Does insecure attachment affect treatment outcome in young persons with post-concussion symptoms? A secondary analysis of the GAIN trial

• Published in: Journal of psychosomatic research 2022-06, Vol.157, p.110900, Article 110900
• Main Authors: Tuborgh, A., Svendsen, S., Elklit, A., Hunter, J., Ørnbøl, E., Jensen, J., Schröder, A., Nielsen, J., Næss-Schmidt, E., Thastum, M., Rask, C.
• Format: Article
• Language: English
• Subjects: Anxiety; Approach-Avoidance; Attachment; Clinical outcomes; Concussion; Disability; Early intervention; Insecurity; Interdisciplinary aspects; Patients; Prospects; Questionnaires; Regression analysis; Symptoms
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2022.110900

Objective Insecure attachment may negatively affect symptom reporting and disability in physical illness, but research on its influence on treatment outcome is scarce. This study explored if insecure attachment: 1) impacted overall treatment outcome, and 2) moderated the effect of an early interdisciplinary intervention in young persons with post-concussion symptoms (PCS). Methods This is a secondary analysis of the 'Get going After concussIoN' (GAIN) trial. Participants aged 15-30 years were randomised to either GAIN or enhanced usual care (EUC). Attachment insecurity (anxiety and avoidance) was measured at baseline with the Experiences in Close Relationships-Relationship Structure Questionnaire, and treatment outcome measured by PCS was recorded by the Rivermead Post-Concussion Symptoms Questionnaire. The impact of insecure attachment was explored using both a dimensional and a categorical approach. Multiple linear regression analysis was used. Results Ninety-one out of 112 trial participants were included. Neither attachment anxiety nor attachment avoidance independently affected the treatment outcome. However, in a categorical approach, fearful patients (i.e., combined high anxiety and high avoidance) had a less favourable outcome (p = 9.98, 95% CI: 4.05; 15.92, p = 0.001) than non-fearful patients. Insecure attachment did not moderate the superior effect of GAIN on PCS compared with EUC. Conclusions This study provided weak support for an association between insecure attachment and the outcome of an early intervention against PCS in young persons after a concussion. However, patients with fearful attachment may represent a more vulnerable subgroup. Further research is needed to explore if attachment-informed intervention may enhance treatment prospects.