Illness representations,coping and psychological adjustment to Parkinson's disease

The present study reports an application of the common sense model (CSM) of illness representations to the prediction of psychological distress in people with Parkinson's disease (PD). The study sought to (i) examine cross-sectional and prospective associations between illness representations, coping and psychological distress, and (ii) test the hypothesis that coping would mediate any relationships between illness representations and psychological distress. Patients with PD (n = 58) completed the Illness Perception Questionnaire-Revised, the Medical Coping Modes Questionnaire and the Hospital Anxiety and Depression Scale. Patients (n = 57) were followed-up at 6 months. Illness representations explained large amounts of variance in time 1 anxiety (R ² = 0.42) and depression (R ² = 0.44) as well as additional variance in time 2 anxiety (ΔR ² = 0.12) and depression (ΔR ² = 0.09) after controlling for baseline scores. In addition, avoidance mediated the effect of emotional representations on time 1 anxiety, and acceptance-resignation mediated the effects of both consequences and emotional representations on time 1 depression. The present study therefore provides partial support for the mediational model outlined in the CSM, as significant mediation effects were found only in the cross-sectional analyses.     

“Digging in” or “Giving in”: Attachment-related threat moderates the association between attachment orientation and reactions to conflict

Prior research suggests that individuals higher in attachment anxiety react to conflict in a more hostile manner than those lower in attachment anxiety. Although less pronounced, there is also evidence that attachment anxiety is associated with submissive behavior in conflict. Thus, the literature presents a paradox, as attachment anxiety is associated with both domineering and submissive responses to relationship conflict. We proposed that attachment-related threat moderates the effects of attachment orientations on conflict behavior, such that under conditions of low threat attachment anxiety would be associated with dominance, whereas under conditions of high threat attachment anxiety would be associated with submission. Further, we expected that this interaction between attachment anxiety and threat condition would be stronger for individuals lower in attachment avoidance, relative to those higher in avoidance. We found support for our hypotheses, such that attachment anxiety, attachment avoidance, and threat interacted to predict responses to relationship conflict.     

Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus

Abstract

The study examined the role of illness perceptions and self-efficacy in diabetic regimen adherence and metabolic control among young patients with Insulin Dependent Diabetes Mellitus (IDDM). Sixty-four outpatients with Insulin Dependent Diabetes completed measures of illness perceptions, generalised and diabetes specific self-efficacy and a self-report measure of adherence. Metabolic control (HbAlc) was also assessed. Control, identity and consequences components of illness perceptions were significantly correlated with self-efficacy expectancies. Control beliefs were consistently associated with self-reported adherence across all treatment aspects and accounted for 39% of the predicted variance in total adherence. The associations of the other psychological predictors examined, varied depending on the regimen area. Multiple regression analysis showed that 30.8% of the variance in HbAlc assays was explained by patients' diabetes specific self-efficacy, consequences and identity. Our findings suggest that patients' beliefs are useful predictors of physiological and behavioural outcomes in diabetes self-management and should thus be the focus of routine clinical assessments and future interventions.     

Attentive processing of threat and adult attachment: a dot-probe study

We examined selective attention to threat stimuli as a function of individual differences in adult attachment. Participants completed a dot-probe task in which a general threat word, attachment-related threat word, general positive or attachment-related positive word was presented together with a neutral word. Results showed that attachment anxiety and avoidance were associated with an attentional bias away from attachment threat words. This attentional avoidance effect was best predicted by the interaction between attachment anxiety and avoidance and not by their unique main effects. The findings are discussed in terms of attachment theory and its relation to attentional biases observed in psychopathology.     

Attachment-related affective dynamics: differential reactivity to others' interpersonal behavior

We examined the influences of attachment orientations on within-person changes in affect as a function of perceptions of the interaction partner's agreeable behavior in interactions involving a romantic partner and other kinds of partners. Working adults reported affect, perceptions of the other person's behavior, and the relationship with the other in interpersonal events during 20 days. As expected, the within-person association between perceived partner's agreeable behavior and negative affect was stronger for individuals higher on attachment anxiety and was weaker for individuals higher on attachment avoidance. These effects were more pronounced in interactions with a romantic partner than with other persons. Findings demonstrate that attachment orientations are associated with differing within-person processes and that these processes are sensitive to kind of interaction partner.     

Attachment Representations and Maternal Confidence: The Mediating Role of Postnatal Depressive Symptoms and Negative Thoughts

Attachment security can act as an inner resource to promote women’s adjustment to motherhood. However, the mechanisms explaining the relationship between attachment representations and maternal adaptation outcomes are not well understood. This study aimed to examine the direct and indirect effects of attachment representations on maternal confidence, through postpartum negative automatic thoughts and depressive symptoms. The sample consisted of 387 postpartum women who completed a cross-sectional online survey including measures of attachment representations, depressive symptoms, postpartum negative automatic thoughts and maternal confidence. Our results showed a significant relationship between more insecure attachment representations and higher depressive symptoms (p?<?.001), but also with more frequent postpartum negative automatic thoughts (p?<?.001); depressive symptoms and postpartum negative automatic thoughts were also inversely associated with women’s maternal confidence (p?<?.001). Moreover, indirect effects of attachment representations on maternal confidence were found, but only through postpartum negative thoughts [attachment-related anxiety: 95% CI?=??0.03/?0.01; attachment-related avoidance: 95% CI?=??0.05/?0.01]. The results of the present study emphasize the important role of the cognitive component of depressive symptomatology (postpartum negative automatic thoughts) in the relationship between attachment representations and maternal confidence, allowing to draw specific implications. We highlight the implications for clinical practice during the perinatal period to address both negative thoughts and women’s maternal confidence.     

Posttraumatic stress symptoms following childbirth and mothers' perceptions of their infants

Postpartum psychological distress can adversely affect the early mother–infant relationship; however, this has not been investigated in relation to posttraumatic stress disorder (PTSD) following childbirth. This article explores whether PTSD symptoms relating to labor and delivery are associated with mothers' early perceptions of their infant. Using labor and childbirth as the stressor criterion, 211 women were assessed at 6 weeks' postpartum for symptoms of intrusions, avoidance, and hyperarousal. Their perceptions of their infants, of mother‐to‐infant attachment, and infant behavioral characteristics also were evaluated. In sum, 3.8% of the women fulfilled full diagnostic criteria, and a further 21.3% reported clinically significant symptoms on at least one dimension of PTSD. Those meeting full or partial criteria perceived their attachment relationships to be significantly less optimal and reported more negative maternal representations in terms of their infants being less warm and more invasive. They also rated them as being temperamentally more difficult, prone to distress, and less easy to soothe. However, when the effects of depression were partialled, only the effect for perceived warmth remained. Posttraumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother–infant relationship. The overlap with depressive symptoms requires further exploration.     

Attachment theory and reactions to others' needs:' evidence that activation of the sense of attachment security promotes empathic responses.

Five studies examined the effects of chronic and contextual activation of attachment security on reactions to others' needs. The sense of attachment security was contextually primed by asking participants to recollect personal memories, read a story, or look at a picture of supportive others or by subliminally exposing them to proximity-related words. This condition was compared against the priming of neutral themes, positive affect, or attachment-insecurity schemas. Then reports of empathy and personal distress or the accessibility of empathy and personal-distress memories were assessed. Attachment-security priming strengthened empathic reactions and inhibited personal distress. Self-reports of attachment anxiety and avoidance were inversely related to empathy, and attachment anxiety was positively related to personal distress. The discussion emphasizes the relevance of attachment theory for explaining reactions to others' needs.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

Attachment insecurity and perceptions of housework: Associations with marital well-being.

This exploratory study examines the interactive effects of attachment insecurity and perceptions of housework on 2 dimensions of marital well-being--satisfaction and perceptions of fairness. Participants were 148 married couples obtained from an area probability sample as part of a larger study. Multilevel modeling analyses with the couple as the unit of analysis showed that women who scored high and men who scored low on the dimension of attachment anxiety and reported that their spouses performed more routine housework (i.e., prepares meals) also reported being over-benefited. Women who scored high and men who scored low on the dimension of attachment avoidance and reported that their spouses performed more intermittent housework (i.e., yard work) reported greater marital satisfaction. These results highlight the role of attachment orientations in explaining why perceptions of housework may have more or less prominent effects on marital well-being.     

Attachment Insecurity and Perceived Partner Suffering as Predictors of Personal Distress

This study examined the extent to which perceptions of partner suffering mediate the association between attachment insecurity (anxiety and avoidance) and personal distress among spouses of older adults with osteoarthritis. Fifty-three spouses watched two videos of targets (their partner and an opposite sex stranger) perform a pain-eliciting household task, and spouses were asked to rate their own distress and perceptions of the targets' pain. Spouses also completed self-report measures of trait attachment. Results revealed that attachment anxiety was associated with greater personal distress in reaction to the partner's suffering, and heightened perceptions of partner pain mediated this association. Avoidant attachment was associated with less distress in reaction to the partner's suffering, but not with less perceived pain. The results of this study identify an important mechanism linking attachment insecurity and heightened distress responses when observing the suffering of a significant other.     

Genes, personality, and attachment in adults: a multivariate behavioral genetic analysis

Behavioral genetic methods were used to estimate genetic and environmental contributions to (a) attachment-related anxiety and avoidance and (b) the overlap between these attachment dimensions and the Big Five personality traits. Two major findings emerged from these analyses. First, individual differences in attachment-related anxiety and avoidance were heritable, and second, much of the overlap between adult attachment and the Big Five traits was due to shared genetic influences. Discussion focuses on the implications of these results for attachment theory and research and provides a speculative account of the interplay between temperamental dimensions and internal working models of relationships across the life span.     

Attachment Orientations: Predicting Psychological Distress in German and Turkish Samples

This study examined the relationship between attachment orientations and psychological distress, as well as cultural moderation in this relationship, among 241 university students from Germany and Turkey. Attachment orientations predicted the elevation of psychological distress in both samples. Attachment anxiety in the German sample and attachment avoidance in the Turkish sample showed stronger association with the elevation in psychological distress. The results and potential implications for counseling research and practice are discussed.     

With or without you: The impact of partner presence and attachment on exploration

Past research has examined the link of attachment anxiety and avoidance with exploration in adults, though results have been inconsistent and have relied primarily on self-reports. We hypothesized that the presence of the attachment figure (i.e., romantic partner) would play a critical moderating role on exploration duration and enjoyment. Eighty-six couples were randomly assigned to explore alone or with the partner in order to examine the moderating effect of partner presence on the effects of individuals' anxiety and avoidance as well as the partner's anxiety and avoidance. Consistent with hypotheses, there were significant two-way interactions of partner presence with anxiety, avoidance, and partner anxiety. When exploring alone, more (vs. less) anxious individuals spent less time exploring and felt less positive affect. When exploring with the partner, more (vs. less) avoidant individuals spent less time exploring and felt less positive affect. Individuals with more anxious partners felt more positive affect after exploring alone than with the partner, whereas individuals with more avoidant partners were not affected by the partner's presence. Above and beyond individuals' attachment style, partner presence and partner attachment style have implications for exploratory behavior.     

Asymmetry in self-other agreement on attachment style among romantic partners

This research reports about asymmetrical relations in self-other ratings of attachment style. Specifically, results showed that romantic partners hold relatively accurate perceptions of each other’s attachment styles with one exception: women’s ability to judge their male partner’s level of attachment-related anxiety was compromised compared with the other agreement indices measured. The effect was not moderated by acquaintanceship length or relationship satisfaction, but it was affected by men’s interpersonally oriented self-control. The findings appear to reflect men’s reluctance from appearing anxious to their female partners and from the nature of the anxiety dimension of attachment. Anxiety (as compared with avoidance) has a less consistent interpersonal behavioral manifestation and thus is more concealable among those motivated and capable of doing so.     

The relationship between sensory responsiveness profiles,attachment orientations,and anxiety symptoms

Individual variations in the way people respond to sensory stimuli can sometimes lead to maladaptive representations of the world. Indeed, sensory responsiveness profiles were found to be associated with mood symptoms such as depression and anxiety. The goal of the current study was to investigate whether attachment orientations can account for the relationship between sensory responsiveness profiles and anxiety symptoms. Participants (N = 194) completed a battery of questionnaires assessing sensory responsiveness profiles, attachment orientations, and anxiety symptoms. As expected, various associations between sensory responsiveness profiles and anxiety symptoms were accounted for by attachment anxiety and avoidance. We suggest a possible causal path, in which early‐developing sensory responsiveness profiles lead to attachment insecurities, which in turn may lead to mood symptoms such as anxiety.     

Do episodic self- and partner-uncertainty mediate the association between attachment orientations and emotional responses to relationship-threatening events in dating couples?

This study examined relational-uncertainty perceptions (a form of cognitive appraisal) to investigate how partners in 272 heterosexual couples responded emotionally to a relationship-challenging event. Participants rated themselves on attachment anxiety and avoidance. Then, after listing a challenging event, they rated how uncertain it made them about their own and their partner's continued involvement in the relationship. Participants also rated how angry and fearful the event made them. An Actor-Partner Interdependence Model yielded three sets of results. First, actor effects from insecure attachment orientations to episodic relational uncertainty emerged. Second, proposed mediation between attachment orientations and emotional reactions by uncertainty was partially supported (perceived partner-uncertainty partially mediated the positive association of anxious attachment and fear, and self-uncertainty partially mediated the positive relation between avoidant attachment and anger). Finally, a partner effect was found between one couple member's avoidant attachment and the other's perceived partner uncertainty. Men and women exhibited similar findings.     

In and out of a daydream: attachment orientations, daily couple interactions, and sexual fantasies

In this study, the authors examined the contribution of attachment orientations to the content of daily sexual fantasies. The two partners of 48 couples independently reported on their attachment orientations and provided daily reports on relationship interactions and sexual fantasies for a period of 21 days. Results showed that attachment anxiety was associated with wishes for intimacy and representations of others as more affectionate in sexual fantasies. Conversely, avoidant attachment was associated with avoidance-related wishes and representations of the self and others as more aggressive and alienated. Negative couple interactions increased habitual attachment-related wishes and self-representations. Specifically, during days characterized by negative couple interactions (relationship-damaging behaviors), attachment anxiety was associated with portrayal of the self as more helpless and avoidant attachment was associated with the expression of more avoidant wishes and portrayal of the self as less helpless. The discussion focuses on the manifestations of attachment-related interpersonal goals in sexual fantasies.     

Together in pain: attachment-related dyadic processes and posttraumatic stress disorder

We used actor-partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor-partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives.