Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders
Anxiety is a highly prevalent in the community and despite improvements in therapy, a significant proportion of people tend to relapse, or remain significantly symptomatic. Theorists have proposed that untreated attachment anxieties and separation conflicts emerge from childhood development as pervasive problems in adulthood. Aim: This study aimed to investigate the influence of juvenile and concurrent adult separation anxiety on psychotherapy outcomes. It was hypothesised that separation anxiety impedes therapy progress. Method: 154 adults with a DSM-IV anxiety disorder received eight weekly sessions of group cognitive-behavior therapy. In addition to intake and termination measures of anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory), participants also completed measures of juvenile (Separation Anxiety Symptom Inventory) and adult (Adult Separation Anxiety Self-Report Checklist) separation anxiety and the influence of these on outcomes was studied. Results: Higher adult separation anxiety was associated with a greater likelihood of anxiety and comorbid depression remaining unremitted at termination of treatment. Higher juvenile separation anxiety was only associated with a greater likelihood of still being comorbidly depressed at termination of treatment. Discussion: Findings of this study highlight the need to modify conventional exposure-based CBT treatments, and provide psychodynamic treatments that address attachment anxieties and separation conflicts.