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Attachment Style in the Prediction of Recovery Following Group Treatment of Combat Veterans With Post-Traumatic Stress Disorder

Forbes, David PhD*; Parslow, Ruth PhD*; Fletcher, Susan PGDip Psych*; McHugh, Tony MA†‡; Creamer, Mark PhD*

The Journal of Nervous and Mental Disease: December 2010 - Volume 198 - Issue 12 - p 881-884
doi: 10.1097/NMD.0b013e3181fe73fa
Original Articles

Post-traumatic stress disorder (PTSD) can be difficult to treat, with gains often particularly modest in combat veterans. Although group-based treatments are commonly delivered for veterans, little is known about factors influencing their outcomes. Attachment style is known to be associated with psychopathology after trauma and is critical to group-based interventions, but has not yet been investigated in relation to treatment outcome. A better understanding of factors that influence outcome is critical in optimizing the effectiveness of such interventions. This study investigated attachment style as a predictor of outcome for 103 veterans attending group-based treatment for combat-related PTSD. Measures included the Clinician Administered PTSD Scale, PTSD Checklist, and Relationship Styles Questionnaire. Path analyses indicated preoccupied attachment style strongly negatively predicted outcome following treatment. The preoccupied attachment style impedes recovery in group-based treatment for veterans with PTSD. Potential mechanisms underlying this finding are discussed. The results suggest that greater attention should be paid at initial assessment to attachment style of veterans before entering PTSD treatment, particularly group-based interventions.

*Department of Psychiatry, Australian Centre for Posttraumatic Mental Health, University of Melbourne, Victoria, Australia; †Victorian Psychological Trauma Recovery Service, Melbourne, Australia; and ‡Department of Psychiatry, University of Melbourne, Melbourne, Australia.

Send reprint requests to David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Level 1/340 Albert St, East Melbourne, Victoria 3002, Australia. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.