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BMC Psychiatry
Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Mood Disorders | Research article

Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression

Authors: Jacqueline G. L. A-Tjak, Nexhmedin Morina, Wouter J. Boendermaker, Maurice Topper, Paul M. G. Emmelkamp

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

Attachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited.

Methods

Explicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome.

Results

Explicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome.

Conclusions

Our findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome.

Trial registration

clinicaltrials.​gov; NCT01517503.
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Metadata
Title
Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression
Authors
Jacqueline G. L. A-Tjak
Nexhmedin Morina
Wouter J. Boendermaker
Maurice Topper
Paul M. G. Emmelkamp
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02547-7

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