Recovery from Post-Traumatic Stress Disorder: The role of Attachment theory and Perceived Social Support

Background: Close to 80% of the population is exposed to at least one traumatic event during their lifetime, while nearly 7% develop Post Traumatic Stress Disorder (PTSD) as a result (Sledjeski, Speisman, & Dierker, 2008). This syndrome can significantly affect daily functioning of people suffering from it and impact their quality of life (Kessler, 2000). Existing treatments bring relief of symptoms in 40-70% of those who complete treatment (Bradley et al., 2005).

While many studies have been conducted regarding the risk factors for developing PTSD and on the efficacy of treatments for the syndrome, few studies explain and describe the ones that do not get better. Of those studies that attempt to explain the recovery, it was found that demographic variables (e.g., age, gender) and genetic factors, as well as the severity of depression and of post-trauma symptoms, and social support are all related to recovery (Blain, Galovski, & Robinson, 2010; Bryant et al., 2010; Rizvi, Vogt, & Resick, 2009; Stein, Dickstein, Schuster, Litz, & Resick, 2012; Thrasher, Power, Morant, Marks, & Dalgleish, 2010). However, these risk factors do not offer a thorough explanation of the mechanism for recovery from the syndrome. As a result, caregivers are not prepared to deal with patients suffering from PTSD with a poor prognosis for recovery.

The present study attempts to characterize the difference between recovery and non-recovery from the syndrome by a person's attachment style according to Bowlby's theory (Bowlby, 1969, 1973). A possible explanation for the link between the attachment style and recovery from PTSD is the social support as a mediator between the two variables.

Research hypotheses: It was hypothesized that the more secure a person's attachment style, the stronger the perceived social support will be. In addition, the more secure a person's attachment style, the better chance he has for recovery. Another hypothesis was that the stronger a person's social support, the better his recovery is likely to be. In addition, a mediator hypothesis was developed, which assumed social support would mediate the relationship between attachment style to recovery. Finally, it was hypothesized that the attachment style explains the recovery from PTSD better than other variables that were found in previous studies to be associated with recovery; such variables include the level of post-traumatic symptoms, depression level, socio-demographic background, treatment received, and social support.

Method: The present study is a secondary quantitative analysis of data collected as part of a clinical study of trauma Research Center at Hadassah University Hospital. This study followed adults who came to the emergency room after a one-time traumatic event and examined the range of interventions following the event. The current study population consisted of 175 people from this population group, who were diagnosed with PTSD, and incorporated into one of the following groups: prolonged exposure therapy, cognitive therapy, medication treatment, placebo treatment, and waiting list.

The research made use of questionnaires to diagnose PTSD (CAPS), to classify attachment styles (ECR), to determine perceived social support (MSPSS), socio-demographic breakdown, PTSD symptoms levels (PSS-SR), and Beck depression (BDI). The analysis was done using the Pearson test, Manova test, T-test, Sobel test, and hierarchical logistic regression analysis.

Results and Discussion: Results of this study confirmed the hypothesis that there is a positive correlation between the attachment style and perceived social support. Other research hypotheses were not confirmed. The hypotheses that assumed a positive relationship between attachment style and recovery from PTSD, and a positive relationship between social support and recovery from PTSD were not confirmed. The research hypothesis that dealt with the mediation of the relationship between the attachment style and the recovery from PTSD, using social support was not confirmed as well. The last hypothesis, which dealt with the contribution of the attachment style in explaining the difference in recovery from PTSD, beyond the contributions of other relevant variables, was not confirmed either. Significant unique contribution was found from active treatment (cognitive therapy, prolonged exposure or medication), therefore the probability of recovery was greater among participants in these treatments, than participants in the inactive treatment (placebo treatment or waiting list).

Limitations: This study did not examine the therapeutic alliance and its impact on recovery. In addition, the attachment style was measured only before the intervention, and not measured at time of completion as well. It was found that the attachment style is dynamic and may change following important events in life, especially following treatment (Mikulincer, Shaver, & Solomon, 2015; Muller & Rosenkranz, 2009). In addition, the study examined recovery only in a dichotomous way. Finally, there is a constraint regarding the size of the sample, and the fact that it refers to a specific, focused traumatic event (car accident) and does not refer to cases of exposure to other types of trauma or prolonged trauma.

Conclusions: Clinically, results suggest that a patient's chances for recovery are "equal". The attachment style, created early in life and remaining largely constant during one's lifetime, is not a helpful in predicting the chances of a person recovering from PTSD. This is also an important contribution for caregivers, who can rely on existing treatments as suitable interventions for patients with a variety of different attachment styles.