a Department of Psychology , The Hebrew University of Jerusalem , Jerusalem , Israel.
Psychother Res. 2019 Apr;29(3):337-353. doi: 10.1080/10503307.2017.1365183. Epub 2017 Aug 22.
This study examined attachment within the framework of cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PDA) by measuring the changes in avoidant and anxious attachment in a session-by-session analysis.
Thirty-one patients with PDA were treated using CBT. Pre-session data on attachment style (ECR), avoidance behaviors (MI-alone: MI-al; MI-accompanied: MI-ac), anxiety sensitivity (ASI), emotion regulation (ERQ), and working alliance (WAI) were collected. Mixed model analyses were conducted to estimate relationship between changes in attachment, PDA symptoms, and related measures.
Variables improved during therapy. Changes in ASI were positively related to changes in avoidant and anxious attachment. Changes in MI-al, but not MI-ac, were related to changes in ECR. Changes in ASI and MI-al predicted changes in ECR-anxiety in the following session, but not vice versa. Similarly, changes in avoidance behaviors and ERQ-suppression, preceded changes in ECR-avoidance unidirectionally. Whereas WAI significantly improved, its variability was related only to simultaneous changes in ECR-anxiety.
Overall, avoidant and anxious attachment improved during CBT for PDA. This change was related to and preceded by improved anxiety sensitivity, avoidance behaviors, and emotion regulation. These findings suggest that CBT for panic probably has downstream effects on attachment representations. Clinical or methodological significance of this article: This is the first report of changes in attachment via cognitive behavioral therapy for panic disorder. Data were examined using repeated measures session by session, allowing for examination of temporal precedence of changes. Results revealed that anxiety sensitivity, avoidance, and suppression preceded changes in attachment. Results are discussed in the framework of modern attachment theory models.
本研究通过对惊恐障碍伴广场恐怖症（PDA）认知行为治疗（CBT）中回避型和焦虑型依恋的变化进行逐会话分析，在认知行为治疗框架内对其进行了研究。
对 31 名患有 PDA 的患者进行 CBT 治疗。收集了依恋风格（ECR）、回避行为（MI-alone：MI-al；MI-accompanied：MI-ac）、焦虑敏感（ASI）、情绪调节（ERQ）和工作联盟（WAI）的治疗前数据。采用混合模型分析来评估依恋变化、PDA 症状和相关测量之间的关系。
变量在治疗过程中得到改善。ASI 的变化与回避型和焦虑型依恋的变化呈正相关。MI-al 的变化与 ECR 的变化有关，但 MI-ac 的变化则不然。ASI 和 MI-al 的变化可预测下一次会话中 ECR-焦虑的变化，但反之则不然。同样，回避行为和 ERQ-抑制的变化先于 ECR-回避的变化，且具有单向性。尽管 WAI 显著改善，但它的变异性仅与 ECR-焦虑的同时变化有关。
总体而言，PDA 的 CBT 可改善回避型和焦虑型依恋。这种变化与焦虑敏感、回避行为和情绪调节的改善有关，且先于其改善。这些发现表明，惊恐症的 CBT 可能对依恋表象产生下游影响。本文对临床或方法学的意义：这是惊恐障碍认知行为治疗中依恋变化的首次报告。数据是通过逐会话的重复测量来检查的，这允许检查变化的时间先后顺序。结果表明，焦虑敏感、回避和抑制先于依恋的变化。结果在现代依恋理论模型的框架内进行了讨论。
