Reiner I, Bakermans-Kranenburg M J, Van IJzendoorn M H, Fremmer-Bombik E, Beutel M
University Medical Center Mainz, Department of Psychosomatic Medicine and Psychotherapy, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
Center for Child and Family Studies, Rommert Casimir Institute for Developmental Psychopathology, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands.
J Affect Disord. 2016 May;195:163-71. doi: 10.1016/j.jad.2016.02.024. Epub 2016 Feb 9.
We explored in a sample of clinically depressed patients the influence of attachment security and unresolved trauma on psychotherapeutic outcome as well as changes in attachment representation through psychotherapeutic intervention.
The sample consisted of 85 women (aged 19-52), 43 clinically depressed patients from a psychosomatic inpatient unit, and 42 healthy control subjects matched for age and education. Average length of hospitalization in the patient group was eight weeks. Attachment representations were assessed with the Adult Attachment Interview at the time of admission (baseline) and at discharge. Depressive symptoms were measured using the PHQ-9 at T1 and T2.
Insecure attachment representations were overrepresented in depressed patients. Treatment effects were moderated by baseline attachment representation: patients with higher attachment security scores at admission benefited more from the inpatient treatment and were less depressed at time of discharge than less secure patients (η(2)=.07). Generally, attachment security increased (η(2)=.19) and depressive symptoms decreased (η(2)=.23) after inpatient psychotherapy treatment in the patient group. No significant effects for unresolved symptoms were found.
The study is not a randomized controlled study, but used a quasi-experimental matched control group design with female subjects only.
Our results suggest that attachment representations play a major role in both the development and treatment of clinical depression. Baseline attachment security may influence psychotherapeutic outcome, perhaps through relational factors such as therapeutic working alliance. Inpatient psychotherapy may also need to address psychological issues associated with depression such as attachment insecurity.
我们在一组临床抑郁症患者样本中，探究了依恋安全性和未解决的创伤对心理治疗结果的影响，以及通过心理治疗干预依恋表征的变化。
样本包括85名女性（年龄19 - 52岁），其中43名来自身心科住院部的临床抑郁症患者，以及42名在年龄和教育程度上匹配的健康对照者。患者组的平均住院时间为8周。在入院时（基线）和出院时，使用成人依恋访谈评估依恋表征。在T1和T2时，使用PHQ - 9测量抑郁症状。
不安全的依恋表征在抑郁症患者中占比过高。治疗效果受到基线依恋表征的调节：入院时依恋安全得分较高的患者从住院治疗中获益更多，出院时的抑郁程度低于安全感较低的患者（η(2)=.07）。总体而言，患者组在住院心理治疗后，依恋安全性增加（η(2)=.19），抑郁症状减轻（η(2)=.23）。未发现未解决症状有显著影响。
该研究不是随机对照研究，而是采用了仅针对女性受试者的准实验匹配对照组设计。
我们的结果表明，依恋表征在临床抑郁症的发展和治疗中都起着重要作用。基线依恋安全性可能会影响心理治疗结果，也许是通过治疗工作联盟等关系因素。住院心理治疗可能还需要解决与抑郁症相关的心理问题，如依恋不安全感。
