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

Abstract

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

Using smartphone surveys to personalize interventions: development and piloting of the Bayesian Statistical Individualization Algorithm (BaSICA)

“…19 At the level of selecting different treatment packages (such as cognitive behavioral therapy, psychodynamic therapy, or antidepressant medication), various statistical algorithms have been developed in recent years. [20][21][22][23] While many of their results are promising, the treatment package selection approach has limitations. A review by Lorenzo-Luaces et al 24 concluded that sample sizes of the development studies were too small and few of these algorithms have been validated in independent studies.…”

The Relevance of Internal Working Models of Self and Others for Equine-Assisted Psychodynamic Psychotherapy

“…There is a general agreement among clinicians, researchers, and patients on the need for more personalized psychotherapy options in order to know “what works for whom” [ 71 , 72 ]. In this vein, several studies have examined how attachment representations or styles may relate to psychotherapy outcomes [ 33 , 73 , 74 , 75 ]. However, no studies have examined the use of Equine-Assisted Psychotherapy with adult patients.…”

Patients’ individual differences in implicit and explicit expectations from the therapist as a function of attachment orientation.

“…Throughout one’s life, these working models influence the individual’s expectations, perceptions, and behaviors in interpersonal relationships. The measurement of attachment orientation can be broadly divided into two central traditions, which form distinct understandings of attachment rather than serve as a substitute for one another (Altmann et al, 2020; Crowell et al, 2008; Simpson et al, 2002; Waters et al, 2002). The first, stemming mostly from developmental traditions, measures representations of attachment, also known as internal working models, by assessing general and specific recollections from the individual’s childhood, mainly through the use of interviews (e.g., the Adult Attachment Interview, AAI, George et al, 1996).…”