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. Author manuscript; available in PMC: 2022 Feb 1.
Published in final edited form as: Psychother Res. 2020 Apr 30;31(2):258–266. doi: 10.1080/10503307.2020.1756513

Change in Dysfunctional Attitudes and Attachment in Interpersonal Psychotherapy for Depressed Adolescents

Yuan Zhou 1, Jessica Arend 2, Laura Mufson 3, Meredith Gunlicks-Stoessel 4
PMCID: PMC7606211  NIHMSID: NIHMS1586088  PMID: 32351173

Abstract

This study examined changes in depressed adolescents’ reports of dysfunctional attitudes while receiving interpersonal psychotherapy (IPT-A) and the relationship between the change in dysfunctional attitudes and change in attachment anxiety and avoidance with IPT-A. Forty adolescents (age 12–17) participated in a 16-week randomized clinical trial of four adaptive treatment strategies that began with IPT-A and augmented treatment for insufficient responders by adding additional IPT-A sessions or the antidepressant medication, fluoxetine. Measures of attachment anxiety and avoidance (Experience in Close Relationships Scale—Revised [ECR-R]), dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]), and depression (Children’s Depression Rating Scale—Revised [CDRS-R]) were administered at baseline and weeks 4, 8, 12, and 16. Adolescents demonstrated a significant decrease in dysfunctional attitudes (DAS) over the course of treatment. Reductions in dysfunctional attitudes (DAS) were also significantly associated with reductions in attachment anxiety and avoidance (ECR-R), controlling for depression (CDRS-R). Our results suggest that change in adolescents’ attachment anxiety and avoidance may be an important mechanism of change in adolescents’ dysfunctional thinking patterns.

Keywords: dysfunctional attitudes, attachment, interpersonal psychotherapy, depression

Attachment theory proposes that individuals seek proximity to attachment figures who respond warmly and sensitively to provide protection, comfort, and care (Bowlby, 1973, 1980). It is a process that is biologically-based and it is influenced by the environment. According to this theory, when children experience distress, they attempt to regulate and regain a sense of security and self-worth by seeking support from an attachment figure (Sroufe & Waters, 1977). The extent to which the attachment figure responds in a sensitive and attuned way also influences the child’s beliefs, or “internal working model,” of the self, world, and relationships (Bowlby, 1980; Hazan & Shaver, 1994). When attachment figures correctly perceive and interpret signals of seeking support and respond appropriately and effectively with warmth and compassion, children develop positive beliefs about themselves as lovable and worthy individuals, they develop trust in relationships to provide support and security, and they learn to view the world as a safe place (Belsky & Fearon, 2002). These positive internalizations later facilitate children’s explorations of the world and are essential in regulating emotions during times of high stress, especially when the attachment figures are not immediately available (Mikulincer, Florian, & Weller, 1993; Mikulincer & Orbach, 1995). In contrast, when attachment figures consistently dismiss or neglect support seeking from their children, these children might develop insecurities about being imperfect or unlovable (Bowlby, 1980).

During adolescence, attachment figures continue to play an important role in helping adolescents regulate their distress (Allen & Tan, 2016). The conceptualization of an attachment figure broadens from parents or close caregivers to also include peers, romantic partners, and other significant relationships (Armsden & Greenberg, 1987; Hazan & Shaver, 1994; Kobak & Sceery, 1988). In addition, the responsibility of attachment figures shifts from attending to most or all of children’s experiences of emotional distress to providing support of adolescents’ efforts towards self-regulation (Kobak & Sceery, 1988). While the threshold and frequency at which the attachment system activates is likely to change for adolescents as compared to infants and young children, adolescents do continue to rely on attachment figures for social and emotional support, particularly when highly distressed (Allen & Tan, 2016; Rosenthal & Kobak, 2010). And even when attachment figures are not immediately available, adolescents whose attachment experiences have enabled them to carry positive internalizations of the self, relationships, and the world may better regulate their emotions than adolescents who carry insecurities around attachment as they face new challenges (Mikulincer, Florian, & Weller, 1993; Mikulincer & Orbach, 1995).

Attachment also plays an important role in the sometimes overwhelming demands and challenges that adolescents face when striving for independence. When attachment figures recognize adolescents’ needs for independence and respond appropriately by encouraging adolescents’ exploration of their growing autonomy, adolescents develop a positive view of themselves as capable and courageous individuals, they develop trust in relationships to respect their boundaries and vulnerabilities, and they learn to embrace the world as a supportive and encouraging environment (Allen & Tan, 2016). When adolescents and attachment figures consistently experience disagreements in negotiating the balance between independence and closeness, adolescents might develop negative biases that they are the cause of the conflicts and that their desire for independence is a threat to their attachment relationships (Allen, Hauser, & Borman-Spurrell, 1996; Allen, Moore, Kuperminc, & Bell, 1998; Beck, 1987). In this way, problems in attachment experiences can contribute to the development of dysfunctional attitudes.

Empirical studies have provided support for the theoretical association between attachment and dysfunctional attitudes (Fuhr, Reitenbach, Kraemer, Hautzinger, & Meyer, 2017; Reinecke & Rogers, 2001; Roelofs, Lee, Ruijten, & Lobbestael, 2011). Attachment is organized around two dimensions: high attachment avoidance is characterized by hesitance to rely on others for emotional support, whereas low attachment avoidance is characterized by feeling comfortable seeking and receiving support from others; high attachment anxiety is characterized by desire for intimacy, but difficulties in feeling secure, whereas low attachment anxiety is characterized by trust in others to provide comfort in times of need (Fraley & Shaver, 2000). Among adults, both anxious and avoidant attachment have been found to be associated with dysfunctional attitudes in normative and clinical samples (Hankin, 2005; Roberts, Gotlib, & Kassel, 1996). Among adolescents, attachment anxiety has been found to predict later development of dysfunctional attitudes in a 4-wave prospective study of normative adolescents (Lee & Hankin, 2009). Attachment avoidance was not significantly associated with dysfunctional attitudes in this sample. Taken together, these adult and adolescent studies suggest a relationship between dysfunctional attitudes and attachment anxiety. The findings regarding dysfunctional attitudes and attachment avoidance are less consistent.

In the context of treatment, changes in dysfunctional attitudes have primarily been examined as a treatment outcome of interventions that directly target negative cognitions, such as cognitive-behavioral therapy (CBT) (Haaga, Dyck, & Ernst, 1991; Westra & Stewart, 1998; Whisman, 1993). CBT is an evidence-based treatment for a range of psychiatric disorders that aims to decrease faulty or unhelpful ways of thinking in everyday life (Butler et al., 2006). In addition, a recent study showed that perfectionism decreased over the course of psychotherapy, even when the therapist trainees were not directly targeting perfectionism (Richardson et al., 2019). Change in attachment has also been examined in the context of a number of therapy approaches, including CBT, psychodynamic therapy, exposure therapy, interpersonal psychotherapy (IPT), emotionally focused therapy, and attachment-focused therapy (see review in Taylor, Rietzschel, Danquah, & Berry, 2015). Some of these therapies, such as interpersonal psychotherapy (IPT), emotion-focused therapy, and attachment-focused therapy, aim to directly target attachment, while others, such as CBT, dialectical behavioral therapy, psychodynamic and exposure therapy, do not. Results suggest that adults and adolescents who received treatments that target attachment demonstrate significant decreases in both attachment anxiety and avoidance among individual, couples, and group therapy modalities (Gunlicks-Stoessel, Westervelt, Reigstad, Mufson, & Lee, 2019; Kilmann et al., 1999; Makinen & Johnson, 2006; Ravitz, Maunder, & McBride, 2008). The results of studies providing treatments that do not directly target attachment have been mixed, with some showing decreases in attachment anxiety and avoidance and others not finding significant effects (Lawson, Barnes, Madkins, & Francois-Lamonte, 2006; Lawson & Brossart, 2009; Ravitz et al., 2008; Stovall-McClough & Cloitre, 2003; Strauß et al., 2018; Tasca, Balfour, Ritchie, & Bissada, 2007). While attachment has been studied as a mechanism of change in attachment-based interventions (Gunlicks-Stoessel et al., 2019; Kilmann et al., 1999; Makinen & Johnson, 2006; McBride, Atkinson, Quilty, & Bagby, 2006; Ravitz et al., 2008; Stovall-McClough & Cloitre, 2003), less is known regarding the impact of an intervention that targets attachment on dysfunctional attitudes.

The current study sought to examine whether interpersonal psychotherapy for depressed adolescents (IPT-A) (Mufson, Dorta, Moreau, & Weissman, 2004), an intervention that aims to treat depression by improving adolescents’ attachment relationships, also has an impact on dysfunctional attitudes. We hypothesized that adolescents’ dysfunctional attitudes would significantly decrease over the course of IPT-A. Given the theoretical and empirical literature suggesting that insecure attachment contributes to the development of dysfunctional attitudes, we hypothesize that that reverse may be true as well – that if attachment relationships improve, in this case due to treatment with IPT-A, this may contribute to a reduction in dysfunctional attitudes. We specifically examined whether change in attachment is significantly associated with change in dysfunctional attitudes when controlling for depression. This allows for the examination of the unique associations between change in attachment and dysfunctional attitudes above and beyond the impact that change in depression may have on these two constructs. We hypothesized that greater decreases in attachment anxiety and avoidance would be associated with greater decreases in dysfunctional attitudes.

Method

Participants

Participants were 40 adolescents participating in a clinical trial of four adaptive treatment strategies for adolescent depression. Previous publications from this clinical trial have reported on the feasibility and acceptability of the adaptive treatment strategies (Gunlicks-Stoessel, Mufson, Westervelt, Almirall, & Murphy, 2016), the main clinical outcomes of each of the adaptive treatment strategies (Gunlicks-Stoessel et al., 2019a), and attachment as an outcome and predictor of depression response to IPT-A (Gunlicks-Stoessel et al., 2019b). The results regarding dysfunctional attitudes have not previously been reported. All adolescents began treatment with IPT-A. Insufficient responders had their treatment augmented by either adding four additional IPT-A sessions scheduled twice per week or adding the antidepressant medication, fluoxetine (Gunlicks-Stoessel et al., 2016, 2019a). Adolescents and parents provided written informed consent and assent. The study was approved and monitored by the site’s institutional review board. Adolescents were aged 12–17 with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of Major Depressive Disorder, Dysthymia, or Depressive Disorder Not Otherwise Specified (NOS); significant symptoms of depression (Children’s Depression Rating Scale – Revised [CDRS-R] raw score > 35); and significant impairment in general functioning (Children’s Global Assessment Scale [CGAS] > 65). Adolescents and parents were required to be English-speaking. Exclusion criteria were as follows: DSM-IV-TR diagnosis of schizophrenia, bipolar disorder, psychosis, substance abuse, obsessive compulsive disorder, conduct disorder, eating disorder, or pervasive developmental disorder; active suicidal ideation with a plan and/or intent; already receiving treatment for depression; taking medication for a psychiatric diagnosis other than ADHD (adolescents taking a stable does of stimulants [> 3 months] were included); non-responder to an adequate trial of IPT-A or fluoxetine in the past; female adolescents who were pregnant, breastfeeding, or having unprotected sexual intercourse; or an intellectual disability disorder.

Adolescents’ mean age was 14.8 (SD = 1.8). Seventy-seven and one half percent of the sample was female and 22.5% was male. Ten percent of the adolescents were Latino (includes black/African American and white Latinos). Racial composition was as follows: 80.0% white, 7.5% Asian, 7.5% American Indian/Alaska Native, and 5.0% biracial. Depression diagnoses were as follows: 92.5% MDD, 2.5% MDD and dysthymic disorder (DD), and 2.5% DD, and 2.5% DD NOS. CDRS-R scores ranged from mild (CDRS-R = 38) to severe (CDRS-R = 73) with a mean severity in the moderate range (CDRS-R = 55.58, SD = 10.54). Forty-five percent of the sample had a comorbid anxiety disorder, 7.5% had ADHD, and 5.0% had oppositional defiant disorder.

Procedures

A full description of the study design and method is included in Gunlicks-Stoessel et al., 2016, 2019. Enrolled adolescents participated in a 16-week sequential multiple assignment randomized trial (SMART) (Lavori & Dawson, 2000, 2004; Murphy, 2005). Adolescents began treatment with an initial treatment plan of 12 sessions of IPT-A delivered within 16 weeks. At Week 1, adolescents reported their depressive symptoms using the Hamilton Rating Scale for Depression (HRSD) (Hamilton, 1967). They were then randomized to have their depression symptoms assessed again at either Week 4 or Week 8 of therapy (Week 4 decision point: n = 20, week 8 decision point: n =20). These assessments were used to guide selection of the subsequent treatment approach. Adolescents who demonstrated a sufficient reduction in HRSD at Week 4 or Week 8 to suggest that they would be likely to be treatment responders by the end of 12 session of IPT-A (≥ 20% reduction in HRSD at week 4 or ≥ 40% reduction in HRSD at week 8) continued the initial treatment plan of 12 IPT-A sessions (n = 17). The criteria for defining sufficient response including the timing of the assessments were empirically derived from a previous clinical trial of IPT-A (Gunlicks-Stoessel & Mufson, 2011). Adolescents who did not demonstrate a sufficient reduction in HRSD at Week 4 or Week 8 were randomized to the addition of fluoxetine (n = 11) or additional IPT-A sessions scheduled twice a week (increase from 12 to 16 sessions) (n = 11). Fluoxetine is empirically supported medication for adolescent depression and has been approved by FDA (March et al., 2004).

Measures

Children’s Depression Rating Scale – Revised

The CSRS-R (Poznanski & Mokros, 1996) is a clinician-administered, semi-structured interview that assesses 17 symptom areas relate to depression experienced during the previous 2 weeks, including those that serve as criteria in the DSM-IV. It provides an overall index of severity of depression and a depressive symptom profile. The interview is conducted with the adolescent and the parent separately, and a summary score is created for each symptom (range = 17–133). The CSRS-R has been found to have good reliability and validity (Poznanski et al., 1984). Interrater reliability calculated on four of the interviews yielded an intraclass correlation coefficient of 0.90.

Experience in Close Relationships – Revised

The ECR-R (Brennan, Clark, & Shaver, 1998) is a widely used self-report measure that assesses attachment. Individuals use a 7-point Likert scale to indicate the extent to which they agree or disagree with statements regarding how they feel in their close relationships (1 = disagree strongly, 4 = neutral/mixed, 7 = agree strongly). Participants were prompted to answer the 36 questions about their general experience in close relationships. The Avoidance subscale assesses discomfort with and avoidance of intimacy (e.g., “I prefer not to show people I am close to how I feel deep down”, “Just when people start to get close to me I find myself pulling away.”). The Anxiety subscale assesses anxiety about rejection and abandonment (e.g., “I worry about being alone”, “I worry that people that I am close to won’t care about me as much as I care about them”). Subscale scores are calculated by computing the mean of each subscale item (range = 1–7). Construct validity of the measure has been demonstrated in both adults (Fairchild & Finney, 2006) and adolescents (Lee & Hankin, 2009). In the current sample, reliability (Cronbach’s alpha) of the Avoidance subscale was .90 and the Anxiety subscale was .87.

Dysfunctional Attitudes Scale

The DAS (Weissman & Beck, 1978) is a self-report measure of attitudes hypothesized to relate to depression. The DAS is composed of 40 items and with two subscales including Perfectionism (e.g., “If I do not do as well as other people, it means I am an inferior human being”) and Need for Social Approval (e.g., “I cannot be happy unless most people I know admire me”). Participants responded to the question using a 7-point Likert-scale that ranged from 1 to 7 (1 = totally disagree and 7 = totally agree). The DAS has been found to have strong internal consistency, and validity has been demonstrated by the DAS’s correlations with measures of depressive symptoms (e.g., Hankin, Fraley, & Abela, 2005). In the current sample, reliability (Cronbach’s alpha) of the DAS was .863, of Perfectionism subscale was .935, and of the Need for Approval subscale was .628.

Treatment

IPT-A

IPT-A (Mufson et al., 2004) is a 12-session, evidence-based psychotherapeutic intervention that aims to decrease depressive symptoms by helping adolescents to improve their attachment relationships and foster interpersonal skills needed to address one or more of four interpersonal problem areas: grief, role disputes, role transitions, and interpersonal deficits. The initial phase of treatment focuses on reviewing the adolescent’s significant relationships and identifying the problem area that will be the focus of the treatment. During the middle phase of the treatment, the therapist identifies and teaches specific communication and interpersonal problem-solving skills needed to resolve or improve the interpersonal difficulties that are most closely related to the depression. The adolescent role-plays these skills in session and implements them in their current relationships. During the termination phase, the therapist and adolescent review improvements in depressive symptoms and interpersonal functioning, identify successful strategies used to improve relationships, and foster generalization of skills to future situations.

Pharmacotherapy

Adolescents who received pharmacotherapy were prescribed fluoxetine. The dosage schedule for fluoxetine followed published guidelines (Brent et al, 2008): 10 mg per day for the first week and 20 mg per day for the following 5 weeks. If no treatment response was observed by the sixth week, the dosage could be increased to 40 mg per day. Pharmacotherapy sessions were scheduled weekly for the first 4 weeks and every other week thereafter.

Analytic Strategy

Group comparisons of adolescents randomized to a week 4 versus week 8 decision point showed that there were no significant group differences in demographics (age, gender, race, income) and baseline CDRS-R, ECR-R Anxiety and Avoidance, or DAS Perfectionism and Need for Social Approval. There were also no significant group differences in CDRS-R at week 4 and week 8, or in ECR-R or DAS assessed at week 8. Thus, analyses were conducted collapsing the two groups to permit use of the whole sample (n = 40) for the analyses.

Two-level linear mixed models were used in the analyses in which multiple waves of assessments were nested within individuals. To test whether the rates of change over time in DAS were significantly different from zero (i.e., no change over time), time effect was tested in the models. To examine the longitudinal relationships between ECR-R and DAS, controlling for CDRS-R, time-varying covariates were included in the models. Effect sizes (Cohen’s d) were computed using the mean baseline and week 16 scores and the pooled standard deviations (.2 = small, .5 = medium, .8 = large) (Cohen, 2013).

Results

Means, standard deviations, and inter-correlations among of all the measures are reported in Table 1. Mixed models testing the linear rate of change over time (i.e., slope) showed that there was a significant linear time effect in DAS Total [estimate = −7.49, SE = 2.84, t(67) = −2.64, p = .01, d = .58], and DAS Perfectionism [estimate = −5.60, SE = 1.83, t(70) = −3.07, p = .003, d = .60] and Need for Approval [estimate = −2.54, SE = 1.06, t(67) = −2.41, p = .019, d = .54].

Table 1.

Descriptive Statistics and Intercorrelations of Study Variables

Variable Baseline Week 16
DAS Perfectionism Need for Approval Anxiety Avoidance CDRS-R DAS Perfectionism Need for Approval Anxiety Avoidance CDRS-R
Mean (SD) 161.51 (27.37) 56.67 (19.02) 45.38 (9.00) 4.24 (1.01) 4.11 (1.28) 55.58 (10.54) 145.60 (27.42) 45.17 (19.09) 39.90 (11.20) 3.39 (1.15) 3.10 (1.14) 37.82 (11.40)
Baseline
 DAS .94** .80** .63** .70** .35* .33 .37 .02 .05 .16 −.07
 Perfectionism .65** .65** .68** .34* .30 .37 −.06 .05 .12 −.07
 Need for Approval .47** .48** .47** .37* .33 .30 .19 .26 .15
 ECR-R Anxiety .45** .292 .35 .39* .29 .51** .16 .26
 ECR-R Avoidance .289 .03 .09 −.16 −.09 .34 .51
 CDRS – R .17 .17 −.05 .33 .19 .53**
Week 16
 DAS .96** .85** .55** .31 .168
 Perfectionism .76** .55** .33 .151
 Need for Approval .69** .14 .169
 ECR-R Anxiety .13 .52**
 ECR-R Avoidance .35
 CDRS – R
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Note.

*

p ≤ .05.

**

p ≤ .01.

DAS = Dysfunctional Attitudes Scale, ECR-R = Experiences in Close Relationships Scale – Revised, CDRS-R = Children’s Depression Rating Scale – Revised.

Time-varying variables of ECR-R Anxiety and Avoidance were each entered in two separate mixed models to examine whether change in Anxiety or Avoidance was related to change in DAS over time. After controlling for CDRS-R, there was a significant time-varying effects of Anxiety on DAS total score [estimate = 16.12, SE = 2.71, t(90) = 5.94, p < .001, d = 1.25], as well as the subscales of Perfectionism [estimate = 11.25, SE = 1.72, t(90) = 6.542, p <. 001, d = 1.38] and Need for Approval [estimate = 5.04, SE = .90, t(82) = 5.62, p < .001, d = 1.24]. There was also a significant time-varying effects of Avoidance on DAS total score [estimate = 13.90, SE = 2.69, t(90) = 5.178, p < .001, d = 1.09], as well as the subscales of Perfectionism [estimate = 10.15, SE = 1.68, t(90) = 6.02, p < .001, d = 1.27] and Need for Approval [estimate = 2.48, SE = .97, t(88) = 2.55, p = .012, d = .55].

The results indicated that the decrease in ECR-R Anxiety and Avoidance over time was significantly associated with the decrease in both dimensions of DAS over time, controlling for depression.

Discussion

In this study, we examined the relationship between change in dysfunctional attitudes and change in attachment as reported by depressed adolescents who received treatment with IPT-A. The results supported our hypothesis that adolescents would demonstrate significant decreases in dysfunctional attitudes over the course of IPT-A. These significant decreases occurred in both dimensions of dysfunctional attitudes, including perfectionism and need for approval. The current study is the first to provide empirical evidence indicating that IPT-A, a treatment that targets attachment relationships but does not directly target dysfunctional attitudes, can also potentially address cognitive vulnerabilities. This supports the utility of attachment theory as a framework for addressing cognitive vulnerabilities to depression. Our findings also inform clinical practice by suggesting that therapists may not have to use a cognitively-focused intervention to address negative cognitions and can consider IPT-A as an alternative treatment approach.

Reductions in dysfunctional attitudes over the course of IPT-A were also significantly associated with decreases in attachment anxiety and avoidance, controlling for depression. These results indicate that decreases in attachment anxiety and avoidance occur in parallel with decreases in dysfunctional attitudes over the course of IPT-A. While no causal inferences can be made, it is theoretically possible, given the purported treatment target of IPT-A, that change in adolescents’ attachment could be an important mechanism of change in adolescents’ dysfunctional thinking patterns. These findings fit in the growing body of research suggesting that clients move towards attachment security over the course of successful therapy (Taylor, Rietzschel, Danquah, & Berry, 2015).

The study has several limitations. First, there is no control group in this study, therefore it is not possible to determine whether these results are unique to IPT-A or whether changes in attachment and dysfunctional attitudes might have been observed in other forms of treatment. Another limitation is that some participants had their treatment augmented; some adolescents received additional IPT-A sessions and some were prescribed fluoxetine. As all adolescents received IPT-A and receipt of fluoxetine was controlled in the analysis, we were able to examine the relationship between change in dysfunctional attitudes, attachment, and depression in IPT-A. However, future clinical trials that deliver IPT-A without augmentation will be useful for providing greater support for our findings. Another limitation of this study is its small sample of primarily upper-middle class females, which limits the generalizability of the findings. It will be important for future studies to recruit more diverse and representative samples to determine if our findings generalize to other populations and better inform clinical practice. Finally, the study relied on adolescents’ self-report of attachment anxiety and avoidance and dysfunctional attitudes. Despite using well-validated questionnaires, it is possible that our results are driven by the common-method variance of measuring both constructs using self-report questionnaires. Future studies could include observational assessments and interview methods.

Despite these limitations, the results of this study have important implications for clinical practice. Our findings suggest that dysfunctional attitudes in adolescents are amenable to an intervention that is not cognitively-focused, and that targeting attachment in the context of IPT-A can improve dysfunctional attitudes, as well. If these results are replicated in future studies that include a control group, it could provide support for using IPT-A as a treatment option for adolescents who present their depression in the context of negative cognitions about themselves and others.

Acknowledgements

Research reported in this publication was supported by Award Number K23MH090216 from the National Institute of Mental Health of the National Institutes of Health and Award Number UL1TR000114 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Center for Research Resources. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Minnesota.

Laura Mufson, Ph.D. receives royalties from Guilford Press, Inc. for the book, Interpersonal Psychotherapy for Depressed Adolescents. No other authors have financial disclosures.

Contributor Information

Yuan Zhou, Department of Psychology, University of Minnesota, Minneapolis, MN

Jessica Arend, Department of Psychiatry, University of Minnesota, Minneapolis, MN

Laura Mufson, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY

Meredith Gunlicks-Stoessel, Department of Psychiatry, University of Minnesota, Minneapolis, MN

References

  1. Allen JP, Hauser ST, & Borman-Spurrell E (1996). Attachment theory as a framework for understanding sequelae of severe adolescent psychopathology: an 11-year follow-up study. Journal of Consulting and Clinical Psychology, 64(2), 254. [DOI] [PubMed] [Google Scholar]
  2. Allen JP, Moore C, Kuperminc G, & Bell K (1998). Attachment and adolescent psychosocial functioning. Child Development, 69(5), 1406–1419. [PMC free article] [PubMed] [Google Scholar]
  3. Allen JP, & Tan JS (2016). The multiple facets of attachment in adolescence. Handbook of Attachment: Theory, Research, and Clinical Applications, 399–415. [Google Scholar]
  4. Armsden GC, & Greenberg MT (1987). The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. Journal of Youth and Adolescence, 16(5), 427–454. [DOI] [PubMed] [Google Scholar]
  5. Beck AT (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy, 1(1), 5–37. [Google Scholar]
  6. Belsky J, & Fearon RMP (2002). Early attachment security, subsequent maternal sensitivity, and later child development: Does continuity in development depend upon continuity of caregiving? Attachment & Human Development, 4(3), 361–387. [DOI] [PubMed] [Google Scholar]
  7. Bowlby J (1973). Attachment and loss, vol. II: Separation. Basic Books. [Google Scholar]
  8. Bowlby J (1980). Loss: Sadness and depression: Vol. 3. Attachment and loss. New York: Basic Books. [Google Scholar]
  9. Brennan KA, Clark CL, & Shaver PR (1998). Self-report measurement of adult attachment: An integrative overview.
  10. Cohen J (2013). Statistical power analysis for the behavioral sciences. Routledge. [Google Scholar]
  11. Fairchild AJ, & Finney SJ (2006). Investigating validity evidence for the experiences in close relationships-revised questionnaire. Educational and Psychological Measurement, 66(1), 116–135. [Google Scholar]
  12. Fraley RC, & Shaver PR (2000). Adult romantic attachment: Theoretical developments, emerging controversies, and unanswered questions. Review of General Psychology, 4(2), 132–154. [Google Scholar]
  13. Fuhr K, Reitenbach I, Kraemer J, Hautzinger M, & Meyer TD (2017). Attachment, dysfunctional attitudes, self-esteem, and association to depressive symptoms in patients with mood disorders. Journal of Affective Disorders, 212, 110–116. [DOI] [PubMed] [Google Scholar]
  14. Gunlicks-Stoessel M, & Mufson L (2011). Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents. Depression and Anxiety, 28(7), 525–531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gunlicks-Stoessel M, Mufson L, Westervelt A, Almirall D, & Murphy S (2016). A pilot SMART for developing an adaptive treatment strategy for adolescent depression. Journal of Clinical Child & Adolescent Psychology, 45(4), 480–494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gunlicks-Stoessel ML, Mufson L, Bernstein G, Westervelt A, Reigstad K, Klimes-Dougan B, Cullen K Murray A, & Vock D (2019a). Critical decision points for augmenting interpersonal psychotherapy for depressed adolescents: A pilot sequential multiple assignment randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 58, 80–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gunlicks-Stoessel M, Westervelt A, Reigstad K, Mufson L, & Lee S (2019b). The role of attachment style in interpersonal psychotherapy for depressed adolescents. Psychotherapy Research, 29(1), 78–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Haaga DA, Dyck MJ, & Ernst D (1991). Empirical status of cognitive theory of depression. Psychological Bulletin, 110(2), 215. [DOI] [PubMed] [Google Scholar]
  19. Hamilton MAX (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6(4), 278–296. [DOI] [PubMed] [Google Scholar]
  20. Hankin BL (2005). Childhood maltreatment and psychopathology: Prospective tests of attachment, cognitive vulnerability, and stress as mediating processes. Cognitive Therapy and Research, 29(6), 645–671. [Google Scholar]
  21. Hankin BL, Fraley RC, & Abela JRZ (2005). Daily depression and cognitions about stress: evidence for a traitlike depressogenic cognitive style and the prediction of depressive symptoms in a prospective daily diary study. Journal of Personality and Social Psychology, 88(4), 673. [DOI] [PubMed] [Google Scholar]
  22. Hazan C, & Shaver PR (1994). Attachment as an organizational framework for research on close relationships. Psychological Inquiry, 5(1), 1–22. [Google Scholar]
  23. Kilmann PR, Laughlin JE, Carranza LV, Downer JT, Major S, & Parnell MM (1999). Effects of an attachment-focused group preventive intervention on insecure women. Group Dynamics: Theory, Research, and Practice, 3(2), 138. [Google Scholar]
  24. Kobak RR, & Sceery A (1988). Attachment in late adolescence: Working models, affect regulation, and representations of self and others. Child Development, 135–146. [DOI] [PubMed] [Google Scholar]
  25. Lavori PW, & Dawson R (2000). A design for testing clinical strategies: biased adaptive within-subject randomization. Journal of the Royal Statistical Society: Series A (Statistics in Society), 163(1), 29–38. [Google Scholar]
  26. Lavori PW, & Dawson R (2004). Dynamic treatment regimes: practical design considerations. Clinical Trials, 1(1), 9–20. [DOI] [PubMed] [Google Scholar]
  27. Lawson DM, Barnes AD, Madkins JP, & Francois-Lamonte BM (2006). Changes in male partner abuser attachment styles in group treatment. Psychotherapy: Theory, Research, Practice, Training, 43(2), 232. [DOI] [PubMed] [Google Scholar]
  28. Lawson DM, & Brossart DF (2009). Attachment, interpersonal problems, and treatment outcome in group therapy for intimate partner violence. Psychology of Men & Masculinity, 10(4), 288. [Google Scholar]
  29. Lee A, & Hankin BL (2009). Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence. Journal of Clinical Child & Adolescent Psychology, 38(2), 219–231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Makinen JA, & Johnson SM (2006). Resolving attachment injuries in couples using emotionally focused therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74(6), 1055. [DOI] [PubMed] [Google Scholar]
  31. McBride C, Atkinson L, Quilty LC, & Bagby RM (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. [DOI] [PubMed] [Google Scholar]
  32. Mufson L, Dorta KP, Moreau D, & Weissman MM (2004). Interpersonal psychotherapy for depressed adolescents. Guilford Press. [Google Scholar]
  33. Murphy SA (2005). An experimental design for the development of adaptive treatment strategies. Statistics in Medicine, 24(10), 1455–1481. [DOI] [PubMed] [Google Scholar]
  34. Poznanski EO, Grossman JA, Buchsbaum Y, Banegas M, Freeman L, & Gibbons R (1984). Preliminary studies of the reliability and validity of the Children’s Depression Rating Scale. Journal of the American Academy of Child Psychiatry, 23(2), 191–197. [DOI] [PubMed] [Google Scholar]
  35. Poznanski EO, & Mokros HB (1996). Children’s depression rating scale, revised (CDRS-R). Western Psychological Services Los Angeles. [Google Scholar]
  36. Ravitz P, Maunder R, & McBride C (2008). Attachment, contemporary interpersonal theory and IPT: An integration of theoretical, clinical, and empirical perspectives. Journal of Contemporary Psychotherapy, 38(1), 11–21. [Google Scholar]
  37. Reinecke MA, & Rogers GM (2001). Dysfunctional attitudes and attachment style among clinically depressed adults. Behavioural and Cognitive Psychotherapy, 29(2), 129–141. [Google Scholar]
  38. Roberts JE, Gotlib IH, & Kassel JD (1996). Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70(2), 310. [DOI] [PubMed] [Google Scholar]
  39. Roelofs J, Lee C, Ruijten T, & Lobbestael J (2011). The mediating role of early maladaptive schemas in the relation between quality of attachment relationships and symptoms of depression in adolescents. Behavioural and Cognitive Psychotherapy, 39(4), 471–479. [DOI] [PubMed] [Google Scholar]
  40. Rosenthal NL, & Kobak R (2010). Assessing adolescents’ attachment hierarchies: Differences across developmental periods and associations with individual adaptation. Journal of Research on Adolescence, 20(3), 678–706. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sroufe LA, & Waters E (1977). Attachment as an organizational construct. Child Development, 1184–1199. [Google Scholar]
  42. Stovall-McClough KC, & Cloitre M (2003). Reorganization of unresolved childhood traumatic memories following exposure therapy. Annals of the New York Academy of Sciences, 1008(1), 297–299. [DOI] [PubMed] [Google Scholar]
  43. Strauß B, Altmann U, Manes S, Tholl A, Koranyi S, Nolte T, … others. (2018). Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder: Results from the SOPHO-Net trial. PloS One, 13(3), e0192802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Tasca G, Balfour L, Ritchie K, & Bissada H (2007). Change in attachment anxiety is associated with improved depression among women with binge eating disorder. Psychotherapy: Theory, Research, Practice, Training, 44(4), 423. [DOI] [PubMed] [Google Scholar]
  45. Taylor P, Rietzschel J, Danquah A, & Berry K (2015). Changes in attachment representations during psychological therapy. Psychotherapy Research, 25(2), 222–238. [DOI] [PubMed] [Google Scholar]
  46. Weissman AN, & Beck AT (1978). Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Proceedings of the Annual Meeting of the American Educational Research Association, Toronto, 1–13. [Google Scholar]
  47. Westra HA, & Stewart SH (1998). Cognitive behavioural therapy and pharmacotherapy: complementary or contradictory approaches to the treatment of anxiety? Clinical Psychology Review, 18(3), 307–340. [DOI] [PubMed] [Google Scholar]
  48. Whisman MA (1993). Mediators and moderators of change in cognitive therapy of depression. Psychological Bulletin, 114(2), 248. [DOI] [PubMed] [Google Scholar]

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