Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre

Submitted: May 19, 2022
Accepted: August 23, 2022
Published: September 1, 2022
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Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.



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Adellund Holt, K., Jensen, P. T., Gilsa Hansen, D., Elklit, A., & Mogensen, O. (2016). Rehabilitation of women with gynaecological cancer: The association between adult attachment, post-traumatic stress disorder and depression. Psycho-Oncology, 25(6), 691–698. DOI:
Aza, A., Verdugo, M., Orgaz, M. B., Amor, A. M., & Fernández, M. (2021). Predictive factors of self-reported quality of life in acquired brain injury: One-year follow-up. International Journal of Environmental Research and Public Health, 18(3), 1–20. DOI:
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. DOI:
Barlow, D. H., Farchione, T., Sauer-Zavala, S., Murray-Latin, H., Ellard, K. K., Bullis, J. R., … Cassiello-Robbins, C. (2017). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide (second edition). DOI:
Beck, A. T., & Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24. DOI:
Beutler, L. E., Harwood, T. M., Alimohamed, S., & Malik, M. (2002). Functional impairment and coping style. In J. Norcross (Ed.), Psychotherapy relationships that work (pp. 145–170). New York: Oxford University Press.
Bilsker, D., Samra, J., & Goldner, E. (2009). Positive coping with health conditions: A self-care workbook (pp. 1–109). pp. 1–109. Retrieved from
Bischoff, T., Anderson, S. R., Heafner, J., & Tambling, R. (2020). Establishment of a reliable change index for the GAD-7. Psychology, Community & Health, 8(1), 176–187. DOI:
Bohart, A. C., & Wade, A. G. (2013). The client in psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 219–257). Hoboken, NJ: Wiley.
Bowlby, J. (1980). Attachment and loss: Loss, sadness and depression (Vol. 3). New York Basic Books.
Brassington, L., Ferreira, N. B., Yates, S., Fearn, J., Lanza, P., Kemp, K., & Gillanders, D. (2016). Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness. Journal of Contextual Behavioral Science, 5(4), 208–214. DOI:
Brown, D. A., & O’Brien, K. K. (2021). Conceptualising Long COVID as an episodic health condition. BMJ Global Health, 6(9), 4–7. DOI:
Brown, S. D., & Lent, R. W. (2008). Handbook of Counseling Psychology (4th ed.).
Brucker, P. S., Yost, K., Cashy, J., Webster, K., & Cella, D. (2005). General population and cancer patient norms for the functional assessment of cancer therapy-general (FACT-G). Evaluation and the Health Professions, 28(2), 192–211. DOI:
Burlingame, G. M., McClendon, D. T., & Yang, C. (2018). Cohesion in Group Therapy: A Meta-Analysis. Psychotherapy, 55(4), 384–398. DOI:
Cano-Vindel, A., Muñoz-Navarro, R., Moriana, J. A., Ruiz-Rodríguez, P., Medrano, L. A., & González-Blanch, C. (2021). Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: The results of the PsicAP randomized controlled trial. Psychological Medicine, 1–13. DOI:
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., … Harris, J. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570–579. DOI:
Christensen, A. B., Wahrén, S., Reinholt, N., Poulsen, S., Hvenegaard, M., Simonsen, E., & Arnfred, S. (2021). “Despite the Differences, We Were All the Same”. Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study. International Journal of Environmental Research and Public Health, 18(10). DOI:
Ciarrochi, J., & Bailey, A. (2008). A CBT practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy & accceptance & commitment therapy.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). New York, New York: Lawrence Erlbaum Associates.
Daré, L. O., Bruand, P. E., Gérard, D., Marin, B., Lameyre, V., Boumédiène, F., & Preux, P. M. (2019). Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: A meta-analysis. BMC Public Health, 19(304), 1–12. DOI:
de Oliveira Almeida, K., Nogueira Alves, I. G., de Queiroz, R. S., de Castro, M. R., Gomes, V. A., Santos Fontoura, F. C., … Neto, M. G. (2022). A systematic review on physical function, activities of daily living and health-related quality of life in COVID-19 survivors. Chronic Illness. DOI:
Dorstyn, D., Mathias, J., & Denson, L. (2011). Efficacy of cognitive behavior therapy for the management of psychological outcomes following spinal cord injury: A meta-analysis. Journal of Health Psychology, 16(2), 374–391. DOI:
Elzen, H., Slaets, J. P. J., Snijders, T. A. B., & Steverink, N. (2007). Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands. Social Science and Medicine, 64(9), 1832–1841. DOI:
Fernández-Nino, J. A., Guerra-Gómez, J. A., & Idrovo, A. J. (2021). Multimorbidity patterns among COVID-19 deaths: Proposal for the construction of etiological models. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 44, 1–9. DOI:
Flückiger, C., Del, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. DOI:
Goyal, N. G., Levine, B. J., Van Zee, K. J., Naftalis, E., & Avis, N. E. (2018). Trajectories of quality of life following breast cancer diagnosis. Breast Cancer Research and Treatment, 169(1), 163–173. DOI:
Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46–58. DOI:
Gullo, S., Lo Coco, G., Di Fratello, C., Giannone, F., Mannino, G., & Burlingame, G. (2015). Group climate, cohesion, and curative climate: A study on the common factors in the group process and their relation with members’ attachment dimensions. Research in Psychotherapy: Psychopathology, Process and Outcome, 18(1), 10–20. DOI:
Haagsma, J. A., Graetz, N., Bolliger, I., Naghavi, M., Higashi, H., Mullany, E. C., … Vos, T. (2016). The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Injury Prevention, 22(1), 3–18. DOI:
Hacker, K. A., Briss, P. A., Richardson, L., Wright, J., & Petersen, R. (2021). COVID-19 and chronic disease: The impact now and in the future. Preventing Chronic Disease, 18(E62), 1–6. DOI:
Hallis, L., Cameli, L., Bekkouche, N. S., & Knäuper, B. (2017). Combining cognitive therapy with acceptance and commitment therapy for depression: A group therapy feasibility study. Journal of Cognitive Psychotherapy, 31(3), 171–190. DOI:
Hayes, S., Strosahl, K., & Wilson, K. (2016). Acceptance and commitment therapy, second edition: The process and practice of mindful change.
Hazan, C., & Shaver, P. (1987). Interpersonal relations and group process: Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. Retrieved from DOI:
Heenan, A., Greenman, P. S., Tassé, V., Zachariades, F., & Tulloch, H. (2020). Traumatic stress, attachment style, and health outcomes in cardiac rehabilitation patients. Frontiers in Psychology, 11(75), 1–12. DOI:
Heijmans, M., Rijken, M., Foets, M., De Ridder, D., Schreurs, K., & Bensing, J. (2004). The stress of being chronically ill: From disease-specific to task-specific aspects. Journal of Behavioral Medicine, 27(3), 255–271. DOI:
Hevey, D., Wilson O’Raghallaigh, J., O’Doherty, V., Lonergan, K., Heffernan, M., Lunt, V., … Kinsella, S. (2020). Pre-post effectiveness evaluation of Chronic Disease Self-Management Program (CDSMP) participation on health, well-being and health service utilization. Chronic Illness, 16(2), 146–158. DOI:
Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70. Retrieved from
Hoyt, M. A., & Stanton, A. L. (2018). Adjustment to chronic illness. In Handbook of Health Psychology (pp. 179–194). DOI:
Hunter, J. J., & Maunder, R. G. (2001). Using attachment theory to understand illness behavior. General Hospital Psychiatry, 23(4), 177–182. Retrieved from DOI:
Jackson, M., Jones, D., Dyson, J., & Macleod, U. (2019). Facilitated group work for people with long-term conditions: A systematic review of benefits from studies of group-work interventions. British Journal of General Practice, 69(682), E363–E372. DOI:
Jacobson, N. S., & Truax, P. (1991). Clinical Significance: A Statistical Approach to Defining Meaningful Change in Psychotherapy Research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. DOI:
Joachim, G., & Acorn, S. (2000). Living with chronic illness: The interface of stigma and normalization. Canadian Journal of Nursing Research, Vol. 32, pp. 37–48. DOI:
Johnsen, T. J., & Friborg, O. (2018). A meta-analysis of group cognitive-behavioral therapy as an antidepressive treatment: Are we gettting better? Clinical Psychology, 59(1), 15–30. DOI:
Juul, S., Poulsen, S., Lunn, S., Sørensen, P., Jakobsen, J. C., & Simonsen, S. (2019). Short-term versus long-term psychotherapy for adult psychiatric disorders: A protocol for a systematic review with meta-analysis and trial sequential analysis. Systematic Reviews, 8(1), 1–13. DOI:
Katon, W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23. DOI:
Kivlighan, D. M., Lo Coco, G., Gullo, S., Pazzagli, C., & Mazzeschi, C. (2017). Attachment anxiety and attachment avoidance: Members’ attachment fit with their group and group relationships. International Journal of Group Psychotherapy, 67(2), 223–239. DOI:
Kocalevent, R. D., Hinz, A., & Brähler, E. (2013). Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 35(5), 551–555. DOI:
Kowal, J., McWilliams, L. A., Péloquin, K., Wilson, K. G., Henderson, P. R., & Fergusson, D. A. (2015). Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program. Journal of Behavioral Medicine, 38(3), 518–526. DOI:
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. DOI:
Lambert, M. J., Gregersen, A. T., & Burlingame, G. M. (2004). The Outcome Questionnaire-45. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (3rd ed., pp. 191–234). Mahwah, New Jersey: Lawrence Erlbaum Associates Publishers.
Lazar, S. G., Bendat, M., Gabbard, G., Levy, K., McWilliams, N., Plakun, E. M., … Yeomans, F. (2018). Clinical necessity guidelines for psychotherapy, insurance medical necessity and utilization review protocols, and mental health parity. Journal of Psychiatric Practice, 24(3), 179–193. DOI:
Levy, K. N., Kivity, Y., Johnson, B. N., & Gooch, C. V. (2018). Adult attachment as a predictor and moderator of psychotherapy outcome: A meta-analysis. Journal of Clinical Psychology, 74(11), 1996–2013. DOI:
Li, Y., Chien, W. T., & Bressington, D. (2020). Effects of a coping-oriented supportive programme for people with spinal cord injury during inpatient rehabilitation: A quasi-experimental study. Spinal Cord, 58(1), 58–69. DOI:
Livneh, H. (2001). Psychosocial adaptation to chronic illness and disability: A conceptual framework. Rehabilitation Counseling Bulletin, 44(3), 151–160. DOI:
Livneh, H. (2021). Psychosocial adaptation to chronic illness and disability: An updated and expanded conceptual framework. Rehabilitation Counseling Bulletin. DOI:
Lo Coco, G., Gullo, S., Albano, G., Brugnera, A., Flückiger, C., & Tasca, G. A. (2022). The alliance-outcome association in group interventions: A multilevel meta-analysis. Journal of Consulting and Clinical Psychology, 90(6), 513–527. DOI:
Lo Coco, G., Tasca, G. A., Hewitt, P. L., Mikail, S. F., & Kivlighan, D. M. (2019). Ruptures and repairs of group therapy alliance: An untold story in psychotherapy research. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(1), 58–70. DOI:
Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2001). Effect of a self-management program on patients with chronic disease. Effective Clinical Practice, 4(6), 256–262. DOI:
Lowe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care, 42(12), 1194–1201. DOI:
Maras, D., Balfour, L., Lefebvre, M., & Tasca, G. A. (2021). Attachment avoidance and health-related quality of life: Mediating effects of avoidant coping and health self-efficacy in a rehabilitation sample. Rehabilitation Psychology. DOI:
Marogna, C., & Caccamo, F. (2014). Analysis of the process in brief psychotherapy group: The role of therapeutic factors. Research in Psychotherapy: Psychopathology, Process and Outcome, 17(1), 43–51. DOI:
Masi, C. M., Chen, H. Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219–266. DOI:
Maunder, R. G., & Hunter, J. J. (2009). Assessing patterns of adult attachment in medical patients. General Hospital Psychiatry, 31(2), 123–130. DOI:
McBride, C., Atkinson, L., Quilty, L. C., & Bagby, R. M. (2006). Attachment as moderator of treatment outcome in major depression: A randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. Journal of Consulting and Clinical Psychology, 74(6), 1041–1054. DOI:
Meredith, P., Strong, J., & Feeney, J. a. (2006). Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain, 123(1–2), 146–154. DOI:
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. Guilford Press.
Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25, 6–10. DOI:
Moos, R. H., & Holahan, C. J. (2007). Adaptive tasks and methods of coping with illness and disability. In E. Martz & H. Livneh (Eds.), Coping with Chronic Illness and Disability (pp. 107–126). New York, New York: Springer. DOI:
Moss-Morris, R. (2013). Adjusting to chronic illness: Time for a unified theory. British Journal of Health Psychology, 18(4), 681–686. DOI:
Nilsson, M. H., Hagell, P., & Iwarsson, S. (2015). Psychometric properties of the General Self-Efficacy Scale in Parkinson’s disease. Acta Neurologica Scandinavica, 132(2), 89–96. DOI:
Norton, P. J., & Paulus, D. J. (2016). Toward a unified treatment for emotional disorders: Update on the science and practice. Behavior Therapy, 47(6), 854–868. DOI:
Osma, J., Martínez-García, L., Quilez-Orden, A., & Peris-Baquero, Ó. (2021). Unified protocol for the transdiagnostic treatment of emotional disorders in medical conditions: A systematic review. International Journal of Environmental Research and Public Health, 18(10). DOI:
Pfeifer, A.-C., Meredith, P., Schröder-Pfeifer, P., Gomez Penedo, J. M., Ehrenthal, J. C., Schroeter, C., … Schiltenwolf, M. (2019). Effectiveness of an attachment-informed working alliance in interdisciplinary pain therapy. Journal of Clinical Medicine, 8(364), 1–17. DOI:
Quiñones, A. R., Botoseneanu, A., Markwardt, S., Nagel, C. L., Newsom, J. T., Dorr, D. A., & Allore, H. G. (2019). Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS ONE, 14(6), 1–13. DOI:
Rizzo, M., Creed, F., Goldberg, D., Meader, N., & Pilling, S. (2011). A systematic review of non-pharmacological treatments for depression in people with chronic physical health problems. Journal of Psychosomatic Research, 71(1), 18–27. DOI:
Rosendahl, J., Alldredge, C. T., Burlingame, G. M., & Strauss, B. (2021). Recent developments in group psychotherapy research. American Journal of Psychotherapy, 74(2), 52–59. DOI:
Ruesch, M., Helmes, A., & Bengel, J. (2017). Cognitive behavioral group therapy for patients with physical diseases and comorbid depressive or adjustment disorders on a waiting list for individual therapy: Results from a randomized controlled trial. BMC Psychiatry, 17(1), 1–13. DOI:
Scholz, U., Doña, B. G., Sud, S., & Schwarzer, R. (2002). Is general self-efficacy a universal construct? Psychometric findings from 25 countries. European Journal of Psychological Assessment, 18(3), 242–251. DOI:
Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In Meausres in health psychology: A user’s portfolio (pp. 35–37). DOI:
Seves, B. L., Hoekstra, F., Hettinga, F. J., Dekker, R., van der Woude, L. H. V., & Hoekstra, T. (2021). Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: A longitudinal cohort study. Quality of Life Research, 30(1), 67–80. DOI:
Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford University Press. DOI:
Skinta, M. D., Lezama, M., Wells, G., & Dilley, J. W. (2015). Acceptance and Compassion-Based Group Therapy to Reduce HIV Stigma. Cognitive and Behavioral Practice, 22(4), 481–490. DOI:
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. DOI:
Stucki, G., Bickenbach, J., Gutenbrunner, C., & Melvin, J. (2018). Rehabilitation: The health strategy of the 21st century. Journal of Rehabilitation Medicine, 50(4), 309–316. DOI:
Talia, A., Miller-Bottome, M., Wyner, R., Lilliengren, P., & Bate, J. (2019). Patients’ Adult Attachment Interview classification and their experience of the therapeutic relationship: Are they associated? Research in Psychotherapy: Psychopathology, Process and Outcome, 22(2), 175–188. DOI:
Tasca, G. A., Balfour, L., Ritchie, K., & Bissada, H. (2007). The relationship between attachment scales and group therapy alliance growth differs by treatment type for women with binge-eating disorder. Group Dynamics, 11(1), 1–14. DOI:
Tasca, G. A., & Gallop, R. (2009). Multilevel modeling of longitudinal data for psychotherapy researchers: I. The basics. Psychother.Res., 19(1468-4381 (Electronic)), 429–437. DOI:
Tasca, G. A., Illing, V., Joyce, A. S., & Ogrodniczuk, J. S. (2009). Three-level multilevel growth models for nested change data: A guide for group treatment researchers. Psychotherapy Research, 19(4–5), 453–461. DOI:
Tasca, G. A., & Maxwell, H. (2021). Attachment and Group Psychotherapy: Applications to Work Groups and Teams. In C. D. Parks & G. A. Tasca (Eds.), The Psychology of Groups: The Intersection of Social Psychology and Psychotherapy Research (pp. 149–167). American Psychologial Association. DOI:
Tasca, G. A., Mikail, S. F., & Hewitt, P. L. (2020). Group Psychodynamic-Interpersonal Psychotherapy. DOI:
Tasca, G. A., Ritchie, K., Conrad, G., Balfour, L., Gayton, J., Lybanon, V., & Bissada, H. (2006). Attachment scales predict outcome in a randomized controlled trial of two group therapies for binge eating disorder: An aptitude by treatment interaction. Psychotherapy Research, 16(1), 106–121. DOI:
Tickell, A., Ball, S., Bernard, P., Kuyken, W., Marx, R., Pack, S., … Crane, C. (2020). The effectiveness of mindfulness-based cognitive therapy (MBCT) in real-world healthcare services. Mindfulness, 11(2), 279–290. DOI:
Tinetti, M., Fried, T., & Boyd, C. (2012). Designing health care for the most commong chronic condition - Multimorbidity. JAMA, 307(23), 2493–2494. DOI:
van Diemen, T., Crul, T., van Nes, I., Group, S., Geertzen, J. H., & Post, M. W. (2017). Associations between self-efficacy and secondary health conditions in people living with spinal cord injury: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 98(12), 2566–2577. DOI:
van Mierlo, M., van Heugten, C., Post, M. W. M., Hoekstra, T., & Visser-Meily, A. (2018). Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study. Disability and Rehabilitation, 40(9), 997–1006. DOI:
Verhaak, E. (2020). Cognition and radiation study A: Cognitive functioning, health-related quality of life, and fatigue in patients with 1 to 10 brain metastases before and after Gamma Knife radiosurgery. Tilburg University.
Victorson, D., Barocas, J., Song, J., & Cella, D. (2008). Reliability across studies from the functional assessment of cancer therapy-general (FACT-G) and its subscales: A reliability generalization. Quality of Life Research, 17(9), 1137–1146. DOI:
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., … Murray, C. J. L. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743–800. DOI:
Wei, M., Russell, D. W., Mallinckrodt, B., & Vogel, D. L. (2007). The Experiences in Close Relationship Scale (ECR)-short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204. DOI:
World Health Organization. (2014). Global status report on noncommunicable diseases. 9789241564854
Yalom, I. ., & Leszcz, M. (2020). The theory and practice of group psychotherapy (6th ed.). New York, NY: Basic Books.

How to Cite

Maras, D., Balfour, L., Lefebvre, M., & Tasca, G. A. (2022). Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(3).