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
Abstract Views: 3078
PDF: 354
Appendix: 115
HTML: 26
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

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.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

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. https://doi.org/10.1002/pon.3996 DOI: https://doi.org/10.1002/pon.3996
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. https://doi.org/10.3390/ijerph18030927 DOI: https://doi.org/10.3390/ijerph18030927
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295x.84.2.191 DOI: https://doi.org/10.1037/0033-295X.84.2.191
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: https://doi.org/10.1093/med-psych/9780190685973.001.0001
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. https://doi.org/10.1146/annurev-clinpsy-032813-153734 DOI: https://doi.org/10.1146/annurev-clinpsy-032813-153734
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 www.comh.ca/selfcare/
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. https://doi.org/10.5964/pch.v8i1.309 DOI: https://doi.org/10.5964/pch.v8i1.309
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. https://doi.org/10.1016/j.jcbs.2016.09.001 DOI: https://doi.org/10.1016/j.jcbs.2016.09.001
Brown, D. A., & O’Brien, K. K. (2021). Conceptualising Long COVID as an episodic health condition. BMJ Global Health, 6(9), 4–7. https://doi.org/10.1136/bmjgh-2021-007004 DOI: https://doi.org/10.1136/bmjgh-2021-007004
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. https://doi.org/10.1177/0163278705275341 DOI: https://doi.org/10.1177/0163278705275341
Burlingame, G. M., McClendon, D. T., & Yang, C. (2018). Cohesion in Group Therapy: A Meta-Analysis. Psychotherapy, 55(4), 384–398. https://doi.org/10.1037/pst0000173 DOI: https://doi.org/10.1037/pst0000173
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. https://doi.org/10.1017/S0033291720005498 DOI: https://doi.org/10.1017/S0033291720005498
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: https://doi.org/10.1200/JCO.1993.11.3.570
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). https://doi.org/10.3390/ijerph18105324 DOI: https://doi.org/10.3390/ijerph18105324
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. https://doi.org/10.1186/s12889-019-7933-4 DOI: https://doi.org/10.1186/s12889-019-6623-6
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. https://doi.org/10.1177/17423953221089309 DOI: https://doi.org/10.1177/17423953221089309
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. https://doi.org/10.1177/1359105310379063 DOI: https://doi.org/10.1177/1359105310379063
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. https://doi.org/10.1016/j.socscimed.2007.02.008 DOI: https://doi.org/10.1016/j.socscimed.2007.02.008
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. https://doi.org/10.26633/RPSP.2020.166 DOI: https://doi.org/10.26633/RPSP.2020.166
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. https://doi.org/10.1037/pst0000172 DOI: https://doi.org/10.1037/pst0000172
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. https://doi.org/10.1007/s10549-018-4677-2 DOI: https://doi.org/10.1007/s10549-018-4677-2
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. https://doi.org/10.1016/j.cpr.2016.04.009 DOI: https://doi.org/10.1016/j.cpr.2016.04.009
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. https://doi.org/10.7411/RP.2014.023 DOI: https://doi.org/10.4081/ripppo.2015.160
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. https://doi.org/10.1136/injuryprev-2015-041616 DOI: https://doi.org/10.1136/injuryprev-2015-041616
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. https://doi.org/10.5888/PCD18.210086 DOI: https://doi.org/10.5888/pcd18.210086
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. https://doi.org/10.1891/0889-8391.31.3.1 DOI: https://doi.org/10.1891/0889-8391.31.3.171
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 http://www2.psych.ubc.ca/~schaller/Psyc591Readings/HazanShaver1987.pdf DOI: https://doi.org/10.1037/0022-3514.52.3.511
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. https://doi.org/10.3389/fpsyg.2020.00075 DOI: https://doi.org/10.3389/fpsyg.2020.00075
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. https://doi.org/10.1023/B:JOBM.0000028498.16767.a2 DOI: https://doi.org/10.1023/B:JOBM.0000028498.16767.a2
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. https://doi.org/10.1177/1742395318792063 DOI: https://doi.org/10.1177/1742395318792063
Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70. Retrieved from http://www.jstor.org/stable/4615733%0Ahttp://www.jstor.org/page/info/about/policies/terms.jsp%0Ahttp://www.jstor.org
Hoyt, M. A., & Stanton, A. L. (2018). Adjustment to chronic illness. In Handbook of Health Psychology (pp. 179–194). https://doi.org/10.4324/9781315167534-13 DOI: https://doi.org/10.4324/9781315167534-13
Hunter, J. J., & Maunder, R. G. (2001). Using attachment theory to understand illness behavior. General Hospital Psychiatry, 23(4), 177–182. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11543843 DOI: https://doi.org/10.1016/S0163-8343(01)00141-4
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. https://doi.org/10.3399/bjgp19X702233 DOI: https://doi.org/10.3399/bjgp19X702233
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. https://doi.org/10.1037/0022-006X.59.1.12 DOI: https://doi.org/10.1037/0022-006X.59.1.12
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: https://doi.org/10.1046/j.1365-2648.2000.01466.x
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: https://doi.org/10.1037/cap0000132
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. https://doi.org/10.1186/s13643-019-1099-0 DOI: https://doi.org/10.1186/s13643-019-1099-0
Katon, W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23. https://doi.org/10.31887/dcns.2011.13.1/wkaton DOI: https://doi.org/10.31887/DCNS.2011.13.1/wkaton
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. https://doi.org/10.1080/00207284.2016.1260464 DOI: https://doi.org/10.1080/00207284.2016.1260464
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. https://doi.org/10.1016/j.genhosppsych.2013.04.006 DOI: https://doi.org/10.1016/j.genhosppsych.2013.04.006
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. https://doi.org/10.1007/s10865-015-9623-8 DOI: https://doi.org/10.1007/s10865-015-9623-8
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. https://doi.org/10.1046/j.1525-1497.2001.016009606.x DOI: https://doi.org/10.1046/j.1525-1497.2001.016009606.x
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. https://doi.org/10.1097/PRA.0000000000000309 DOI: https://doi.org/10.1097/PRA.0000000000000309
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. https://doi.org/10.1002/jclp.22685 DOI: https://doi.org/10.1002/jclp.22685
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. https://doi.org/10.1038/s41393-019-0320-2 DOI: https://doi.org/10.1038/s41393-019-0320-2
Livneh, H. (2001). Psychosocial adaptation to chronic illness and disability: A conceptual framework. Rehabilitation Counseling Bulletin, 44(3), 151–160. DOI: https://doi.org/10.1177/003435520104400305
Livneh, H. (2021). Psychosocial adaptation to chronic illness and disability: An updated and expanded conceptual framework. Rehabilitation Counseling Bulletin. https://doi.org/10.1177/00343552211034819 DOI: https://doi.org/10.1177/00343552211034819
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. https://doi.org/10.1037/ccp0000735 DOI: https://doi.org/10.1037/ccp0000735
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. https://doi.org/10.4081/ripppo.2019.352 DOI: https://doi.org/10.4081/ripppo.2019.352
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. https://doi.org/10.1016/j.ijnurstu.2007.09.009 DOI: https://doi.org/10.1016/j.ijnurstu.2007.09.009
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: https://doi.org/10.1097/00005650-200412000-00006
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: https://doi.org/10.1037/rep0000398
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. https://doi.org/10.7411/RP.2014.019 DOI: https://doi.org/10.4081/ripppo.2014.161
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. https://doi.org/10.1177/1088868310377394 DOI: https://doi.org/10.1177/1088868310377394
Maunder, R. G., & Hunter, J. J. (2009). Assessing patterns of adult attachment in medical patients. General Hospital Psychiatry, 31(2), 123–130. https://doi.org/10.1016/j.genhosppsych.2008.10.007 DOI: https://doi.org/10.1016/j.genhosppsych.2008.10.007
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. https://doi.org/10.1037/0022-006X.74.6.1041 DOI: https://doi.org/10.1037/0022-006X.74.6.1041
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. https://doi.org/10.1016/j.pain.2006.02.025 DOI: https://doi.org/10.1016/j.pain.2006.02.025
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. https://doi.org/10.1016/j.copsyc.2018.02.006 DOI: https://doi.org/10.1016/j.copsyc.2018.02.006
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: https://doi.org/10.1007/978-0-387-48670-3_6
Moss-Morris, R. (2013). Adjusting to chronic illness: Time for a unified theory. British Journal of Health Psychology, 18(4), 681–686. https://doi.org/10.1111/bjhp.12072 DOI: https://doi.org/10.1111/bjhp.12072
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. https://doi.org/10.1111/ane.12368 DOI: https://doi.org/10.1111/ane.12368
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. https://doi.org/10.1016/j.beth.2015.07.002 DOI: https://doi.org/10.1016/j.beth.2015.07.002
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). https://doi.org/10.3390/ijerph18105077 DOI: https://doi.org/10.3390/ijerph18105077
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. https://doi.org/10.3390/jcm8030364 DOI: https://doi.org/10.3390/jcm8030364
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. https://doi.org/10.1371/journal.pone.0218462 DOI: https://doi.org/10.1371/journal.pone.0218462
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. https://doi.org/10.1016/j.jpsychores.2011.02.011 DOI: https://doi.org/10.1016/j.jpsychores.2011.02.011
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. https://doi.org/10.1176/appi.psychotherapy.20200031 DOI: https://doi.org/10.1176/appi.psychotherapy.20200031
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. https://doi.org/10.1186/s12888-017-1494-9 DOI: https://doi.org/10.1186/s12888-017-1494-9
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. https://doi.org/10.1027//1015-5759.18.3.242 DOI: https://doi.org/10.1027//1015-5759.18.3.242
Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In Meausres in health psychology: A user’s portfolio (pp. 35–37). DOI: https://doi.org/10.1037/t00393-000
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. https://doi.org/10.1007/s11136-020-02647-7 DOI: https://doi.org/10.1007/s11136-020-02647-7
Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford University Press. DOI: https://doi.org/10.1093/acprof:oso/9780195152968.001.0001
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. https://doi.org/10.1016/j.cbpra.2014.05.006 DOI: https://doi.org/10.1016/j.cbpra.2014.05.006
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. https://doi.org/10.1001/archinte.166.10.1092 DOI: https://doi.org/10.1001/archinte.166.10.1092
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. https://doi.org/10.2340/16501977-2200 DOI: https://doi.org/10.2340/16501977-2200
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. https://doi.org/10.4081/ripppo.2019.361 DOI: https://doi.org/10.4081/ripppo.2019.361
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. https://doi.org/10.1037/1089-2699.11.1.1 DOI: https://doi.org/10.1037/1089-2699.11.1.1
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: https://doi.org/10.1080/10503300802641444
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: https://doi.org/10.1080/10503300902933188
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: https://doi.org/10.1037/0000201-009
Tasca, G. A., Mikail, S. F., & Hewitt, P. L. (2020). Group Psychodynamic-Interpersonal Psychotherapy. DOI: https://doi.org/10.1037/0000213-000
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. https://doi.org/10.1080/10503300500090928 DOI: https://doi.org/10.1080/10503300500090928
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. https://doi.org/10.1007/s12671-018-1087-9 DOI: https://doi.org/10.1007/s12671-018-1087-9
Tinetti, M., Fried, T., & Boyd, C. (2012). Designing health care for the most commong chronic condition - Multimorbidity. JAMA, 307(23), 2493–2494. https://doi.org/10.1001/jama.2012.5265.Designing DOI: https://doi.org/10.1001/jama.2012.5265
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. https://doi.org/10.1016/j.apmr.2017.03.024 DOI: https://doi.org/10.1016/j.apmr.2017.03.024
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. https://doi.org/10.1080/09638288.2017.1292320 DOI: https://doi.org/10.1080/09638288.2017.1292320
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. https://doi.org/10.1007/s11136-008-9398-2 DOI: https://doi.org/10.1007/s11136-008-9398-2
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. https://doi.org/10.1016/S0140-6736(15)60692-4 DOI: https://doi.org/10.1016/S0140-6736(15)60692-4
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. https://doi.org/10.1080/00223890701268041 DOI: https://doi.org/10.1080/00223890701268041
World Health Organization. (2014). Global status report on noncommunicable diseases. https://doi.org/ISBN 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). https://doi.org/10.4081/ripppo.2022.634