Implicit Attachment Schemas and Therapy Outcome for Panic Disorder Treated with Manualized Confrontation Therapy

Different studies have shown that a patient's attachment correlates with the psychotherapy outcome. However, these findings are based on the traditional interview and paper and pencil attachment methods. Latency-based methods like the Implicit Association Test (IAT) have not yet been investigated in clinical attachment research, specifically in therapy outcome research.

It can be hypothesized that patients with positive schemas of their mother and their partner may show a better psychotherapeutic outcome than those with less positive schemas of their mother/partner.

A sample of 103 patients suffering from panic disorder with or without agoraphobia (age 36.73, SD = 10.80), including 56% of patients with affective or other anxiety disorders as comorbidities without a personality disorder, based on the Structured Clinical Interview for DSM-IV (SCID-I/II), were treated with a manualized cognitive-behavioral confrontation therapy. Two IATs (for mother and partner) were implemented before the therapy (t1). The symptom reduction was assessed by the Symptom Checklist-90 (SCL-90) and the Beck Depression Inventory (BDI) with symptoms at t1 and IAT at t1 as predictors of symptoms at t2.

The results confirmed a moderate to high therapeutic effect of the confrontation therapy. Furthermore, the mother's IAT at t1 predicted the Global Severity Index (β = 0.20) as well as the Anxiety subscale (β = 0.18) at t2 above and beyond the t1 measurement of the criteria.

Implicit attitudes of the mother predicted the symptom reduction and a better therapeutic outcome. Relationship aspects with less impact awareness predicted the therapeutic outcome, even though mostly cognitive-behavioral techniques were used.