Abstract
Severe posttraumatic stress symptoms (PTSS) are connected to a variety of health-related and interpersonal problems, among them are the insecure attachment orientations. However, psychotherapy seems to improve not only PTSS but also attachment insecurities. In a large multicenter, randomized clinical trial, the attachment characteristics and PTSS of 85 adolescents and young adults (aged 14–21 years) with clinically relevant abuse-related PTSS were assessed at study entry, at the end of treatment, and 3 months after the end of treatment. Participants were randomized either to a developmentally adapted cognitive processing therapy (D-CPT) or to a wait-list with treatment advice (WL/TA). The purpose of the study was to analyze the association between PTSS and attachment at study entry as well as changes in attachment during the trial. We found that attachment-related avoidance (AR avoidance) was positively associated with PTSS from both self-reports and clinician ratings, whereas attachment-related anxiety (AR anxiety) was only related to self-reported PTSS (Pearson correlation coefficients between 0.37 and 0.46). Changes in AR anxiety occurred in both conditions at some point during the study (baseline to 3-month follow-up effect size was d = 0.60 for D-CPT and d = 0.44 for WL/TA) whereas for AR avoidance, only participants in D-CPT improved significantly (baseline to 3-month follow-up effect size was d = 0.75). The results indicate that PTSS and attachment are connected. Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.Trial registration: German Clinical Trials Register (DRKS); Germanctr.de; identifier: DRKS00004787; date of registration: 18 March 2013.
Highlights
Sexual and physical abuse in childhood and adolescence is associated with severe negative consequences for mental health [1, 2]
Besides an increased risk of substance abuse, suicidal behavior, affective, anxiety and personality disorders [3, 4], posttraumatic stress disorder (PTSD) is a frequently reported consequence with prevalence rates in adolescents ranging from 31% for physical abuse to 41% for rape [5]
There were no significant differences between the developmentally adapted cognitive processing therapy (D-cognitive processing therapy (CPT)) and WL/TA group except for higher WL/TA scores for AR anxiety (WL/TA: M = 4.09, SD = 1.24; D-CPT: M = 3.54, SD = 1.20; t83 = 2.06, p = 0.043) and prevalence of nicotine dependence (WL/TA: 20 [48%]; D-CPT: 11 [26%]; χ21 = 4.45, p = 0.035)
Summary
Sexual and physical abuse in childhood and adolescence is associated with severe negative consequences for mental health [1, 2]. Besides an increased risk of substance abuse, suicidal behavior, affective, anxiety and personality disorders [3, 4], posttraumatic stress disorder (PTSD) is a frequently reported consequence with prevalence rates in adolescents ranging from 31% for physical abuse to 41% for rape [5]. Child maltreatment impacts interpersonal functioning and is related to insecure attachment in children [6], adolescents [7], and adults [8]. A focus on adult romantic relationships has evolved that uses two dimensions to describe the quality of attachment relationships: attachment-related anxiety (AR anxiety) and attachment-related avoidance (AR avoidance; [13, 14]). The anxiety dimension is associated with anxiety and vigilance concerning rejection and abandonment, whereas the avoidance dimension refers to discomfort with closeness or a reluctance to become intimate with others [14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
