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Abstract

Although cognitive and behavioural approaches to depression have garnered significant empirical support, epidemiological data does not indicate that the depression burden has decreased (Ormel et al., 2020). With Cognitive Behavioural Therapy (CBT) now being regularly delivered in a remote capacity since the COVID-19 pandemic (Lutz et al., 2021; Wolstencroft, 2020), attachment theory could develop the understanding of how CBT works and for whom it may be more effective for (Horvath, 2018; Levy et al., 2018; Levy & Johnson, 2019; Wampold, 2015), across the two delivery methods (in-person and remote). As such, this thesis aimed to explore whether client attachment moderated the relationship between the delivery mode of CBT (remote or in-person) and therapeutic outcomes for depression (PHQ-9) within an NHS Talking Therapies Service (formerly IAPT).

A quantitative, cross-sectional design was implemented to investigate the role of adult client attachment on treatment outcomes following 8 sessions of CBT for Depression in an NHS Talking Therapies Service. 124 participants were recruited to participate in the study, where 58 individuals completed CBT in-person, and 66 participants completed CBT remotely. Participants completed the Experiences in Close Relationships Revised (ECR-r) questionnaire to assess attachment and engaged with CBT as usual. Depressive symptomology was measured using the Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer & Williams, 2001), prior to participants beginning CBT as well as at the end of treatment.

In line with existing literature, quantitative analysis provided further evidence to suggest the efficacy of CBT to treat depression with little differences in outcomes for those who completed CBT remotely compared to those who completed CBT in-person. Preliminary results provide evidence of the role of attachment as a moderator. High attachment anxiety positively moderated when CBT was completed in-person, but not in the remote condition. Conversely, there was no significant effect of high attachment avoidance in either the remote or in-person condition.

Results imply that attachment theory could inform the development of CBT to include recognition of interpersonal and relational factors to case conceptualisation, formulation and treatment plans for depressed individuals. Adaptations to current CBT protocols are suggested as well as considerations for future research.

Publication Type:	Thesis (Doctoral)
Subjects:	B Philosophy. Psychology. Religion B Philosophy. Psychology. Religion > BF Psychology R Medicine
Departments:	School of Health & Medical Sciences > Psychology School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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