In Brief: Finding the right t... Health Article
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In Brief
It's known that several kinds of psychotherapy are effective treatments for depression, but little is known about which ones are best for which patients. A study conducted at the University of Toronto suggests that it may help to consider attachment styles — the patterns of feeling, thought, and behavior that develop as we learn, mainly through childhood experiences, to balance the need for support with the desire for independence.
According to attachment theory, secure attachment in adult life is based on a deep conviction that others will be available for support when needed. Insecure attachment takes several forms; in this study, the researchers compared attachment anxiety with attachment avoidance.
People with an avoidant attachment style tend to minimize the importance of close relationships. They value thought rather than feeling, often seem cool and remote, and retreat when threatened with intimacy. People with an anxious attachment style are more likely to seek contact and support from others, but their personal relationships are volatile and they are hypersensitive to what they see as rejection or abandonment.
In the Toronto study, questionnaires were used to judge attachment avoidance and anxiety in 56 depressed patients. Then they were assigned at random to interpersonal or cognitive behavioral therapy in four to five months of weekly sessions. The researchers expected interpersonal therapy to be more effective for people high in attachment anxiety, cognitive behavioral therapy more effective for those high in attachment avoidance.
Both treatments were equally effective in reducing depressive symptoms. As the researchers predicted, depressed patients who were high in attachment avoidance responded better to cognitive behavioral therapy than to interpersonal therapy — whether the result was judged by the patient or the therapist.
It did not work the other way, though. Patients high in attachment anxiety benefited equally from interpersonal and cognitive behavioral therapy. The authors suggest that attachment anxiety responds better to psychotherapy in general than attachment avoidance does. In support of that opinion, they point out that in this study, irrespective of a good or bad overall outcome, both cognitive behavioral therapy and interpersonal therapy reduced attachment anxiety much more than attachment avoidance.
McBride C, et al. "Attachment As Moderator of Treatment Outcome in Major Depression: A Randomized Controlled Trial of Interpersonal Psychotherapy Versus Cognitive Behavior Therapy," Journal of Consulting and Clinical Psychology (2006): Vol. 74, No. 6, pp. 1041–54.