of Sara Kerstine Nielsen's thesis:

The overall aim of the thesis was to examine the factors associated with the development and maintenance of anxiety disorders in adults and the predictive value of these factors in relation to group-based cognitive behavioral therapy delivered in routine clinical settings.

The thesis includes one protocol article and four empirical articles, which examine:

  1. if the associations between insecure attachment style and anxiety symptoms are mediated by difficulties in emotion regulation,
  2. if emotion regulation, attentional control, and attachment style predict the outcome of group-based CBT,
  3. if attachment style influences attentional abilities, and
  4. if attachment style, emotion regulation, and attention control change over the course of group-based CBT.

This investigation focused on a sample of 91 adults with anxiety disorders (generalized anxiety disorder, social anxiety, panic disorder and agoraphobia) referred for treatment in three outpatient clinics in mental health services in the Capital Region of Denmark. Articles 1, 3 and 4 also include a sample of 57 non-anxious adults. The studies showed that the association between attachment anxiety and anxiety symptoms was fully mediated by difficulties in emotion regulation. Furthermore, the results showed that high attachment anxiety significantly predicted poorer CBT outcome. In addition, the results revealed that attachment style affected basic attentional abilities; specifically, individuals with high levels of attachment anxiety and avoidance were slower to initiate the processing of relevant stimuli after being presented with irrelevant angry faces. Lastly, the results showed that emotion regulation and attachment anxiety changed significantly after CBT, but only the effect on emotion regulation was maintained at the 6-month follow-up. In conclusion, the results support the theoretical conceptualizations and previous empirical findings that attachment style is involved in the etiology and maintenance of anxiety disorders, and that individuals with high attachment anxiety may not profit from group-based CBT in clinical settings.