Dialectical Behavior Therapy in Acquisition of Earned Secure Attachment to Improve Medication Adherence among Patients with Hypertension in Selected Mission Hospitals in Thika, Kenya

Abstract

Attachment styles govern responses to stressful events and are emotional bonds formed in childhood between infants and caregivers. Some individuals develop secure attachment styles while others develop insecure attachment styles. Diagnosis and management of hypertension is a stressful experience that could trigger attachment behavior. However, research on psychological interventions for medication adherence remains limited. The purpose of this study was to investigate the impact of Dialectical Behavior Therapy (DBT) in the acquisition of earned secure attachment to enhance medication adherence among patients with hypertension in selected mission hospitals in Thika, Kenya. The study aimed to establish determinants of medication adherence, examine relationship between attachment styles and medication adherence as well as distress tolerance, and evaluate influence of earned secure attachment on medication adherence. The study was grounded on Attachment Theory, DBT Theory, and DBT theory of change. The study had a quasi-experimental design. Calculated sample size of 80 guided selection of male and female participants obtained through random sampling. Quantitative data were collected using a sociodemographic questionnaire, the Relationship Questionnaire, the Morisky’s Medication Adherence Scale-8, and the Distress Tolerance Scale. Data were analyzed using descriptive and inferential statistics using SPSS v29. Education was a significant demographic predictor of adherence from midline (p =.021). Medication adherence improved significantly due to acquisition of earned secure attachment (ESA) (p =.002). Dismissing attachment style significantly predicted lower distress tolerance (p =.004). DBT was effective in facilitating acquisition of ESA (RD = 47%, NNT = 3) and having ESA predicted 12 times more likelihood for higher adherence (p <.001). Overall, the study demonstrated that DBT can effectively enhance medication adherence by acquisition of earned secure attachment and enhancing distress tolerance among patients with insecure attachment styles. The study concluded that attachment dynamics are important in health behaviors and recommended that attachment-based support may be incorporated in chronic disease care focusing on transition to earned secure attachment. Future research could explore long-term sustainability of ESA, cross-cultural applicability of DBT in medical settings, and integration of clinical psychology interventions within multidisciplinary care models.