Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder: Results from the SOPHO-Net trial

• Published in: PloS one 2018-03, Vol.13 (3), p.e0192802-e0192802
• Main Authors: Strauß, Bernhard, Altmann, Uwe, Manes, Susanne, Tholl, Anne, Koranyi, Susan, Nolte, Tobias, Beutel, Manfred E, Wiltink, Jörg, Herpertz, Stephan, Hiller, Wolfgang, Hoyer, Jürgen, Joraschky, Peter, Nolting, Björn, Ritter, Viktoria, Stangier, Ulrich, Willutzki, Ulrike, Salzer, Simone, Leibing, Eric, Leichsenring, Falk, Kirchmann, Helmut
• Format: Article
• Language: English
• Subjects: Adults; Anxiety; Anxiety disorders; Attachment; Avoidance; Biology and Life Sciences; Care and treatment; Caregivers; Clinical psychology; Clinical trials; Cognitive ability; Comparative analysis; Correlation analysis; Goethe, Johann Wolfgang von (1749-1832); Medicine; Medicine and Health Sciences; Multivariate analysis; Patients; Psychosomatic medicine; Psychotherapy; Randomization; Research and Analysis Methods; Research design; Risk factors; Social anxiety; Social Sciences; Theory; Therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0192802

Within a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments. 495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance. LSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up. The current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial. Controlled-trials.com ISRCTN53517394.