Journal of Affective Disorders Reports (Apr 2023)

Change of attachment representation after Cognitive Behavioral Analysis System of Psychotherapy

  • Franziska Konvalin,
  • Matthias A. Reinhard,
  • Eva Behr,
  • Franziska Weigel-Weinberger,
  • Tabea Nenov-Matt,
  • Barbara B. Barton,
  • Peter Zill,
  • Andrea Jobst,
  • Eva-Lotta Brakemeier,
  • Anna Buchheim,
  • Frank Padberg

Journal volume & issue
Vol. 12
p. 100495

Abstract

Read online

Background: Insecure and unresolved attachment is frequently observed in persistent depressive disorder (PDD). Initial evidence suggests that psychotherapy can promote changes in attachment representations. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a disorder-tailored psychotherapy for PDD focusing on the therapeutic relationship. Therefore, this naturalistic study investigates whether a CBASP inpatient program modifies attachment representations in PDD and if this change is associated with symptom severity and experience of childhood maltreatment (CM). Methods: Thirty-three patients with PDD (DSM-5) attended a 10-weeks CBASP inpatient program. All patients underwent comprehensive clinical assessment including the Adult Attachment Projective Picture System (AAP), Beck Depression Inventory (BDI-II), Montgomery-Asberg Depression Rating Scale (MADRS), Borderline Symptom List (BSL-23), UCLA Loneliness Scale and Childhood Trauma Questionnaire (CTQ). Results: At baseline, insecure attachment representations were predominant (87.9%, n = 29), and 48.5% (n = 16) showed unresolved patterns. No significant differences between unresolved versus organized attached individuals were found concerning severity of depressive symptoms, BSL-23 and CTQ scores. After ten weeks of CBASP, unresolved representations were significantly less frequent (6%, n = 2) and insecure attachment was observed in 79% (n = 26). Neither symptom severity, nor CM levels predicted the change of attachment representations after treatment. Limitations: Limitations are the small sample size, naturalistic setting, lack of a control group and the possibility of nonspecific inpatient treatment effects. Conclusions: This pilot study showed a significant effect of an intense CBASP inpatient program in changing individual attachment representations towards organized patterns. This change may be related to mechanisms of CBASP action, inpatient treatment, or non-specific factors.

Keywords