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.     

延长哀伤障碍的概念、流行病学和病理机制

延长哀伤障碍是一种由亲近的人去世引发的病理性哀伤反应, 即死亡发生6个月后, 个体对死者的想念影响到了生活各方面, 且社会功能受损, 其最近20年才开始受到临床心理学研究者关注和探讨。本文首先回顾了概念提出及后续发展, 并讨论了其与持续性复杂哀伤相关障碍的区别与联系。随后, 本文综述了其独立的诊断标准、评估工具和流行病学调查、以及与正常哀伤、抑郁症和创伤后应激障碍的区别。接下来, 本文对其病理机制的理论思考和实证研究进行了讨论。最后, 本文指出未来可考察诊断标准的跨文化适用性、丰富病理机制的理论与研究。     

Social control of health behavior: associations with conscientiousness and neuroticism

Despite considerable research demonstrating associations of conscientiousness and neuroticism with health-related behavior, our understanding of how and why these traits are related to lifestyle is limited. This study examined the social regulation of health behavior in a probability sample of 509 household residents who completed a Random Digit Dial (RDD) telephone survey. Results suggest that the social regulation of health behavior experienced by highly conscientious individuals has more to do with their own internalized notions of responsibility and obligation to others than to specific actions by others aimed at influencing their health habits. In contrast, individuals with higher neuroticism experience more overt attempts by others to influence their health habits but have more negative affective and behavioral responses to these social influence attempts. Findings suggest that elucidating the distinct social influence processes that operate for conscientiousness and neuroticism may further understanding of how these traits are related to health behaviors and status.     

Intrusive thoughts mediate the association between neuroticism and cognitive function

Although research has established a negative association between trait neuroticism and cognition, little is known about the mechanisms that underlie this relationship. We examined the tendency to experience intrusive thoughts and negative affect as potential mediators of the relationship between neuroticism and cognitive performance. We hypothesized that the tendency to experience intrusive thoughts reflects ineffective attentional control and would account for the relationship between neuroticism and cognitive performance over and above the mediating effect of negative affect. Three hundred seventeen adults (M_age = 49.43) completed a series of attention-demanding cognitive tasks as well as self-report measures of intrusive thoughts, negative affect, and neuroticism. Intrusive thoughts mediated the association between trait neuroticism and cognitive performance beyond negative affect. These findings are consistent with the hypothesis that the tendency to experience intrusive thoughts is a mechanism through which trait neuroticism influences cognitive performance.     

The relationship of Laing's concept of ontological insecurity to extraversion and neuroticism

Four components were extracted from Laing's concept of ontological insecurity and operationally measured. The desire to be noticed was found to be correlated with extraversion while doubts in one's existence was related to neuroticism. The desire to be remembered after death and the rootedness of the mind in the body were not related to extraversion or neuroticism scores.     

Cognitive reactivity mediates the relationship between neuroticism and depression

Although neuroticism has long been established as an important risk factor for depression, the mechanisms through which this temperamental predisposition translates into the occurrence of symptoms are still relatively unclear. This study investigated cognitive reactivity, i.e. the ease with which particular patterns of negative thinking are reactivated in response to mild low mood, as a potential mediator. Individuals with (N = 98) and without a previous history of depression (N = 83) who had provided neuroticism scores six years previously were assessed for cognitive reactivity and current symptoms of depression using self-report questionnaires. Tendencies to respond to mild low mood with ruminative thinking mediated the relation between neuroticism and current symptoms of depression in both groups. Reactivation of hopelessness and suicidal thinking occurred as an additional mediator only in those with a history of previous depression. The results suggest that neuroticism predisposes individuals to depression by generally increasing the likelihood of ruminative responses to low mood. In those with a history of depression in the past, neuroticism additionally increases risk of recurrence by facilitating reactivation of previously associated patterns such as suicidal thinking and hopelessness. These findings suggest potential targets for interventions to help preventing the occurrence, or recurrence of depression in those who due to their temperamental predisposition are at an increased risk.     

Neuroticism and attachment insecurity as predictors of bereavement outcome

Adult attachment dimensions as well as the personality trait neuroticism have been shown to be related to psychological adjustment after bereavement. No investigations so far have studied the relative contribution of these constructs to grief and depression. In our study of 219 bereaved parents, the two adult attachment dimensions, attachment anxiety and attachment avoidance, were compared to the personality trait neuroticism in predicting psychological adjustment. The attachment dimensions explained a unique part over and above neuroticism, but contrary to expectations, neuroticism explained more variance than attachment dimensions. Implications are discussed.     

Hand preference for writing and associations with selected demographic and behavioral variables in 255,100 subjects: the BBC internet study

In an Internet study unrelated to handedness, 134,317 female and 120,783 male participants answered a graded question as to which hand they preferred for writing. This allowed determination of hand preference patterns across 7 ethnic groups. Sex differences in left-handedness were found in 4 ethnic groups, favoring males, while no significant sex differences were found in three of the groups. Prevalence of left-handedness in the largest of the ethnic groups (self-labelled as "White") was comparable to contemporary hand preference data for this group [Gilbert, A. N., & Wysocki, C. J. (1992). Hand preference and age in the United states. Neuropsychologia, 30, 601-608] but the prevalence of left-handedness in individuals >70 years of age was considerably higher in the present study. Individuals who indicated "either" hand for writing preference had significantly lower spatial performance (mental rotation task) and significantly higher prevalence of hyperactivity, dyslexia, asthma than individuals who had clear left or right hand preferences, in support of Crow et al. [Crow, T., Crow, L., Done, D., & Leask, S. (1998). Relative hand skill predicts academic ability: global deficits at the point of hemispheric indecision. Neuropsychologia, 36, 1275-1282]. Similarly, an association of writing hand preference and non-heterosexual orientation was clearest for individuals with "either" writing hand responses. We conclude that contradictions in the literature as to whether or not these variables are linked to handedness stem largely from different definitions of hand preference. Due to a lack of statistical power in most studies in the literature, the "either" hand writing preference group that yielded the most salient results in this study is not normally available for analysis.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

Test anxiety: associations with personal and family variables

Test anxiety is a common behavior among students facing social pressure centered on mastery. Only a few studies have analyzed the relations between test anxiety, academic procrastination, personal and family variables and math grades. This work focus on the analysis of the impact of students' social-personal variables such as parents' education level, number of siblings and under-achievement by performing ANOVAs in two samples of 533 and 796 students from junior high-school. Corroborating the findings in other studies, the data stress that test anxiety is higher in girls and decreases when students' parents have higher educational levels, with the number of courses flunked, and when students' math grades were lower. Test anxiety and procrastination correlate positive and significantly. Findings are discussed and compared with those of previous researches. The implications for teaching practice are also analyzed.     

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.     

Genetic and caregiving-based contributions to infant attachment: unique associations with distress reactivity and attachment security

In the longitudinal study reported here, we examined genetic and caregiving-based contributions to individual differences in infant attachment classifications. For 154 mother-infant pairs, we rated mothers' responsiveness to their 6-month-old infants during naturalistic interactions and classified infants' attachment organization at 12 and 18 months using the Strange Situation procedure. These infants were later genotyped with respect to the serotonin-transporter-linked polymorphic region (5-HTTLPR). Maternal responsiveness uniquely predicted infants' attachment security. Infants' 5-HTTLPR variation uniquely predicted their subtype of attachment security at 12 months and their subtype of attachment insecurity at 12 and 18 months. The short allele for 5-HTTLPR was associated with attachment classifications characterized by higher emotional distress. These findings suggest that 5-HTTLPR variation contributes to infants' emotional reactivity and that the degree to which caregivers are responsive influences how effectively infants use their caregivers for emotion regulation. Theoretical implications for the study of genetic and caregiving influences are discussed.     

Cognitive and behavioral distancing from the poor

The author argues that distancing is the dominant response to poor people on the part of those who are not poor and that distancing, separation, exclusion, and devaluing operationally define discrimination. Such responses, together with stereotypes and prejudice, define classism. The article focuses on classism in the United States. Classism is examined in the context of theoretical propositions about the moral exclusion of stigmatized others and is illustrated by cognitive distancing, institutional distancing (in education, housing, health care, legal assistance, politics, and public policy), and interpersonal distancing. The adoption of the Resolution on Poverty and Socioeconomic Status by the American Psychological Association Council of Representatives in August 2000 is cited as an important step in the direction of eliminating the invisibility of low-income persons in psychological research and theory.     

Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder

Background/ObjectiveThe main aim of this study was to analyze differences in inhibition and cognitive flexibility, taking into account some variables that may influence results (non verbal reasoning, depression, anxiety, intolerance of uncertainty, comorbidity, medication consumption).MethodThe participants were 95 adults aged 17-61 years old (M = 33.48, SD = 11.13), primary (most severe) Generalized Anxiety Disorder or Obsessive-Compulsive Disorder and a healthy control group. Neuropsychological neasures were completed using computerized Wisconsin Card Sorting Test, Stroop Color Word Test and Go/NoGo Task.ResultsClinical groups presented worse results in cognitive flexibility to the control group. The obsessive-compulsive group showed worse scores in flexibility than the generalized anxiety group, once non-verbal reasoning and tolerance to uncertainty were controlled. Comorbidity and medication use did not affect results in the obsessive compulsive group but did however influence the generalized anxiety group.ConclusionsCognitive flexibility could be included treatment in the treatment of obsessive-compulsive disorder and generalized anxiety disorder.     

A Nonrandomized Trial of Prolonged Exposure and Cognitive Processing Therapy for Combat-Related Posttraumatic Stress Disorder in a Deployed Setting

For many decades, the U.S. military’s general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist–Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.     

Cognitive and behavioral attention in children with math difficulties

Cognitive assessments and behavioral ratings of attention were used to examine the relation of inattention to math performance in children. Third grade students with math difficulties (MD; n?=?17) and math and reading difficulties (MDRD; n?=?35) were administered the Attentional Network Test (ANT), as well as achievement and intelligence measures. Strengths and Weaknesses of ADHD-Symptoms and Normal-Behavior-IV (SWAN-IV) Inattention ratings were collected from teachers. Two comparison groups were also recruited: a typically achieving group (n?=?23) and a group that responded to a math-tutoring intervention (responders; n?=?54). On the ANT, children with MD and MDRD did not perform significantly different than typically achieving children or responders on measures of alerting and orienting attention and executive control. All subgroups did demonstrate performance patterns that were expected on the ANT. However, performance across blocks of the task was inconsistent, suggesting poor reliability. There were no relations between ANT performance and SWAN-IV behavioral inattention scores, though behavioral ratings of inattention correlated significantly with math performance. Children with MD and MDRD may have more difficulty with distraction and attention to detail in contextual situations, as opposed to impulsive responding in these settings. The lack of relation between cognitive attention and math performance may suggest that either the ANT does not assess the relevant attention constructs associated with math difficulties or may parallel studies of attention deficit/hyperactivity disorder (ADHD) in which cognitive and behavioral assessments are weakly related.     

The self-regulation of automatic associations and behavioral impulses

The distinction between automatic processes and controlled processes is a central organizational theme across areas of psychology. However, this dichotomy conceals important differences among qualitatively different processes that independently contribute to ongoing behavior. The Quadruple process model is a multinomial model that provides quantitative estimates of 4 distinct processes in a single task: the likelihood that an automatic response tendency is activated; the likelihood that a contextually appropriate response can be determined; the likelihood that automatic response tendencies are overcome when necessary; and the likelihood that in the absence of other information, behavior is driven by a general response bias. The model integrates dual-process models from many domains of inquiry and offers a generalized, more nuanced framework of impulse regulation across these domains. The model offers insights into many central questions surrounding the operation and the interaction of automatic and controlled processes. Applications of the model to empirical and theoretical concerns in a variety of areas of psychology are discussed.     

Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel

ABSTRACT

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 –.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 ?.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = –.30) and alterations in arousal and reactivity (β = –.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 –.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.