Adverse childhood experiences lead to slower symptom improvement during psychotherapy of patients with anxiety disorders

Abstract

Background Adverse childhood experiences were previously identified to be important risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The aim of the present study was to investigate the effects of adverse and protective childhood experiences on symptom improvement of patients with anxiety disorders during outpatient psychotherapy. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as a potential predictor. Methods The sample consisted of n = 312 completed psychotherapies. The symptom improvement rate was calculated using a two-stage hierarchical linear model. Direct and indirect effects of adverse and protective childhood experiences on the symptom improvement rate during psychotherapy were then examined using a structural equation model. Results The presence of adverse childhood experiences predicted a slower improvement rate during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict symptom improvement rate during psychotherapy. Conclusions Among patients with anxiety disorders, adverse childhood experiences lead to slower symptom improvement in psychotherapy. Therefore, childhood adversity should be regularly assessed before starting psychotherapy in patients with anxiety disorders.