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The Role of Attachment in brief group therapy for depression: An empirical study  

Dr Jo WilsonProfessor Phil Richardson

Objective

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

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

40 item questionnaire5 point likert scale5 dimensionsValidated on psychiatric populationContinuous constructsCorrelated with existing attachment norms

Dimensions of the ASQ.

Confidence

Discomfort with closenessRelationship as secondary

Need for Approval

Preoccupied with relationshipsNeed for Approval

Attachment styles.

Secure

Avoidant/Dismissing

Fearful

Anxious / Ambivalent

Results

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)

0.334*(t 1.744)

R Square

* significance < 0.1 **significance < 0.05

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)

-0.102(t-0.480)

R Square

**significance < 0.05 *significance < 0.1

Conclusions

Depressive symptomatology may improve over the course of brief group psychotherapy, though the study design precludes attribution of these changes to the 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. 

Dimensions of the ASQ.

Confidence

Discomfort with closenessRelationship as secondary

Need for Approval

Preoccupied with relationshipsNeed for Approval

Attachment styles.

Secure

Avoidant/Dismissing

Fearful

Anxious / Ambivalent

Implications for Attachment theory-

”Self” and “Others”

SummaryAttachment style as predictor of group outcome

Limitations

Measure limitationsSmall sampleHigh attrition rates order of acquisition assumptions of group treatmentProcess versus outcome factorsMedication not controlled for