The Role of Attachment in brief group therapy

The Role of Attachment in brief group therapy for depression: An empirical study Click to edit Master subtitle style Dr Jo Wilson Professor Phil Richardson

Objective l The (nature of the) relationship between attachment style and symptom reduction was examined in a group of depressed outpatients across the course of brief time -limited group psychotherapy.

Method l 51 patients attending a 16 session outpatient group psychotherapy service completed the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI-II) and the Attachment Style Questionnaire (ASQ) at pre and post intervention for the purposes of routine outcome monitoring. The relationship between patterns of attachment style and changes in depression and anxiety across the course of therapy was examined using multiple regression modelling.

Measures The Attachment Style Questionnaire (ASQ) Feeney et al. 1994 l l l 40 item questionnaire 5 point likert scale 5 dimensions Validated on psychiatric population Continuous constructs Correlated with existing attachment norms

Attachment styles. Dimensions of the ASQ. Secure Confidence Avoidant/ Dismissing Discomfort with closeness Relationship as secondary Fearful Anxious / Ambivalent Need for Approval Preoccupied with relationships

Results l l Patients showed significant mean reductions in depression and anxiety scores across the course of therapy as well as some change in predominant attachment style. When age and sex were controlled for, higher pre treatment scores on the ASQ Need for Approval dimension, and low scores on Secure Attachment were significantly predictive of improvement in depression scores.

Table 2 Paired samples t-test on sets of scores for both complete and intention to treat conditions Completers * + score = numerical decrease, - score = numerical increase, so scores are negative and positive values accordingly. ** significant scores

Table 3 Paired samples t-test on the pre and post ASQ scores for Secure and Insecure Attachment components. t ASQ Secure Confidence score ASQ Insecure Need for Approval Relationship as Secondary Discomfort with Closeness * significant scores

Table 4 Correlations between ASQ secure and insecure component change scores using Pearsons r. *=P<0. 001 (1%)

Table 5 Correlations of Change score correlations of Depression with Attachment profiles at pre group assessment. ASQ secure (Confident) *significant at <0. 05

Table 6 Correlation Matrix for Differences in pre and post condition scores across measures using Pearson’s r. p<0. 005 (0. 05%) for all * results.

Table 7 Regression Models with change in Depression as the DV. Model -0. 053 (t-. 274) -0. 027 (t -. 144) -0. 125 (t-. 650) -0. 071 (t -. 371) 0. 384** (t 2. 121) 0. 157 (t 0. 773) 0. 388** (t 2. 210) R Square * significance < 0. 1 **significance < 0. 05 0. 334* (t 1. 744)

Table 8 Regression Models for change scores with change in Depression as the DV. Model -0. 130 (t -0. 700) -0. 060 (t -0. 324) -0. 442** (t 2. 580) -0. 336 (t – 1. 584) -138 (t -0. 727) R Square **significance < 0. 05 *significance < 0. 1 -0. 102 (t-0. 480)

Conclusions l l Depressive symptomatology may improve over the course of brief group psychotherapy, though the study design precludes attribution of these changes to therapy process itself. Information concerning initial attachment styles may have predictive value in identifying those depressed patients most likely to benefit in the course of group psychotherapy. The role of short term changes in attachment style as a possible mediator of change is explored.

Attachment styles. Dimensions of the ASQ. Secure Confidence Avoidant/ Dismissing Discomfort with closeness Relationship as secondary Fearful Anxious / Ambivalent Need for Approval Preoccupied with relationships

Implications for Attachment theory- ”Self” and “Others”

Summary Attachment style as predictor of group outcome

Limitations l l l l Measure limitations Small sample High attrition rates order of acquisition assumptions of group treatment Process versus outcome factors Medication not controlled for