The influence of adult attachment style on social anxiety Yulisha Byrow Bachelor of Arts

237 Pages·2016·1.43 MB·English

by  Yulisha Byrow

The influence of adult attachment style on social anxiety

Yulisha Byrow
Bachelor of Arts- Psychology (Hons)

A dissertation submitted in partial fulfilment of the requirements of the degree of Doctor of
Philosophy
Department of Psychology, Macquarie University

May 2015

Table of Contents
List of Tables .............................................................................................................................. viii
List of Figures ................................................................................................................................ x
Thesis Summary .......................................................................................................................... xii
Statement of Candidature ......................................................................................................... xiv
Acknowledgements ..................................................................................................................... xv

Chapter 1: General Introduction ................................................................................................ 1
Introduction ................................................................................................................................... 2
Prevalence and Etiology of Social Anxiety Disorder ................................................................. 2
Adult Attachment Style ............................................................................................................... 3
Attachment Style and Anxiety .................................................................................................... 5
Attachment and Social Anxiety Disorder. ............................................................................... 6
Anxiety related Attention Biases ................................................................................................ 7
Theoretical Accounts of Anxiety and Attention Bias ................................................................. 8
Vigilance-avoidance model of attention .................................................................................. 8
Cognitive Behavioural Therapy Models of Social Anxiety and Attention Biases .................... 10
Rapee and Heimberg (1997) CBT model of social anxiety and attention. ............................ 10
Clark and Wells (1995) CBT model of social anxiety and attention. ................................... 12
Attention Biases and Treatment Outcome for Social Anxiety Disorder. .................................. 13
Adult Attachment Style and Attention Biases .......................................................................... 14
Limitations of research investigating attention biases and Social Anxiety Disorder. ............... 15
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Therapeutic Alliance ..................................................................................................................17
Therapeutic alliance and treatment outcome. .........................................................................17
Factors influencing the Therapeutic Alliance ............................................................................17
Social Anxiety Disorder and the therapeutic alliance ............................................................18
Attachment and the therapeutic alliance. ...............................................................................18
Limitations of research investigating the therapeutic alliance and Social Anxiety Disorder. ...20
Overview of chapters in this thesis .............................................................................................21
References .....................................................................................................................................23

Chapter 2: Anxiety, Attachment & Attention: The influence of adult attachment style on
attentional biases of anxious individuals. ..................................................................................36
Abstract ........................................................................................................................................38
Anxiety, Attachment, and Attention: The influence of adult attachment style on
attentional biases of anxious individuals ...................................................................................39
Method ..........................................................................................................................................46
Participants .................................................................................................................................46
Materials .....................................................................................................................................47
Measures of Anxiety. .............................................................................................................47
Measures of Attachment Style. ..............................................................................................47
Other Variables. ......................................................................................................................48
Procedure ...................................................................................................................................49
Attachment Prime. ..................................................................................................................50
Eye-tracking task. ...................................................................................................................51
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Eye-tracking Data Analysis....................................................................................................... 51
Statistical Analysis .................................................................................................................... 52
Results .......................................................................................................................................... 52
Descriptive Measures ................................................................................................................ 52
Manipulation Check .................................................................................................................. 53
Anxiety induction task ........................................................................................................... 53
Attachment prime. ................................................................................................................. 54
Vigilance for Threat .................................................................................................................. 55
Time Course of Attention .......................................................................................................... 58
Discussion .................................................................................................................................... 60
References .................................................................................................................................... 67

Chapter 3: Time course of attention in socially anxious individuals: Investigating the
effects of adult attachment style. ............................................................................................... 82
Abstract ........................................................................................................................................ 84
Time course of attention in socially anxious individuals: Investigating the effects of adult
attachment style .......................................................................................................................... 85
1. Introduction ............................................................................................................................. 85
1.2 Hypotheses .......................................................................................................................... 91
2. Method ..................................................................................................................................... 92
2.1 Participants .......................................................................................................................... 92
2.2. Measures ............................................................................................................................ 92
2.2.1 The Anxiety Disorders Interview Schedule (ADIS-IV). .............................................. 92
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2.2.2 The Social Interaction Anxiety Scale (SIAS). ...............................................................93
2.2.3 Depression, Anxiety and Stress Scales (DASS-7). .......................................................93
2.2.4 Experiences in Close relationships- Revised (ECR-R). ................................................93
2.3 Procedure .............................................................................................................................94
2.3.1 Passive viewing eye tracking task. ................................................................................94
3. Results .......................................................................................................................................96
4. Discussion ...............................................................................................................................102
5. References ...............................................................................................................................107

Chapter 4: The impact of adult attachment style on attention biases and treatment
outcome in adults with social anxiety disorder. ......................................................................114
Abstract ......................................................................................................................................116
The impact of adult attachment style on attention biases and treatment outcome in
adults with social anxiety disorder. ..........................................................................................117
Method ........................................................................................................................................124
Participants ...............................................................................................................................124
Measures ..................................................................................................................................125
Anxiety symptoms. ...............................................................................................................125
Depression symptoms. ..........................................................................................................126
Adult attachment style. .........................................................................................................126
Attention Bias .......................................................................................................................126
Procedure .................................................................................................................................129
Results .........................................................................................................................................129
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Sample description .................................................................................................................. 129
Pre-treatment attention bias differences between socially anxious and non-anxious
participants .............................................................................................................................. 131
Initial attention bias. ............................................................................................................ 131
Difficulty to disengage. ....................................................................................................... 133
Changes in attention biases between pre- and post-treatment ................................................ 133
Initial attention bias. ............................................................................................................ 134
Difficulty to disengage. ....................................................................................................... 135
Prediction of treatment outcome ............................................................................................. 136
Initial attention bias. ............................................................................................................ 137
Difficulty to disengage. ....................................................................................................... 138
Discussion .................................................................................................................................. 141
References .................................................................................................................................. 148

Chapter 5: The role of therapeutic alliance and adult attachment in cognitive
behavioural therapy for Social Anxiety Disorder. ................................................................. 168
Abstract ...................................................................................................................................... 170
The role of therapeutic alliance and adult attachment in cognitive behavioural therapy
for Social Anxiety Disorder ...................................................................................................... 171
Method ....................................................................................................................................... 174
Participants .............................................................................................................................. 174
Treatment ................................................................................................................................ 175
Measures ................................................................................................................................. 175
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Working Alliance Inventory (WAI). ....................................................................................175
Experiences in Close Relationships-revised (ECR-R). ........................................................175
Social Interaction Anxiety Scale (SIAS ...............................................................................176
Procedure .................................................................................................................................176
Data Analysis ...........................................................................................................................176
Results .........................................................................................................................................177
Therapeutic Alliance as a Mediator between Attachment and Treatment Outcome. ..............178
Attachment Style as a Moderator of the Relationship between Therapeutic Alliance and
Treatment Outcome. .................................................................................................................178
Discussion ...................................................................................................................................179
References ...................................................................................................................................183

Chapter 6: General Discussion .................................................................................................191
Overview .....................................................................................................................................192
The influence of adult attachment style on attention biases and anxiety .................................192
The influence of adult attachment style on attention biases and Social Anxiety Disorder ......194
The influence of adult attachment style on attention biases and treatment outcome ...............196
The influence of adult attachment style on the therapeutic alliance and treatment outcome ..202
Theoretical Implications of the Current Findings ..................................................................203
Implications of the current findings for cognitive behavioural models of Social Anxiety
Disorder ....................................................................................................................................204
Implications of the current findings for attachment theory ......................................................205
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Clinical Implications of the Current Findings ....................................................................... 206
Attention biases and Social Anxiety Disorder ........................................................................ 206
Therapeutic alliance and Social Anxiety Disorder .................................................................. 207
Limitations of the Current Research and Recommendations for Future Research........... 209
Conclusion ................................................................................................................................. 210
References .................................................................................................................................. 211
Appendix……………………………………………………………………………………217

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List of Tables
Chapter 2
Table 1. Mean, standard deviation and significance for self-report measures of anxiety, social
anxiety, depression, and attachment style. ....................................................................................74
Table 2. Mean and standard deviations for angry and happy bias scores in the anxiety
induction and no anxiety induction conditions. .............................................................................75
Table 3. Vigilance for threat: Final mixed effects model of predictors of attention bias .............76
Table 4. Attention bias scores for participants by time interval (ms), anxiety condition and
stimulus valence. ............................................................................................................................77
Table 5. Time course of attention: Final mixed effects model of predictors of attention bias .....78
Chapter 3
Table 1. Differences in age, social anxiety, depression, anxious and, avoidant attachment
style for Control and Clinical Groups. ..........................................................................................97
Table 2. Results from tests comparing the effects of orthogonal polynomial time terms on
model fit. ........................................................................................................................................98
Table 3. Results from the growth curve analysis. .........................................................................99
Chapter 4
Table 1. Mean Scores for Control and Clinical Groups on Self-report Measures of Social
Anxiety, Depression and Attachment Style ..................................................................................156
Table 2. Mean (and Standard Deviation) Bias Scores Indicating the Probability of First
Fixation on the Emotional Relative to the Neutral Stimulus. ......................................................157
Table 3. Mean (and Standard Deviation) Bias Scores Indicating the Mean Disengagement
Time (milliseconds), and Mean Disengagement Time Relative to Neutral Images
(milliseconds). ..............................................................................................................................158
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