Attachment style change and working alliance in panic disorder patients treated with cognitive behavioral therapy.

Abstract

An insecure attachment style (AS), described as being highly anxious and/or avoidant, is often assumed to be stable over time, yet some studies show that AS can change. To the extent that AS may be malleable over shorter time periods, it potentially impacts key therapy processes and outcomes. In the present study, we first investigated the stability of AS in patients with panic disorder (N = 49) treated with short-term cognitive behavioral therapy (CBT) including follow-up. Second, we tested whether time-specific change of AS predicted subsequent symptom severity, interpersonal distress (ID), and alliance, or vice versa. Third, we investigated if anxious attachment and ID average levels impact the alliance-outcome relation. Analyses were conducted at within-and between-patient levels with 5 measurements (baseline, intermediate, end, and follow-up after 4 and 8 months) over the course of CBT (12 sessions/8 weeks, 2 booster sessions) using linear mixedeffects models. A strong decrease in anxious attachment was found that was stable until 8 months after therapy. At the within-patient level, a reciprocal relationship of reduction in anxious attachment with less symptom severity, stronger alliance, and a prediction of less ID was found. ID decrease preceded less avoidance. At the between-patient level, anxious attachment and ID moderated the relation of alliance change and subsequent depressive symptoms. The prolonged improvement in interpersonal patterns suggests that short-term CBT positively modifies attachment working models in panic disorder patients. Effects on therapy process indicate that anxiously attached and interpersonally distressed patients seem to benefit more from alliance increase. 206 Psychotherapy

Attachment, Mental Health, and Alcohol Use by Men: The Mediating Role of Cumulative Lifetime Violence Severity

“…Our previous research indicated that most men have experiences as both targets and perpetrators of violence, which therefore challenges the stereotypical view of “monstrous perpetrators and virtuous victims” (Hamby & Grych, 2013, p. 71) among health and other service professionals. This recognition is key to ensuring that men with violence histories and insecure attachment style are provided opportunities to access mental health services to help decrease attachment anxiety (Lange et al, 2021; Zalaznik et al, 2022) and moderate distress responses in violence situations.…”

Changes in attachment dimensions during the treatment of acute post-traumatic stress disorder in sexually assaulted Brazilian women

“…The treatment targeted improvements in PTSD symptoms and not changes in attachment, particularly in the sertraline group, where patients received medication and psychiatric treatment as usual. Nevertheless, short-term interventions in psychotherapy studies, such as CBT for panic disorder ( Zalaznik et al, 2019 ; Lange et al, 2021 ) and IPT for depression in adolescents and adults ( Bernecker et al, 2014 ; Gunlicks-Stoessel et al, 2017 ) have shown alterations in attachment. A pilot study of 29 veterans treated for PTSD with IPT observed improvement in separation anxiety symptoms, which can be considered a proxy for insecure attachment ( Milrod et al, 2020 ).…”

DNA-methylation dynamics across short-term, exposure-containing CBT in patients with panic disorder

“…Exposure sessions were conducted outside the clinic, depending on the feared situation (e.g., subway, supermarket, height) and specific concern (e.g., fainting, asphyxiation, losing control). The type of exposure was determined by the patient, with the goal of highest fear provocation (for detailed information on therapy and exposure intervention see [ 24 ]).…”