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Development, Feasibility and Outcome of Attachment Integrated Therapy for Persistent Depressive Disorder: A Pilot Study

Hassan Rahioui, Lana Kheirallah*, Jean Belbeze

Objectives: Persistent Depressive Disorder (PDD), newly developed in DSM-5, merges the diagnoses of chronic major depressive disorder with that of dysthymia. It is disabling and often difficult to treat. In psychotherapy, only the Cognitive Behavioural Analysis System of Psychotherapy (CBASP) has shown an interest in this pathology, especially in combination with antidepressants. However it has not taken attachment into consideration. With this limitation, we felt it was essential to integrate the attachment dimension and Attachment Integrated Therapy (AIT) was developed specifically for PDD. The purpose of the study was to assess the feasibility and results, found at the beginning (T1) at end of therapy (T2), 6 months after therapy (T3), and one year after therapy (T4), This article will present our preliminary results (T1 and T2), T3 and T4 are to follow.

Methods: This study included eight patients, suffering from PDD, according to the DSM-5, followed in an outpatient setting, at the Sainte-Anne hospital in Paris. The assessments were conducted on three levels: Depressive symptomatology (MINI, BDI-II), Attachment (RSQ) and Social Support (SSQ6).

Results: The BDI-II-results over both assessment times show an evolution, with an average reduction of depressive scores of 50%. In addition, attachment insecurity as reflected in attachment styles as well as representations of oneself and others also improves.

Conclusion: The findings on outcomes as well as on feasibility of the outpatient AIT program are promising. Moreover, this study suggests that chronic activation of the attachment system may be a predictor of the development of depressive persistent disorder. When treating depressive persistent disorder, attachment should therefore be addressed.