Attachment and alliance in the treatment of depressed, sexually abused women.

Publisher: Wiley Country of Publication: United States NLM ID: 9708816 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1520-6394 (Electronic) Linking ISSN: 10914269 NLM ISO Abbreviation: Depress Anxiety Subsets: MEDLINE

Original Publication: New York, NY : Wiley, c1997-

Object Attachment* ; Psychotherapy*; Child Abuse, Sexual/*psychology ; Depression/*psychology ; Depression/*therapy; Adolescent ; Adult ; Anxiety ; Borderline Personality Disorder/epidemiology ; Child ; Comorbidity ; Depression/epidemiology ; Female ; Humans ; Interpersonal Relations ; Middle Aged ; Stress Disorders, Post-Traumatic/epidemiology ; Treatment Outcome ; Young Adult

Background: Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women's difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse.
Method: Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual.
Results: Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group.
Conclusion: Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve the treatments for depressed women with a history of childhood sexual abuse.
(© 2012 Wiley Periodicals, Inc.)

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K23 MH064528-01A1 United States MH NIMH NIH HHS; K23MH64528 United States MH NIMH NIH HHS; K23 MH064528 United States MH NIMH NIH HHS; T32 MH020061-01A1 United States MH NIMH NIH HHS; T32 MH020061 United States MH NIMH NIH HHS; T32MH020061 United States MH NIMH NIH HHS

Date Created: 20111109 Date Completed: 20120720 Latest Revision: 20211021

20221213

PMC3325338

10.1002/da.20913

22065593