The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms: A Study Among Portuguese War Veterans

We analyzed the role of both attachment anxiety and attachment avoidance as a mediators of the effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. Participants were Portuguese veterans (N = 60) divided into 2 groups: 30 suffered from chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). Combat exposure, attachment patterns, and PTSD symptoms were assessed through self-report measures. Mediation test was performed by conducting several hierarchical regression analyses. Results showed higher attachment anxiety among nonrecovered participants. We did not find statistically significant differences between groups for both attachment avoidance and combat exposure level scores. In mediation analysis, at first step, attachment avoidance was not a significant predictor of PTSD symptoms, and attachment avoidance did not enter in subsequent analysis. Attachment anxiety was a partial mediator of the effect of combat exposure on PTSD symptoms. Implications of the findings for both attachment theory and clinical intervention on trauma are discussed.     

The role of partner characteristics in attachment insecurity and depressive symptoms

Depression is associated with marital distress and attachment insecurity in romantic relationships. In this article, I propose an attachment‐theory model of depression, which links the characteristics of romantic partners to attachment insecurity and depression. I hypothesized that individuals who are avoidant of closeness and/or who devalue their spouses will be perceived as unresponsive to their spouses’ vulnerability, which will increase the spouse's attachment insecurity. Attachment insecurity was then proposed to contribute to depressive symptoms over time. A sample of married or cohabiting couples was recruited to complete questionnaires at an Internet Web site at 2 time points, approximately 3 months apart. Path analysis showed that for both husbands (N= 82) and wives (N= 99), avoidance of closeness in 1 partner was associated with perceived unresponsiveness to vulnerability and attachment insecurity in the other partner. In addition, for husbands, attachment insecurity at T1 predicted depressive symptoms at T2, above and beyond baseline levels of depression. These results provide encouraging support for an attachment‐theory approach to the study and treatment of depression, particularly among married or cohabiting men.     

The Role of Attachment Insecurity and Big Five Traits on Sensory Processing Sensitivity

Abstract

This study examined the interplay between behavioral inhibition/activation systems (BIS/BAS) sensitivity, attachment insecurity (i.e., anxiety and avoidance), and Big Five personality traits in predicting sensory processing sensitivity (SPS). We have specifically tested three alternative theoretical models to explain the process through which BIS/BAS sensitivity link to SPS; unique effects of attachment dimensions and personality traits, as well as moderating and mediating role of these variables. Participants (N?=?494) completed the highly sensitive Person scale, BIS/BAS scales, experiences in close relationships-revised scale, and big five inventory. The findings revealed the complex role of attachment dimensions and personality traits on SPS. Attachment avoidance, but not attachment anxiety, moderated the effect of BIS activity on SPS indicating that, compared to those with high BIS sensitivity, those with low levels of both BIS and attachment avoidance reported lower level of SPS. Attachment anxiety, neuroticism, extraversion, and openness partially mediated the effects of BIS on SPS. Conceptual implications of the findings and suggestions for future research are discussed.     

Associations between lower order anxiety sensitivity dimensions and DSM-5 posttraumatic stress disorder symptoms

Anxiety sensitivity (AS), a well-established individual difference variable reflecting a tendency to fear bodily sensations associated with arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite these associations, little research has examined the relations between AS subfactors (eg physical, cognitive, and social) and PTSD symptoms and none have examined these associations in the context of DSM-5 (Diagnostic Statistical Manual of Mental Disorders, Fifth Edition) PTSD clusters (ie intrusion, avoidance, negative alterations in cognitions/mood, and arousal). Participants included 50 veterans presenting to an outpatient Veteran Affairs Clinic for psychological services. Upon intake, veterans completed a brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. Results revealed unique associations between lower order AS dimensions, in particular the cognitive concerns dimension, and all four DSM-5 PTSD symptom clusters. Given the malleable nature of AS cognitive concerns, as well as the growing number of veterans in need of care, future research should determine the extent to which targeting this cognitive risk factor reduces PTSD symptom severity among veterans.     

Attachment dimensions and sexual motives

Little research has examined the relation between the attachment behavioral system and the sexual behavioral system, although these two systems, along with the caregiving system, are theorized to constitute romantic love ( Fraley & Shaver, 2000 ; Hazan & Shaver, 1987 ). College students (N = 400) completed measures of two dimensions of attachment style, anxiety and avoidance, and motives for having sex. Anxiety was predicted to be associated with having sex to reduce insecurity and foster intense intimacy. Avoidance was predicted to correlate inversely with having sex to foster intimacy and positively with nonromantic goals, such as increasing one's status and prestige among peers. The results supported both sets of predictions. People high on the attachment anxiety dimension reported having sex to reduce insecurity and establish intense closeness; people high on the attachment avoidance dimension reported having sex to impress their peer group, especially if they were having casual, uncommitted sex. Theoretical and practical implications of the findings are discussed.     

Let's talk about us: Attachment,relationship‐focused disclosure,and relationship quality

This research tested whether attachment avoidance and anxiety were associated with couples' (N = 59) disclosure during recorded discussions of recent events. The links between attachment and disclosure with relationship quality across 1 year were also assessed. Attachment was not associated with amount or intimacy of disclosure, but greater attachment anxiety was associated with more relationship‐focused disclosure, whereas attachment avoidance was associated with less relationship‐focused disclosure. Relationship‐focused disclosure was also positively associated with relationship quality across time, whereas attachment avoidance predicted lower relationship quality. These findings indicate that spontaneous relationship‐focused disclosure during routine conversations helps maintain relationships, but because people high in avoidance are less focused on sustaining closeness, their relationships tend to deteriorate over time.     

Anxiety sensitivity and distress tolerance typologies and relations to posttraumatic stress disorder: A cluster analytic approach

A growing literature suggests a relationship between a high anxiety sensitivity (AS; the fear of anxiety and its related consequences)/low distress tolerance (DT; the capacity tolerate internal negative states) profile and posttraumatic stress disorder (PTSD) symptoms. However, specific profiles have not been identified or examined specifically in Veteran samples. Thus, the aims of the present study were to establish empirically derived profiles created from response patterns on the Anxiety Sensitivity Index and Distress Tolerance Scale and to examine associations with PTSD symptom clusters among a sample of combat-exposed Veterans (N = 250). A cluster analytic approach was used to identify AS/DT profiles, and a series of multivariate analyses of variance with post hoc analyses was conducted to examine the relationship between each AS/DT profile and each PTSD symptom cluster. Results indicated a 3-cluster solution including a high AS/low DT “at risk” profile, a low AS/high DT “resilient” profile, and an average AS/DT “intermediate” profile. The at-risk profile was associated with significantly greater symptoms in each PTSD cluster (i.e., hyperarousal, avoidance, re-experiencing) when compared to the other two profiles. The at-risk profile was also associated with greater depressive symptoms and lower self-reported resilience. These findings extend the previous literature by identifying a high AS/low DT “at risk” profile and its associations with PTSD symptoms, underscoring the potential utility in targeting these affect-regulation constructs for clinical intervention.     

Adolescent attachment insecurity and parasympathetic functioning predict future loss adjustment

Losing a close relationship is highly stressful and a robust predictor of major depression in adolescents. The current study examined relationships between attachment insecurity, parasympathetic nervous system activity, indexed by respiratory sinus arrhythmia (RSA), and adolescent adjustment to the loss of a close social partner. Adolescents with more attachment anxiety to their mother at age 14 were more likely to report poorer adjustment to a subsequent loss than adolescents with less attachment anxiety. Attachment avoidance interacted with stress-induced changes in RSA to predict loss adjustment. Among adolescents with higher RSA in response to the stressor, those with more attachment avoidance reported better loss adjustment, whereas among adolescents with lower RSA in response to the stressor, those with more attachment avoidance reported poorer loss adjustment. In sum, the combination of attachment insecurity and stress-induced changes in RSA predicted how well adolescents adjusted to a loss.     

“I can’t get no satisfaction”: Insecure attachment,inhibited sexual communication,and sexual dissatisfaction

An Internet survey was conducted to extend the investigation of attachment style to the domains of sexual communication and sexual satisfaction. We hypothesized that insecure attachment would be associated with sexual dissatisfaction, mediated by inhibited communication of sexual needs. Further, the association of attachment with inhibited communication was expected to be mediated by attachment‐related tendencies toward deference to partners’ needs, concern with the relationship implications of sexual choices, general anxiety regarding sex, and feelings for one’s partner. Somewhat different mediational pathways were predicted for each of the 2 dimensions of attachment insecurity: anxiety and avoidance. Respondents (N= 1,989, around half of them involved in a sexual relationship at the time of the study and half not involved but with previous sexual relationship experience) completed measures of attachment‐related anxiety and avoidance, neuroticism (a possible confound), and sexual communication and satisfaction. Results generally supported the hypotheses and provided additional evidence regarding the associations between attachment style, sexual communication, and sexual satisfaction.     

Relation of positive memory recall count and accessibility with post-trauma mental health

ABSTRACT

Positive memory encoding and retrieval deficits have an empirical relation with several post-trauma outcomes. Drawing from the Contractor et al. model, we examined relations between positive memory characteristics and post-trauma mental health indicators. A trauma-exposed community sample of 203 participants (M_age?=?35.40 years; 61.10% female) was recruited via Amazon's Mechanical Turk. Participants completed measures of posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), posttraumatic cognitions (Posttraumatic Cognitions Inventory), affect (Positive and Negative Affect Schedule), count/number of recalled specific positive memories (Autobiographical Memory Test) and accessibility of a specific positive memory (i.e., subjective ease of recalling details of a memory; Memory Experiences Questionnaire-Short Form). Linear regression results indicated that PTSD intrusion severity, PTSD negative alterations in cognitions and mood (NACM) severity, PTSD alterations in arousal and reactivity (AAR) severity, self-blame, and positive affect significantly and negatively predicted the count of specific positive memories. Further, PTSD NACM severity, PTSD AAR severity, negative cognitions about the self, and negative affect significantly and negatively predicted accessibility of a specific positive memory. Thus, count/accessibility of specific positive memories was associated with several post-trauma mental health indicators; this highlights the relevance and potential impact of integrating positive memories into trauma treatment.     

Daily variations in attachment anxiety and avoidance: A density distributions approach

Attachment theory proposes that experiences of acceptance and rejection will modify feelings of attachment security, but such processes have rarely been investigated. In this study, daily variations in attachment anxiety and avoidance were investigated across 7 days in a sample of college undergraduates currently in romantic relationships. We observed significant within-person variation in attachment avoidance and anxiety. Participants reported lower anxiety and avoidance on days on which they felt more accepted by their romantic partners. Further, perceptions of acceptance predicted the following day’s attachment security through lower negative mood. Greater variability in attachment avoidance and anxiety was associated with greater physical aggression in relationships.     

A Pilot Study Exploring PTSD Symptom Clusters as Mediators between Trauma Exposure and Attachment Behaviors in Married Adults

The purpose of this pilot study was to examine the mediating effect of posttraumatic stress disorder (PTSD) symptom clusters on the association between trauma exposure and attachment behaviors. Results from bootstrapped mediation analyses with a sample of 116 married adults revealed that total PTSD, avoidance, negative alterations in cognition/mood, and arousal symptoms partially mediated the effect of trauma exposure on perceived attachment behaviors in men only; the intrusion symptom cluster was not significant and there were no significant mediation effects for women. Findings shed light on possible gender variant mechanisms by which trauma may threaten secure attachment bonds in couples.     

Attachment in individuals with social anxiety disorder: the relationship among adult attachment styles,social anxiety,and depression

Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive-behavioral treatment of social anxiety disorder.     

Mental health of the bisexual Veteran

Despite evidence showing that bisexual individuals may be at greater risk for mental health issues than lesbian and gay individuals, they are often combined into a single group, with lesbian and gay individuals the actual focus of the research. This study aims to address this gap in the literature among US Veterans. Using data collected from a multicity purposive sample (N = 4,493), logistic regression was used to analyze whether the following groups differ in current posttraumatic stress disorder (PTSD) and depression: (a) bisexual (n = 101) vs. heterosexual Veterans (n = 4,271); (b) bisexual vs. lesbian/gay Veterans (n = 121); (c) lesbian/gay vs. heterosexual Veterans; and (d) combined group of lesbian, gay, and bisexual (LGB; n = 222) vs. heterosexual Veterans. Controlling for significant covariates, bisexual Veterans had 2.5 times the risk of severe depression (95% confidence interval [CI] = 1.34–4.67; p = 0.004) and 2.3 times the odds of PTSD (95% CI = 1.40–3.77; p = 0.001) relative to heterosexual Veterans. Bisexual Veterans had 3 times the risk of severe depression (95% CI = 1.22–7.44; p = 0.017) and 1.9 times the risk of PTSD (95% CI = 1.02–3.70; p = 0.045) compared to lesbian/gay Veterans. Lesbian/gay Veterans had no significant difference in risk for depression compared to heterosexual Veterans. However, the combined group of LGB Veterans had 1.6 times the odds of PTSD (95% CI = 1.12–2.15; p = 0.008) compared to heterosexual Veterans. These findings suggest that past research showing mental health disparities between LGB and heterosexual individuals may be driven by the inclusion of bisexual individuals. Research should assess bisexual individuals as a distinct group, and future studies should explore factors leading to depression and PTSD among bisexual Veterans.     

I am going to gag: Disgust cognitions in spider and blood–injury–injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood–injury–injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioural avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity

Abstract

Prolonged Grief Disorder (PGD) is a debilitating syndrome of grief. A recent cognitive behavioral model asserts that three processes are critical to this condition: (1) insufficient integration of the loss with autobiographical knowledge about the self and the lost person; (2) negative cognitions; and (3) anxious and depressive avoidance behaviors. These processes are assumed to contribute to PGD symptoms and to mediate the influence of personality-related vulnerabilities on the development and maintenance of these symptoms. The present study examined the mediational role of these three processes in the linkage between neuroticism, attachment anxiety, and attachment avoidance on the one hand and PGD symptom severity on the other hand. Self-reported data from 348 bereaved people were used. The results showed that the three personality variables were significantly associated with PGD symptom severity. Moreover, the results provided support for the mediating effects of indices of insufficient integration, negative cognitions, as well as avoidance behaviors – even after controlling for the shared variance between mediators. Theoretical and clinical implications are discussed.     

Linking attentional control and PTSD symptom severity: the role of rumination

Although deficits in attentional control have been linked to posttraumatic stress disorder (PTSD), the mechanism that may account for this association has not been fully elucidated. The present study examined rumination as a mediator of the relationship between attentional control and PTSD symptoms. Veterans with PTSD and trauma-exposed veterans without PTSD completed measures of attentional control, rumination, and PTSD symptom severity. As predicted, the findings showed that veterans with PTSD reported significantly lower levels of attentional control than veterans without PTSD. Veterans with PTSD also reported significantly higher levels of rumination than veterans without PTSD. Subsequent analysis of the total sample revealed that the relationship between attentional control and PTSD symptom severity was accounted for by excessive rumination. Attentional control may contribute to PTSD symptoms through excessive rumination. Attentional control and rumination may be important targets for PTSD interventions.     

Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder

ObjectiveTo investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD).MethodAn online survey of traumatic experiences, featuring 528 adults.ResultsNegative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not.ConclusionsOur findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5rather than the Intrusion, Avoidance and Hyperarousal clusters.