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The Role of Attachment in brief
group therapy for depression:
An empirical study
Click to edit Master subtitle style
Dr Jo Wilson
Professor Phil Richardson
Objective
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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
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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
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40 item questionnaire
5 point likert scale
5 dimensions
Validated on psychiatric population
Continuous constructs
Correlated with existing attachment norms
Attachment styles. Dimensions of the ASQ.
Secure
Confidence
Avoidant/
Dismissing
Discomfort with
closeness
Relationship as
secondary
Fearful
Need for Approval
Anxious / Ambivalent
Preoccupied with
relationships
Results
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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)
R Square
* significance < 0.1 **significance < 0.05
0.334*
(t 1.744)
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)
R Square
**significance < 0.05 *significance < 0.1
-0.102
(t-0.480)
Conclusions
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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.
Attachment styles. Dimensions of the ASQ.
Secure
Confidence
Avoidant/
Dismissing
Discomfort with
closeness
Relationship as
secondary
Fearful
Need for Approval
Anxious / Ambivalent
Preoccupied with
relationships
Implications for Attachment theory”Self” and “Others”
Summary
Attachment style as predictor of group outcome
Limitations
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Measure limitations
Small sample
High attrition rates
order of acquisition
assumptions of group treatment
Process versus outcome factors
Medication not controlled for