Improvement in adult anxious and avoidant attachment during cognitive behavioral therapy for panic disorder

Zalaznik, Dina; Weiss, Michal; Huppert, Jonathan D.

doi:10.1080/10503307.2017.1365183

Cited by 23 publications

(28 citation statements)

References 66 publications

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“…Notably, the cognitive intervention related to anxiety sensitivity, which is described in the first stage of the model, implies that therapist's physical presence is not essential. In contrast, the interventions regarding avoidance behaviors highlight the central role of the therapist: "external or internalized therapist encourages independent exploration of experiences" (Stage 2) and: "CBT: Therapist encourages exploration of experiences of bodily sensations without suppression or avoidance" (Stage 3; Zalaznik et al, 2019). These both refer to the presence of the therapist.…”

Section: Discussionmentioning

confidence: 99%

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Zalaznik¹,

Strauss²,

Halaj³

et al. 2022

Journal of Counseling Psychology

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The purpose of this study was to examine whether anxious and avoidant attachment styles improve during guided internet-based cognitive behavioral treatment (ICBT) for panic disorder, and if so, to identify potential theoretically driven mechanisms related to the change. We examined changes in anxious and avoidant attachment and their time-lagged (1 week), longitudinal relationship with panic-related constructs in patients participating in ICBT (n = 79) in an open trial. Anxious attachment scores improved significantly with a medium effect during ICBT, d = 0.76 [0.45, 1.08]. According to benchmark analyses, changes were similar to the magnitude of change in face-to-face CBT and final scores to values of a nonclinical sample. Additionally, similar to findings in face-to-face CBT for panic disorder, longitudinal time analyses revealed that anxiety sensitivity scores predicted later improvement in anxious attachment scores, but not vice versa. Counter to our hypothesis, avoidant attachment did not significantly change during treatment, d = 0.15 [0.02, 0.46]; however, pretreatment level of avoidant attachment in ICBT was similar to the nonclinical sample. Also counter to our hypotheses, agoraphobic avoidant behaviors when alone did not predict changes in anxious attachment. These results suggest that anxious attachment can improve in ICBT for panic disorder even though the focus of the treatment is not on interpersonal relationships. These changes appear to follow changes in anxiety sensitivity. Public Significance StatementResults of this study suggest that anxious attachment improves following an internet-based intervention for panic disorder with minimal therapist contact (ICBT). This improvement appears to follow changes in anxiety sensitivity, or fear of one's bodily sensations, which are likely facilitated by self-driven techniques of cognitive restructuring and exposure. Thus, interpersonal factors can improve in psychotherapeutic interventions even when the involvement of the therapist is limited and the focus is on cognitive and behavioral change.

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Section: Discussionmentioning

confidence: 99%

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Zalaznik¹,

Strauss²,

Halaj³

et al. 2022

Journal of Counseling Psychology

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“…However, we should not assume that this type of psychotherapy is appropriate for all Shidu parents with PTSD. In China, there are many more severe cases of post-traumatic stress disorder among Shidu parents, and they cannot get over the grief of losing their only child, lose hope for life, and refuse all help [8]. It is difficult for researchers to intervene in the Shidu parents with such strong resistance to psychotherapy.…”

Section: Limitations and Prospects Of Cognitive-behavioral Erapy In T...mentioning

confidence: 99%

Cognitive-Behavioral Therapy (CBT) Is Applied in Post-Traumatic Stress Disorder (PTSD) of Chinese Shidu Parents Who Lost Their Only Child

Liu

Chiang‐Hanisko

et al. 2022

Security and Communication Networks

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Objective. The objective is to help Chinese Shidu parents who have lost their only child to relieve post-traumatic stress disorder. Methods. A qualitative phenomenology study using the hermeneutical phenomenological method was employed in a major metropolitan city in China. Participants were 46 parents who had lost their only child and suffered from post-traumatic stress disorder. Three major themes are: (1) to conduct semistructured in-depth interviews with 46 Shidu parents; (2) to develop and implement a psychological intervention program combining with group intervention and individual counseling based on cognitive-behavioral therapy; (3) to assess the effect of psychological intervention through PTSD Checklist for DSM-5 (PCL-5). Results. Those Shidu parents who lost their only child got great relief from PTSD. The Shidu parents got great relief and changed a lot after the intervention. They became active to participate in group counseling and willing to help others because they experienced the value and fun in the process. They rebuilt their attachment and looked forward to their future life. Conclusion. Cognitive-behavioral therapy can alleviate and even cure post-traumatic stress disorder in Shidu parents who have lost their only child.

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“…Alliance has also been shown to mediate the relationship between client attachment and psychotherapy outcome (subjective distress, interpersonal relations, and social role performance) in clients presenting with mixed pathology (e.g., mood and anxiety disorders; Byrd et al, 2010). One study in PD patients showed that changes in anxious attachment preceded improvement in alliance across CBT (Zalaznik et al, 2019).…”

Section: Clinical Impact Statementmentioning

confidence: 99%

“…An insecure AS appears to be a predisposition for the development of anxiety disorders (AD) as well as a maintaining factor (Colonnesi et al, 2011; Esbjorn et al, 2012; Levy et al, 2011; Manning et al, 2016) and vice versa (Davila et al, 1997; Horesh et al, 2014). The constant sense of threat in AD probably leads to frequent activation of the attachment system (Zalaznik et al, 2019). Earlier studies show that AD patients often have an insecure and mainly preoccupied/anxious AS (de Ruiter & Van Ijzendoorn, 1992; Manning et al, 2016; Marazziti et al, 2007; Nielsen et al, 2017).…”

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confidence: 99%

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

Lange¹,

Goerigk²,

Nowak³

et al. 2021

Psychotherapy

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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

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Improvement in adult anxious and avoidant attachment during cognitive behavioral therapy for panic disorder

Cited by 23 publications

References 66 publications

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Cognitive-Behavioral Therapy (CBT) Is Applied in Post-Traumatic Stress Disorder (PTSD) of Chinese Shidu Parents Who Lost Their Only Child

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

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