Long‐term changes in attachment patterns after psychotherapy in outpatients with Axis I and personality disorders vs. Axis I disorders only

Abstract

Background -Adult attachment can be self-reported by rating anxiety of deception and avoidance of emotional closeness. There are few studies of changes in adult attachment patterns after psychotherapy. Aim -This study investigated how attachment anxiety and avoidance mean scores changed from pre-treatment to follow-up in patients with Axis I disorders only vs. patients with Axis I and comorbid personality disorders (comorbid group) after outpatients psychotherapy. Method -Of 156 patients with pre-treatment evaluation, 64 (41%) participated in follow-up 6 years later. Axis I and personality disorder interviews were performed at pre-treatment and follow-up, and the participants self-reported attachment patterns at both time points. Results -At both pre-treatment and follow-up, the Axis I group had significantly lower attachment avoidance scores than the comorbid group, while no significant between-group differences were observed for attachment anxiety. After adjustment, neither the Axis I nor the comorbid group showed any significant reductions in attachment anxiety or avoidance over time. The pre-treatment attachment scores were the only significant predictors of the follow-up scores. Conclusion -Neither attachment anxiety nor avoidance were amenable to change over time. These findings may be associated with the psychotherapy given. Pre-treatment attachment scores were the only significant predictors of these scores at follow-up.