Implicit Attachment Schemas and Therapy Outcome for Panic Disorder Treated with Manualized Confrontation Therapy

Abstract

Background: Different studies have shown that a patient's attachment correlates with the psychotherapy outcome. However, these findings are based on the traditional interview and paper and pencil attachment methods. Latency-based methods like the Implicit Association Test (IAT) have not yet been investigated in clinical attachment research, specifically in therapy outcome research.

Objectives: It can be hypothesized that patients with positive schemas of their mother and their partner may show a better psychotherapeutic outcome than those with less positive schemas of their mother/partner.

Method: A sample of 103 patients suffering from panic disorder with or without agoraphobia (age 36.73, SD = 10.80), including 56% of patients with affective or other anxiety disorders as comorbidities without a personality disorder, based on the Structured Clinical Interview for DSM-IV (SCID-I/II), were treated with a manualized cognitive-behavioral confrontation therapy. Two IATs (for mother and partner) were implemented before the therapy (t1). The symptom reduction was assessed by the Symptom Checklist-90 (SCL-90) and the Beck Depression Inventory (BDI) with symptoms at t1 and IAT at t1 as predictors of symptoms at t2.

Results: The results confirmed a moderate to high therapeutic effect of the confrontation therapy. Furthermore, the mother's IAT at t1 predicted the Global Severity Index (β = 0.20) as well as the Anxiety subscale (β = 0.18) at t2 above and beyond the t1 measurement of the criteria.

Conclusions: Implicit attitudes of the mother predicted the symptom reduction and a better therapeutic outcome. Relationship aspects with less impact awareness predicted the therapeutic outcome, even though mostly cognitive-behavioral techniques were used.

Keywords: Attachment; Confrontation therapy; Implicit Association Test; Panic disorder; Therapy outcome.