The influence of adult attachment style on social anxiety

Cognitive bahavioural therapy (CBT) is widely recognised as an efficacious treatment for social anxiety disorder (SAD). However, results from recent meta-analyses suggest that CBT is moderately effective in reducing the symptoms of this disorder. It remains unclear why a significant number of individuals do not respond to treatment. Thus, the overall aim of this thesis is to establish adult attachment as an important individual difference variable that can influence factors that maintain symptoms of social anxiety as well as impact treatment outcome. The current thesis specifically examined the influence of attachment style on attention biases as well as on the therapeutic alliance. Attention biases are considered important cognitive factors that maintain symptoms of social anxiety disorder. Attention biases are considered important cognitive factors that maintain symptoms of social anxiety disorder (Clark & Wells, 1995; Rapee & Heimberg, 1997). Study one investigated the influence of adult attachment style on the relationship between attention biases and anxiety in a non-clinical sample. Participants were randomly allocated to receive an anxiety inducing speech task or not, and viewed an emotional stimulus (image of either an angry or a happy face) paired with a neutral stimulus in a passive eye-tracking task. The results showed that those in the anxiety induction condition were less likely to attend to the emotional stimulus than those in the no anxiety condition. Furthermore, the results showed that an avoidant attachment style moderated the relationship between attention and anxiety; however an anxious attachment style did not have a significant moderating effect. Thus, study one establishes adult attachment style as a relevant individual difference variable to consider within the context of attention biases and anxiety. Accordingly, study two examines the time course of attention, in a clinical sample of participants diagnosed with SAD, and whether attachment style is a moderator of this relationship. The findings showed that those with SAD, compared to a non-clinical control sample, were more likely to avoid attending to emotional stimuli in general. Attachment style did not moderate this relationship, however an anxious attachment style independently influenced attention biases, with anxiously attached individuals displaying greater vigilance for emotional compared to neutral stimuli. Study three examined the effect of attachment style as a moderator of the relationship between attention biases and CBT treatment outcome for individuals with SAD. There were no differences in attention biases (vigilance or difficulty to disengage from threat) between the clinical and control sample. However, clinical participants who were avoidant of threat at pre-treatment became significantly more vigilant for emotional stimuli in general, after treatment, while those who were vigilant for threat at pre-treatment showed no significant changes in attention at post-treatment. Furthermore, attention biases significantly predicted treatment outcome; difficulty disengaging from happy stimuli predicted poorer treatment outcomes and attachment style moderated the relationship between difficulty disengaging from threatening and neutral stimuli and treatment outcome. These findings established not only that attention biases can significantly predict treatment outcome but also that attachment style moderates this relationship. Previous research has identified that the therapeutic alliance is important in producing positive treatment outcomes in a variety of mental health settings. Similarly, there is a large body of research which suggests that adult attachment style significantly influences the development of the therapeutic alliance and consequently treatment outcomes. Consequently, study four examined the influence of attachment on the development of the therapeutic alliance and treatment outcome for individuals attending a group CBT treatment for SAD. The findings showed that attachment is a significant moderator of the therapeutic alliance and treatment outcome relationship. Specifically, individuals with an insecure attachment style benefit more from CBT when therapeutic alliance scores are high. Taken together, the findings from the current research thesis have demonstrated that attachment style contributes to factors that can maintain symptoms of SAD as well as treatment outcome for these individuals. Thus, attachment style is an important individual difference variable to examine within the context of SAD.