peer sexual risk behavior in online youth social networks. Black, SR., Schmiege, S., Bull, S.[2021]

Friendship networks significantly influence adolescents' engagement in risky behaviors such as alcohol consumption, smoking, sexual activity, and marijuana use, as shown in a systematic review of 15 studies utilizing Social Network Analysis and Add Health data.

The studies reviewed demonstrated good methodological quality, with an average score of 4.6 out of 9, suggesting that health educators can develop more effective programs by targeting friendship dynamics to mitigate risky behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

US adolescents' friendship networks and health risk behaviors: a systematic review of studies using social network analysis and Add Health data. Jeon, KC., Goodson, P.[2022]

The study identified two types of friendship trajectories among adolescents: interdependent friendships, which are characterized by high perceived closeness and balanced relatedness, and disengaged friendships, which show lower levels of intimacy and problem-solving skills.

Adolescents in disengaged friendships, particularly girls, experienced less improvement in balanced relatedness and higher levels of depression compared to those in interdependent friendships, highlighting the importance of supportive friendships for mental health and problem-solving development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developmental trajectories of perceived friendship intimacy, constructive problem solving, and depression from early to late adolescence. Selfhout, MH., Branje, SJ., Meeus, WH.[2018]

In a study of 349 adolescents aged 12 to 18, girls showed higher expectations and greater levels of attachment and intimacy in friendships compared to boys, indicating gender differences in friendship dynamics.

The quality of friendships, particularly attachment and lack of conflict, plays a significant role in personal adjustment, suggesting that strong, conflict-free friendships can help adolescents develop adaptive behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Friendship and personal adjustment during adolescence. Claes, ME.[2022]

Sociodemographic factors are the strongest determinants of friendship formation among adolescents, with participation in illicit drug use being a significant factor as well.

Peer influence is particularly crucial for initiating marijuana use, while parental influence becomes more important as adolescents transition to using other illicit drugs, highlighting the different roles parents and peers play in adolescent drug involvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

On processes of peer influences in adolescent drug use: a developmental perspective. Kandel, DB.[2007]

Adolescent friendships are characterized by reciprocity, co-construction, and consensual validation, highlighting their importance in psychological development.

Despite the increasing influence of peers during adolescence, parents continue to play a significant role in socialization, and understanding friendship dynamics requires considering cultural and historical contexts, especially regarding gender differences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Friendship in adolescence. Youniss, J., Haynie, DL.[2005]

Adolescent risk behaviors, such as sexual activity and substance use, are influenced by psychological development and social environments, with significant differences observed based on age and gender.

Effective interventions to change these risk behaviors must consider the developmental stage and social context of adolescents, as evidenced by trends in alcohol consumption and sexual activity among U.S. teens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral risks for HIV in adolescents. Moss, N.[2019]

A study of 1,439 adolescents found that the frequency of drunkenness increased when their friends and romantic partners' friends also drank more, highlighting the strong influence of social networks on alcohol use.

Positive attitudes towards alcohol from romantic partners were linked to higher drunkenness frequency, and older adolescents were more affected by unstructured socializing compared to younger ones, suggesting targeted interventions may be needed for different age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sources of Social Influence on Adolescents' Alcohol Use. Wesche, R., Kreager, DA., Lefkowitz, ES.[2020]

Peer relationships significantly influence mental health outcomes, and understanding these dynamics can help identify new psychological processes and health risks in youth.

Future research should explore how peer interactions affect physical health, including stress responses and immune system markers, especially in the context of digital communication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Future Directions in Peer Relations Research. Prinstein, MJ., Giletta, M.[2020]

A 32-week intervention aimed at enhancing resilience in 16 adolescents showed promising results, particularly with reductions in mental health problems for all boys in both intervention groups after 12 months.

While the intervention did not show statistically significant differences due to the small sample size, there were mixed results, including a slight increase in substance use problems among boys and girls in the Positive Adolescent Life Skills (PALS) group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Positive Adolescent Life Skills Training on Long Term Outcomes for High-Risk Teens. Campbell-Heider, N., Tuttle, J., Knapp, TR.[2021]

In a study of 430 early adolescents, having new friendships and a larger friendship network was found to be more beneficial for social adjustment than maintaining existing friendships.

While stability in friendships was linked to a greater sense of belonging at school, losing a significant number of friends negatively impacted social adjustment, highlighting the importance of friendship dynamics during early adolescence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of school friendship stability, instability, and network size in early adolescents' social adjustment. Ferguson, S., Brass, NR., Medina, MA., et al.[2022]

Citations

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The stress-buffering role of friendships in young people with ... This study examined whether perceived friendship quality was related to better mental health and lower neural stress response in young people with CA.

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A Few Close Friends? Adolescent Friendships' Effect ... Model 2B revealed significant one-step mediation effects of unreciprocated friendship nominations on social anxiety and depression symptoms, mediated by desire.

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Importance of Friendship and Stress Results revealed that adolescents reported more negative peer group outcome expectations, more negative response valuations, and lower self ...

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The importance of friendships in reducing brain responses ... Adolescent friendship support may help reduce (or buffer) neural stress responses (dashed lines) that are thought to aid psychopathology in young people ...

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When best friendships end: young adolescents' responses ... This study examined young adolescents' responses to two types of hypothetical best friendship dissolution (complete and downgrade dissolutions).

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The interplay between adolescent friendship quality and ... We show that friendship quality and resilient functioning after CA inter-relate and change together between ages 14 and 17.

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Interpersonal stress and proinflammatory activity in ... Interpersonal stress during adolescence and young adulthood can threaten healthy developmental trajectories. A “primed” proinflammatory response to acute ...

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Investigating the Role of Friendship Interventions on the ... It is the first of its kind to comprehensively investigate the literature on friendship interventions and their role on adolescent mental health outcomes.

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The importance of friendships in reducing brain responses ... ... Indeed, there is preliminary evidence that suggests that friendships reduce stress responses in young people (Masten et al., 2012). Yet, a ...

10. apa.org apa.org/monitor/2025/04-05/teen-social-emotional-support

U.S. teens need far more emotional and social support Only 58.5% of US teens always or usually receive the social and emotional support they need, according to a report by researchers at the US Centers for Disease ...