Abstract
The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients’ attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients’ lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients’ attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient’s experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.
Highlights
Accepted: 17 September 2021The rapid spread and devastating impact of COVID-19 has led governments’ to impose global social distancing measures, lockdowns, quarantine requirements, and curfews in order to slow the spread of the virus
In answer to our first hypothesis, we found that the level of attachment avoidance in our sample was lower than community (e.g., [19]) and clinical populations (e.g., [63]), which might be explained by the lower likelihood of these avoidant patients participating in an online survey posted on social media
We found that lower levels of COVID-related traumatic distress at the three month follow-up was predicted by patients’ low levels of attachment anxiety and high levels of therapeutic agency in their online sessions, while controlling for baseline distress
Summary
Accepted: 17 September 2021The rapid spread and devastating impact of COVID-19 has led governments’ to impose global social distancing measures (i.e., public health measures taken to restrict when and where people can gather), lockdowns, quarantine requirements, and curfews in order to slow the spread of the virus. It is not surprising that the pandemic has shown to adversely affect our well-being, and increase psychological distress [1,2,3,4]. Many individuals reported a fear of COVID-19 [5], which has been linked to increased levels of depression and anxiety [6,7]. The pandemic has been especially stressful for individuals with pre-existing mental health problems. Patients with diagnosed mental health disorders have reported more personal worries about COVID-19 and fear of contagion than healthy controls, they have reported increased psychosocial distress [8] and worsening of their symptomatology [9,10,11], increasing their need for psychological support
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