Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder: Results from the SOPHO-Net trial

Abstract

ObjectivesWithin a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments.Research design and methods495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance.ResultsLSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up.ConclusionsThe current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial.Trial registrationControlled-trials.com ISRCTN53517394

Differential effects of adult attachment in cognitive‐behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self‐rating and an observer rating

“…The aim of this study was to examine the attachment-outcome association depending on attachment measures and the therapeutic approach in a subsample of patients with SAD recruited in the SOPHO-NET trial (Leichsenring et al, 2013). So far, analyses of this data set (Manes et al, 2016;Strauss et al, 2017;Strauss et al, 2018) were exclusively related to self-reported dimensional measures of attachment (the partner-related revised Experiences in Close Relation- The following hypotheses are tested: According to Eng et al (2001), securely attached patients should be less impaired on several pretreatment symptom scales than insecurely attached patients (Hypothesis 1; H1). Due to different measurement approaches and foci, AAPR and BQCE should not be associated (H2) as it was the case in the study of Strauss et al (2006).…”

“…Recent studies including SAD found only weak evidence for an interaction of treatment and attachment: Strauss et al (2018) examined change of attachment measured in the domain of romantic relationships. Patients reported lower attachment avoidance (assessed with ECR-R) following CBT than patients treated with PDT (Strauss et al, 2018). However, when considering the reduction of social anxiety, no significant interaction of treatment by attachment was found (Strauss et al, 2017).…”

Attachment‐specific speech patterns induce dysphoric mood changes in the listener as a function of individual differences in attachment characteristics and psychopathology

“…Anxious‐preoccupied adults, however, have a negative self‐perception but a positive IWM of significant others. Constant worries about abandonment characterize their relationships, along with a strong desire for being loved and supported (Bartholomew, 1990; Strauß et al , 2018). Furthermore, insecure‐preoccupied individuals show attachment hyperactivating strategies, reflecting potentially desperate efforts to find a secure base.…”

Negative Indikatoren im psychotherapeutischen Prozess: Häufigkeit und Zusammenhang mit Bindungsmerkmalen und Therapieerfolg bei Patienten mit sozialer Angststörung

“…[25]) als auch im Hinblick auf Teilstichproben untersucht [24], wobei hier der potenziell prädiktive Wert von Bindungscharakteristika, die sowohl über Fragebögen (ECR) als auch -in Teilstichproben -über Interviews erfasst wurden, insgesamt eher gering war. Allerdings konnte in der Gesamtstichprobe gezeigt werden, dass sich Bindungsvermeidung und Bindungsangst im Therapieverlauf jeweils reduzierten [26].…”

“…[24]), da nur in dieser Teilstichprobe (bei 194 der 251 Patienten) auch Bindungsinterviews geführt wurden (während im gesamten SOPHO-Net-Projekt systematisch nur Selbsteinschätzungen von Bindungsangst und -Vermeidung mit der ECR-Skala erhoben wurden; vgl. [26]). Von den 194 Patienten wurden im Gesamtprojekt 111 Personen der STPP-und 83 der CBT-Bedingung zufällig zugewiesen.…”