Attachment styles and clinical correlates in people at ultra high risk for psychosis

Evidence suggests that attachment styles may influence subclinical psychosis phenotypes (schizotypy) and affective disorders and may play a part in the association between psychosis and childhood adversity. However, the role of attachment in the initial stages of psychosis remains poorly understood. Our main aim was to describe and compare attachment styles in 60 individuals at ultra high risk for psychosis (UHR) and a matched sample of 60 healthy volunteers (HV). The HV had lower anxious and avoidant attachment scores than the UHR individuals (p < .001). Sixty-nine percentage of the UHR group had more than one DSM-IV diagnosis, mainly affective and anxiety disorders. The UHR group experienced more trauma (p < .001) and more mood and anxiety symptoms (p < .001). Interestingly, in our UHR group, only schizotypy paranoia was correlated with insecure attachment. In the HV group, depression, anxiety, schizotypy paranoia, and social anxiety were correlated with insecure attachment. This difference and some discrepancies with previous studies involving UHR suggest that individuals at UHR may compose a heterogeneous group; some experience significant mood and/or anxiety symptoms that may not be explained by specific attachment styles. Nonetheless, measuring attachment in UHR individuals could help maximize therapeutic relationships to enhance recovery.     

Early trauma,negative affect,and anxious attachment: the role of metacognition

Background and Objectives: Metacognition is linked to the etiology and maintenance of negative emotions and psychological disorder in the Self-Regulatory Executive Function Model. Although there is significant evidence supporting the model, little is currently known about the situational factors for developing dysfunctional metacognitions. The current study explored the hypothesis that early aversive experiences might be important and also tested if metacognitions could mediate the relationship between such experiences and psychological symptoms. Design and Methods: Three hundred and fifty non-clinical adults completed a retrospective early trauma measure, as well as measures of current metacognitive beliefs, negative affect, and anxious attachment. Results: Early emotional abuse positively and significantly correlated with several metacognitive belief dimensions but other forms of early trauma did not. Metacognition fully mediated the relationship between emotional abuse and negative affect. Anxious attachment was also positively and significantly associated with metacognitive beliefs and specific relationships remained after controlling for early emotional abuse and current negative affect. Conclusions: Findings are consistent with the ideas that: (i) early negative experiences, and emotional abuse in particular, could be a factor in the formation of problematic metacognitions and (ii) these metacognitions may be important in determining the effects of abuse on subsequent psychological symptoms.     

Patterns of attachment and parents' adjustment to the death of their child

The impact of adult attachment on psychological adjustment among bereaved parents and the mediating effect of relationship satisfaction were examined among a sample of 219 couples of parents. Data collection took place 6, 13, and 20 months after loss. Use of the actor partner interdependence model in multilevel regression analysis enabled exploration of both individual as well as partner attachment as predictors of grief and depression. Results indicated that the more insecurely attached parents were (on both avoidance and anxiety attachment), the higher the symptoms of grief and depression. Neither the attachment pattern of the partner nor similarity of attachment within the couple had any influence on psychological adjustment of the parent. Marital satisfaction partially mediated the association of anxious attachment with symptomatology. Contrary to previous research findings, avoidant attachment was associated with high grief intensity. These findings challenge the notion that the avoidantly attached are resilient.     

Adult attachment dimensions and specificity of emotional distress symptoms: prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms

Three prospective studies examined the relation between adult attachment dimensions and symptoms of emotional distress (anxiety and depression). Across all three studies, avoidant and anxious attachment prospectively predicted depressive symptoms, and anxious attachment was associated concurrently with anxiety symptoms. Study 2 tested a cognitive risk factors mediational model, and Study 3 tested an interpersonal stress generation mediational model. Both cognitive and interpersonal mediating processes were supported. The cognitive risk factors pathway, including elevated dysfunctional attitudes and low self-esteem, specifically mediated the relation between insecure attachment and prospective elevations in depression but not anxiety. For the interpersonal stress generation model, experiencing additional interpersonal, but not achievement, stressors over time mediated the association between insecure attachment and prospective elevations in depressive and anxious symptoms. Results advance theory and empirical knowledge about why these interpersonal and cognitive mechanisms explain how insecurely attached people become depressed and anxious.     

Navigating the interdependence dilemma: Attachment goals and the use of communal norms with potential close others

Four studies investigated attachment in the context of new relationship development. Anxiously attached individuals overwhelmingly used communal norms and avoided using exchange norms when interacting with a potential close other; however, when a potential close other used communal norms, anxious individuals experienced increased interpersonal anxiety. Anxious individuals also used discrete communal behaviors to diagnose relationship potential. By contrast, secure individuals were more comfortable in potential communal situations. Moreover, implicit thoughts about closeness were associated with improved performance on a mental concentration task for secure individuals, whereas implicit closeness thoughts were associated with poorer performance for anxious individuals. Finally, avoidant individuals disliked the potential close other when the other used communal norms and downplayed relational motives for the other's communal behavior.     

Emotional regulation,attachment to possessions and hoarding symptoms

This study aimed to test which particular facets of emotion regulation (ER) are most linked to symptoms of hoarding disorder, and whether beliefs about emotional attachment to possessions (EA) mediate this relationship. A non‐clinical sample of 150 participants (108 females) completed questionnaires of emotional tolerance (distress tolerance, anxiety sensitivity, negative urgency – impulsivity when experiencing negative emotions), depressed mood, hoarding, and beliefs about emotional attachment to possessions. While all emotional tolerance measures related to hoarding, when considered together and controlling for depression and age, anxiety sensitivity and urgency were the significant predictors. Anxiety sensitivity was fully mediated, and urgency partially mediated, via beliefs regarding emotional attachment to possessions. These findings provide further support for (1) the importance of anxiety sensitivity and negative urgency for hoarding symptoms, and (2) the view that individuals with HD symptoms may rely on items for emotion regulation, leading to stronger beliefs that items are integral to emotional wellbeing.     

The Role of Attachment Anxiety and Avoidance in Communication Modality and Relationship Quality of Romantic Relationships Initiated Online

This study explores the relationships among an individual's attachment anxiety and avoidance, the ratio of technology mediated communication (TMC) in their relationship, and relationship quality for individuals who met their romantic partners online. Participants (N = 219) consisted of individuals between the ages of 18–25, who were US citizens, and met a romantic partner utilizing online dating, dating mobile web applications, social networking sites, online chatrooms, or any way of meeting through technology. A survey measuring relationship beliefs, relationship attitudes, and use of technology was distributed and completed via MTurk. Structural equation modeling revealed that anxious attachment was associated with a higher ratio of TMC, whereas avoidant attachment was not significantly related with the ratio of TMC. Higher ratios of TMC were associated with lower relationship quality. Implications for intervention are discussed.     

Attachment orientations and depression: a longitudinal study of new parents

In this longitudinal study, we followed a large sample of first-time parents (both partners) across the first 2 years of the transition to parenthood. Guided by attachment theory (Bowlby, 1969), we tested several predictions about how attachment anxiety and avoidance are related to the incidence, maintenance, increase, and decline of depressive symptoms in both sexes across the first 2 years of the transition. We found that (a) the association between attachment anxiety and depressive symptoms was moderated by factors related to the marital and/or romantic relationship; (b) the association between avoidance and depressive symptoms was moderated by factors related to family responsibilities; (c) styles of caregiving provided by romantic partners affected depressive symptoms differently among anxious and avoidant persons; and (d) in certain predictable situations, depressive symptoms persisted at higher levels or increased to higher levels in anxious or avoidant persons across the 2-year transition period. Important implications of these results are discussed.     

Childhood Maltreatment,Adult Attachment,and Depression as Predictors of Parental Self-Efficacy in At-Risk Mothers

Childhood abuse and neglect can have far-reaching effects on adult relationships, mental health, and parenting. This study examined relations between maltreatment types, anxious and avoidant adult attachment, maternal depression, and parental self-efficacy in a community sample of 76 at-risk mothers. After controlling for other forms of maltreatment, emotional abuse uniquely predicted higher levels of anxious attachment and maternal depression. Structural equation modeling revealed that childhood maltreatment predicted lower parental self-efficacy through indirect pathways involving anxious attachment and depression. Specifically, maltreatment's influence on maternal depression was mediated by attachment anxiety, while its influence on parental self-efficacy was mediated by depressive symptoms. Results are discussed in terms of attachment theory and ways in which parental self-efficacy contributes to adaptive caregiving behavior.     

Comparison of problematic internet and alcohol use and attachment styles among industrial workers in Korea

The objective of this article is to fully understand Internet addiction, we aimed to compare the attachment styles and psychopathologies associated with problematic Internet use with those related to alcohol use. Through the participation of 141 male participants, the present study assessed problematic Internet and alcohol use, attachment, psychopathology, and demographic data via the use of self-rating questionnaires. We explored the significant predictors among avoidant and anxious attachments, depression, anxiety, and phobia to explain problematic Internet and alcohol use. The results showed that anxious attachment, depression, and anxiety could explain problematic alcohol use. In contrast, both anxious and avoidant attachment as well as depression and phobia explained problematic Internet use. Additionally, depression moderated the effects of avoidant attachment on problematic Internet use. We demonstrated that the interaction of attachment and psychopathology predicts problematic Internet use originating from an earlier stage of life than that associated with problematic alcohol use.     

Prospective Relations Between Dysfunctional Metacognitive Beliefs,Metacognitive Strategies,and Anxiety: Results From a Four-Wave Longitudinal Mediation Model

The metacognitive model of psychological disorders suggests that emotional disorders are related to maladaptive metacognitive strategies corresponding to underlying dysfunctional metacognitive beliefs. There is substantial empirical evidence supporting a role of metacognition in psychopathology, but fewer studies have evaluated the metacognitive model using longitudinal data and taken into consideration its differentiation between components and how they are hypothesized to be related to each other. Thus, more specific model evaluation is important as it relates to identifying mechanisms of disorder with a potential to provide clinical advances. In the present study, 868 participants took part in a 4-wave survey and reported on metacognitive beliefs and strategies and anxiety symptoms. Two longitudinal mediation models (forward and reversed causation) were run to test temporal precedence and bidirectional relations. The results indicated that metacognitive beliefs significantly predicted metacognitive strategies, which further predicted anxiety symptoms and mediated the indirect effect in the relationship between metacognitive beliefs and anxiety over time. The relationship between metacognitive beliefs and anxiety symptoms over time were bidirectional, but this relationship was not accounted for by metacognitive strategies. These findings largely support central predictions set forward by the metacognitive model and indicate that metacognitions play a preceding and maintaining role in anxiety.     

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.     

A prospective investigation of the impact of attachment style on stress generation among clinically depressed individuals

The present study sought to determine if attachment style contributed to the generation of stressful life events among clinically depressed individuals during the course of treatment. Participants (N=68) were interviewed about life stressors experienced during a 3-month treatment protocol using a contextual approach (Life Events and Difficulties Schedule; [Brown, G. W., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. New York: Free Press]). Results suggested interactive effects between severity of depression and attachment style on stress associated with future sociotropic and dependent life events. Mildly depressed individuals who reported a dismissing attachment style (higher levels of avoidant attachment and lower levels of anxious attachment) or preoccupied style (lower levels of avoidant attachment and higher levels of anxious attachment) experienced higher levels of stress associated with sociotropic events. Likewise, a dismissing attachment style predicted stress associated with dependent events among mildly depressed individuals. These effects were not present among our more severely depressed participants.     

Examining the role of positive and negative metacognitive beliefs in depression

Many psychological models have been developed to explain the development and maintenance of depression. The most widely evaluated model is the cognitive model of depression, and it is against this model that emerging models should be compared. Accordingly, this cross‐sectional study examined whether metacognitive beliefs, as specified in the metacognitive model of depression, would explain additional variance in depressive symptoms over dysfunctional attitudes; the core feature of the cognitive model. Moreover, mediational relationships between metacognitive beliefs, rumination, and depressive symptoms, predicted by the metacognitive model were also explored, whilst controlling for dysfunctional attitudes. A sample of 715 students completed self‐report questionnaires measuring depressive symptoms, rumination, dysfunctional attitudes, and metacognitive beliefs. Regression analyses showed that metacognitive beliefs made a significant statistical contribution to depressive symptoms, after controlling for age, gender, rumination and dysfunctional attitudes. Furthermore, as predicted by the metacognitive model, the relationship between positive metacognitive beliefs and depressive symptoms was fully mediated by rumination, whilst the relationship between negative metacognitive beliefs about uncontrollability and danger and depressive symptoms was partially mediated by rumination. The results provide further empirical support for the metacognitive model of depression and indicate that positive and negative metacognitive beliefs play an integral role in the maintenance of depressive symptoms.     

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.     

Understanding associations between negatively biased attention and depression and social anxiety: positively biased attention is key

ABSTRACT

Background and objectives: Although research supports the premise that depressed and socially anxious individuals direct attention preferentially toward negative emotional cues, little is known about how attention to positive emotional cues might modulate this negative attention bias risk process. The purpose of this study was to determine if associations between attention biases to sad and angry faces and depression and social anxiety symptoms, respectively, would be strongest in individuals who also show biased attention away from happy faces.

Methods: Young adults (N?=?151; 79% female; M?=?19.63 years) completed self-report measures of depression and social anxiety symptoms and a dot probe task to assess attention biases to happy, sad, and angry facial expressions.

Results: Attention bias to happy faces moderated associations between attention to negatively valenced faces and psychopathology symptoms. However, attention bias toward sad faces was positively and significantly related to depression symptoms only for individuals who also selectively attended toward happy faces. Similarly, attention bias toward angry faces was positively and significantly associated with social anxiety symptoms only for individuals who also selectively attended toward happy faces.

Conclusions: These findings suggest that individuals with high levels of depression or social anxiety symptoms attend preferentially to emotional stimuli across valences.     

The Interpersonal Model of Health Anxiety: Testing predicted paths and model specificity

Health anxiety involves persistent worry about one’s health and is characterized by dysfunctional interpersonal processes such as excessive health-related reassurance-seeking and feelings of alienation from others. Cognitive-behavioral models largely ignore cyclical, interpersonally averse behaviors and social cognitions observed amongst health anxious individuals. The Interpersonal Model of Health Anxiety (IMHA) proposes health anxiety is maintained through activated anxious attachment insecurities, which drive frequent, but ineffective, health-related reassurance-seeking from others. Such excessive health-related reassurance-seeking leads to health-related alienation and beliefs others are unconcerned about one’s perceived health problems. Feeling alienated from others fuels further health-related worry, resulting in continued self-defeating attempts at health-related reassurance-seeking. The present study offers the first comprehensive articulation and test of the IMHA. Using a cross-sectional design and 107 undergraduates, path analysis supported five of six hypothesized paths in the model; all paths except that from anxious attachment to health-related reassurance-seeking were significant and in the expected direction. Specificity tests suggested anxious attachment was more central than avoidant attachment to the IMHA. The present test of the IMHA as a single, coherent model provides a conceptual foundation for future research on interpersonal processes in health anxiety. Clinical implications are discussed.     

Naturalistic Partial Sleep Deprivation Leads to Greater Next-Day Anxiety: The Moderating Role of Baseline Anxiety and Depression

The detrimental effects of insufficient sleep on emotional functioning have been well established. Total sleep deprivation usually leads to increased anxiety and depressive symptoms the following day. However, no study has yet examined the relationships between unmanipulated partial sleep deprivation and next-day symptoms of anxiety and depression in everyday life, which this study sought to characterize. Participants (N = 94) completed daily diary surveys twice per day for 2 weeks without instructions to alter their sleep in any way. Nights of spontaneous, naturally occurring partial sleep deprivation were followed by increased levels of self-reported symptoms of anxious arousal the next day, but were unrelated to next-day symptoms of anhedonic depression or general distress. The relationship between partial sleep deprivation and next-day anxious arousal was found to be moderated by both baseline depressive symptoms and anxiety such that individuals reporting higher levels of depression or anxiety at baseline showed relatively greater increases in symptoms of anxiety following partial sleep deprivation. These results suggest that partial sleep deprivation occurring in everyday life can lead to higher next-day levels of anxious arousal, a relationship that is particularly deleterious for individuals with higher overall levels of anxiety or depressive symptoms.     

Adult attachment and perceptions of closeness

An online sample of more than 150,000 participants was used to examine whether—in addition to predicting how much intimacy people want—attachment styles also predict how people define and perceive intimacy. Results indicated that, as compared with relatively secure individuals, people with high levels of attachment anxiety required more time, affection, and self‐disclosure to construe a relationship as “close.” Additionally, anxious individuals perceived less intimacy in relationship vignettes than did their less anxious peers. In contrast, highly avoidant individuals required less time, affection, and self‐disclosure to define a relationship as “close,” and they perceived more intimacy in vignettes than did their more secure peers. These findings indicate that people who are relatively anxious not only want more intimacy in their relationships, but they are also less likely to perceive intimacy, as compared with their less anxious peers. Conversely, people high in avoidance not only want less intimacy, but they are also more sensitive to its presence, as compared with their less avoidant peers.     

Structure and Measurement Invariance of Adult Romantic Attachment

Romantic attachment is a popular theory for explaining affect, cognition, and behavior in romantic contexts. This popularity has led to a surge of self-report measures assessing dimensions of attachment. In this study, we considered the ability of 2 common attachment measures, the Adult Attachment Questionnaire (AAQ) and the Experience in Close Relationships–Revised (ECR–R), to replicate the avoidant and anxious attachment factors. We also determined the degree of measurement invariance across, and mean differences between, genders and single and nonsingle individuals. Both the AAQ (N = 650) and the ECR–R (N = 1,271) successfully distinguished avoidant and attachment factors. The AAQ showed evidence for partial strong measurement invariance, whereas the ECR-R showed strict factorial invariance for both gender and relationship status. Gender differences were detected on both measures in a direction consistent with previous research, with males exhibiting higher levels of avoidant attachment (relative to females) and females exhibiting higher levels of anxious attachment (relative to males). Furthermore, when compared to individuals who were currently single, those in romantic relationships exhibited lower levels of avoidant tendencies. This research aligns with the notion that the AAQ and ECR–R reliably assess similar constructs, across genders and single and nonsingle individuals.