Attachment Style and Response to Psychotherapy for Depression

An important question for psychotherapists is how to determine the preferred treatment for an individual depressed patient. Interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) are similarly effective treatments for depression, but they have important differences. IPT posits a bidirectional relationship between interpersonal problems and depressive symptoms; it focuses on changing the patient’s experience of her interpersonal world. CBT posits a bidirectional relationship between dysfunctional thoughts and depressive symptoms; it focuses on changing dysfunctional thoughts.

These researchers hypothesized that IPT is better suited to individuals with anxious attachment (i.e., valuing relationships over autonomy and experiencing heightened sensitivity to rejection) and that CBT is better suited to individuals with avoidant attachment (i.e., denying the importance of relationships and valuing rationality over emotions). The researchers conducted a randomized, controlled trial in which 56 patients with major depression received CBT or IPT and completed self-report scales on attachment style.

CBT and IPT performed equally well in improving depression symptoms. In analyses conducted on intent-to-treat and completer groups, avoidant attachment predicted better response to CBT than to IPT on all outcome measures, but anxious attachment did not predict different outcomes with the two treatments. The findings for CBT remained consistent even after adjustment for obsessive-compulsive and avoidant personality disorder symptoms.