A descriptive study of symptom change as a function of attachment and emotion regulation in a naturalistic adolescent inpatient setting.

This is the first study to describe the relation between attachment security, emotion regulation, and symptom change in a sample of adolescents completing inpatient treatment in a naturalistic setting. We examined whether attachment security predicted symptom change, and whether emotion regulation capacities mediated this relation. A sample of n = 194 inpatient adolescents was assessed (65.5 % female, Mage = 15.45 years, SD = 1.44) at admission and discharge and analyses were conducted in accordance with the aforementioned objectives including testing of moderation and mediation models. We found that securely attached adolescents experienced greater reduction in internalizing symptoms from admission to discharge, even when controlling for length of stay. Nonacceptance of emotional responses mediated the relation between maternal attachment security and internalizing symptom change. These findings did not hold for externalizing symptoms, nor when paternal attachment was explored. Attachment plays an important role in symptom change for internalizing problems, with nonacceptance of emotional responses partially mediating this link. Possible explanations for the absence of moderation for paternal attachment and externalizing problems are discussed, as are explanations for the mediating effect of emotion regulation.