Cognitive Behaviour Therapy for Children and Adolescents: Can Attachment Theory Contribute to Its Efficacy?

Abstract

Meta-analyses consistently demonstrate that cognitive behaviour therapy (CBT) provides effective evidence-based treatment for children and adolescents with emotional and behaviour problems. Also consistent across meta-analyses is the observation that CBT treatment effects are often medium in size. This observation has instigated a search for factors that could help explain the limited treatment effects and that could be focused upon to enhance CBT treatment outcomes. The current qualitative review focuses on the parent-child attachment relationship as one factor that could be relevant to enhance CBT treatment effects. This review first acknowledges reasons why CBT has historically not been attracted to attachment theory and its postulates. Second, recent evidence is examined to evaluate whether attachment can be approached from a cognitive schema perspective. Subsequently, research is described showing how restoring attachment relationships could result in large treatment effects. Finally, this evidence is integrated in a model of attachment assessment and intervention that might be compatible with CBT. In sum, this review suggests that restoring trust in insecure parent-child attachment relationships can be integrated within CBT and could contribute to its treatment outcomes.Cognitive behaviour therapy (CBT) is one of the most clearly conceptualized and best-studied therapeutic approaches for treating children and adolescents (e.g. Seligman and Ollendick 2011). Years of research confirm the positive effects of CBT and demonstrate significant reductions in a variety of child and adolescent emotional and behavioural problems (Hofmann et al. 2012). Part of the strength of CBT is its dynamic nature and flexibility to addressing these problems. Consequently, during the past decades, CBT with adults has broadened its treatment emphasis from focusing solely on changing behaviour, to focusing on challenging maladaptive cognitions, and, more recently, to accepting existential emotional distress (e.g. De Houwer et al. 2016). CBT for children and adolescents has roughly followed these developments and benefited from them. This is illustrated by the increasing number of meta-analyses that confirm that CBT provides an effective treatment for a plethora of child and adolescent internalizing and externalizing behaviour problems (e.g. Reynolds et al. 2012).However, meta-analyses also suggest that effect sizes often remain small to medium in size (e.g. Cuijpers et al. 2006;Kazdin 1995;Klein et al. 2007;Reynolds et al. 2012;Silverman et al. 2008;Weisz et al. 2006;Weisz et al. 2013) and that relapse rates following treatment are quite high (e.g. 30-50 % for mood disorders, Lewinsohn et al. 1990;Brent et al. 1999). This suggests that CBT for children and adolescents might benefit from a new conceptualization and expansion of treatment goals. The current literature review aims at providing arguments that one such expansion could be restoring attachment relationships. This paper will discuss the main components of tradition...

Repetitive thinking about the mother during distress moderates the link between children's attentional breadth around the mother and depressive symptoms in middle childhood

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Assessment of Internalized Early Attachment Experience through Scripts: Turkish Adaptation of the Attachment Script Assessment Procedure

“…Beyond being a new assessment tool, by providing an alternative perspective to understand the cognitive underpinnings of the attachment representations, ASA has become an intriguing method not only for attachment but also for cognitive therapy literature. It has been discussed that conceptualizing and assessing attachment representations as cognitive secure base scripts may offer alternative answers to some questions that are still be sought in cognitive therapies (Bosmans, 2016).…”

“…İlk olarak İÇM'lerin yapısına dikkat çeken Bretherton (1990); bu modellerin dil gelişiminden önceki dönemde yapılandığına dikkat çekerek, bağlanma temsilinin semantik bilgiden ziyade, duygu düzenlemeye (stres yönetimine) yönelik işlemsel bilgi içeren senaryolardan oluştuğunu öne sürmüştür. Waters ve Rodrigues-Doolabh (2001) Deneyim ve bilişsel gelişimle çocuğun zihninde neden-sonuç zinciri olarak yapılandığı belirtilen bu temsiller, Waters ve Waters (2006) (Bosmans, 2016). Çoğu bilişsel terapi yaklaşımı, erken dönem bağlanma ilişkisinin en derindeki inançları yapılandırdığını ifade etmektedir (Beck, 1995;Safran, 1990;Young, 1999 (Bosmans, 2016).…”

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Intensive Home Treatment for adolescents in psychiatric crisis

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