Disorganized and unresolved states in adulthood

Using the DRS-8 to measure unresolved/disorganized attachment: Associations with states of mind on the adult attachment interview, psychopathology, and offspring social-emotional development

BACKGROUND

Unresolved/disorganized (U/d) attachment states of mind are associated with poor outcomes across numerous domains of functioning. However, the validity of existing self-report instruments measuring this construct remains questionable.

OBJECTIVES

The aim of the current study was to validate the DRS-8, an alternative version of the Disorganized Response Scale (DRS), by assessing its construct validity, internal consistency, and criterion validity with the U/d attachment scales on the Adult Attachment Interview (AAI).

PARTICIPANTS AND SETTING

Date were collected from 222 expectant parents (78 % women) at T1 and from 67 of them at 12 months postpartum (T2).

METHODS

Participants completed the DRS-8 and questionnaires assessing childhood trauma, romantic attachment, and psychological symptoms during pregnancy (T1). Seventy-four of them participated in the AAI at T1. At T2, parents completed a questionnaire assessing their infants' social-emotional development.

RESULTS

The DRS-8 has two highly correlated dimensions, i.e., lapses in the monitoring of reasoning (four items) and discourse (four items). A confirmatory factor analysis supported a bifactor structure of the instrument, showing good fit indices and internal consistency (ω = 0.87). The DRS-8 was significantly correlated with U/d states of mind on the AAI, r(72) = 0.28, p = .016, and demonstrated excellent construct validity. Significant indirect effects of the DRS-8 were found in the associations between childhood trauma and psychological symptoms, and between parental trauma and infant social-emotional development.

CONCLUSIONS

The DRS-8 appears to be a promising self-report measure of U/d states of mind showing criterion validity with the AAI.

Resolving trauma: The unique contribution of trauma-specific mentalization to maternal insightfulness

Resolving trauma may contribute to mental health and parenting in mother with histories of childhood maltreatment. The concept of trauma-specific reflective functioning (T-RF) was developed to assess the complexity of thought processes regarding trauma. The study aimed to validate the T-RF scale applied to the Trauma Meaning-Making Interview by examining its psychometric properties, associations with measures of trauma-processing strategies, maternal reflective functioning and mental health (depression and post-traumatic stress disorder [PTSD]), as well as evaluating whether T-RF offered a unique contribution to maternal insightfulness. Good construct validity of the T-RF scale was confirmed in a sample of 112 mothers with histories of childhood maltreatment using an independent coding system of trauma-processing. Better mentalization of trauma was prospectively associated with higher parental reflective functioning and mothers with high T-RF were much more likely to be insightful regarding the child's mental states than non-reflective mothers and mothers with limited T-RF. The association between T-RF and insightfulness was observed even when controlling for maternal reflective functioning, trauma-processing strategies, maternal education and sociodemographic risk. T-RF was associated neither with depression, PTSD nor the characteristics of trauma. Findings suggest that mentalizing trauma would be an important protective factor in the intergenerational trajectories of trauma.

The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic

OBJECTIVES

The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic.

METHODS

Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021.

RESULTS

Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association.

CONCLUSIONS

These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

The predictive significance of attachment script assessment hyperactivation and deactivation: evidence of associations with romantic relationship functioning

This study examined the significance of a novel coding system for evaluating hyperactivation, deactivation, and anomalous content in the Attachment Script Assessment for romantic relationship functioning. In a sample of 208 couples (69% White, Mage 28.7 years), we tested whether ASA hyperactivation and deactivation were associated with theoretically relevant correlates, including observed behavior, parasympathetic reactivity, self-reported affective reactivity to conflict, and relationship satisfaction. Exploratory analyses examined associations of secure base script knowledge (SBSK) and anomalous content with these outcomes. ASA hyperactivation and deactivation were associated with behavioral, physiological, and self-reported functioning in theory-consistent ways. Anomalous content was not associated with romantic functioning. SBSK was associated with satisfaction, but this was not robust to covariates. Findings support the predictive validity of the hyperactivation and deactivation dimensions and suggest that these scales complement SBSK, enabling researchers to assess a wider range of behavioral and physiological indicators associated with distinctive forms of attachment insecurity.

Facets of Mindfulness Mediate the Relationship Between Attachment Orientation and Emotion Regulation in University Students

Whilst both mindfulness and adult attachment have been linked to wellbeing, little is known about how these constructs relate to emotion regulation that can underpin wellbeing. The present study examined the association between adult attachment orientation and emotion regulation (strategies and difficulties) and the mediating role of facets of dispositional mindfulness. A sample of 301 university students (Mage = 23.08, SD = 8.08; 74.75% female) completed measures of adult attachment, emotion regulation, difficulties in emotion regulation, and dispositional mindfulness. Parallel multiple mediation analyses indicated that the act with awareness and non-judging facets of mindfulness repeatedly emerged as significant mediators in the positive associations between the dimensions of attachment insecurity (anxiety, avoidance, and disorganized) and maladaptive emotion regulation strategies and difficulties in emotion regulation. Those individuals exhibiting greater attachment insecurity employ maladaptive emotion regulation strategies and display difficulties in emotion regulation via mindfulness deficits. The present findings extend our current understanding of the role of dispositional mindfulness in the associations between adult attachment orientation and varying aspects of the emotion regulation process.

Maternal childhood maltreatment trauma resolution: Development of a novel narrative coding measure and implications for intergenerational parenting processes

Child maltreatment constitutes a significant environmental risk for children, with carryover effects into future generations. There is a need to characterize protective factors that may buffer against the intergenerational transmission of maltreatment. The current study addresses this gap through two primary aims: 1) the development and validation of a novel measure assessing resolution of maternal childhood maltreatment trauma using narrative coding methods and 2) the evaluation of maternal maltreatment trauma resolution as a buffering factor that may moderate associations between maternal neglect histories and sensitive parenting of offspring. Results of reliability analyses from this sample of 210 diverse, low-income mothers suggest the novel childhood maltreatment trauma resolution measure is highly reliable. Furthermore, results highlight the generalizability, criterion validity, and concurrent and predictive validity of the measure. Results from cross-sectional analyses show that trauma resolution moderates associations between maternal physical neglect histories and sensitive parenting, such that under high maternal trauma resolution, there is no longer a negative association between neglect histories and sensitive parenting. Results from longitudinal analyses also show a protective effect of maternal trauma resolution, such that trauma resolution has a protective-enhancing effect on maternal sensitivity. Implications for research and clinical practice with families are discussed.

Decreased brain network global efficiency after attachment memories retrieval in individuals with unresolved/disorganized attachment-related state of mind

The main aim of the study was to examine how brain network metrics change after retrieval of attachment memories in individuals with unresolved/disorganized (U/D) attachment-related state of mind and those with organized/resolved (O/R) state of mind. We focused on three main network metrics associated with integration and segregation: global (E_glob) efficiency for the first function, local (E_loc) efficiency and modularity for the second. We also examined assortativity and centrality metrics. Electroencephalography (EEG) recordings were performed before and after the Adult Attachment Interview (AAI) in a sample of 50 individuals previously assessed for parenting quality. Functional connectivity matrices were constructed by means of the exact Low-Resolution Electromagnetic Tomography (eLORETA) software and then imported into MATLAB to compute brain network metrics. Compared to individuals with O/R attachment-related state of mind, those with U/D show a significant decrease in beta E_glob after AAI. No statistically significant difference among groups emerged in E_loc and modularity metrics after AAI, neither in assortativity nor in betweenness centrality. These results may help to better understand the neurophysiological patterns underlying the disintegrative effects of retrieving traumatic attachment memories in individuals with disorganized state of mind in relation to attachment.

ATTACHMENT AND MEMORY STABILITY

Previous studies confirm that attachment representations are very stable and are rooted in semantic and episodic autobiographic memory systems. The Adult Attachment Interview (AAI) provides a means to assess secure, insecure, and disorganized (U) states of mind; it incorporates a fine-grained analysis of attachment-related memories. The AAI is not a measure to determine false versus true memories or to claim it can identify veridical truth; however, longitudinal research studies demonstrate that the AAI is highly stable in how (degree of coherence) the speaker discusses past events. This IRB approved study (n = 130) examined a non-clinical sample of active individuals. The results indicated that passive states of mind was a predictor variable for unresolved loss and unresolved childhood abuse and both passive states of mind and more Adverse Childhood Experiences (ACEs) predicted overall lack of resolution (U). Lack of memory and dissociative amnesia were not significant predictors. This study and previous studies demonstrate that retrospective reporting of ACEs remain stable over time. These findings suggest that clinical focus should follow the attachment protocol of examining the state of mind of the speaker. Autobiographical memory systems reveal enduring Internal Working Models (IWMs) that influence how memories are stored and recounted.

Attachment as a mechanism between childhood maltreatment and subclinical psychotic phenomena: Results from an eight-year follow-up study

We previously reported that fearful attachment mediated associations of childhood maltreatment with subclinical psychotic phenomena. At an eight-year follow-up, we aimed to replicate and extend this finding by examining the mediating role of disorganized attachment. Participants were 169 young adults who completed baseline and eight-year follow-up questionnaires. Physical/emotional maltreatment was prospectively associated with paranoid beliefs and positive schizotypy. For paranoid beliefs, fearful and disorganized attachment were significant mediators in separate models, whereas only disorganized was significant when examining all attachment styles concurrently. For positive schizotypy, no mediation was found. Findings support psychological models of paranoia and may inform intervention efforts.

Human attachment triggers different social buffering mechanisms under high and low early life stress rearing

Social buffering - the attenuation of stress by maternal safety signals - is a core mammalian-general stress management mechanism implicating two ancient systems: the oxytocinergic and HPA systems. Yet, because human attachments are representation-based, understanding social buffering mechanisms in humans requires the assessment of relationship history and consideration of early life stress (ELS), which alters stress responsivity. We followed a unique trauma-exposed cohort across childhood, versus a low-stress control group, and repeatedly observed maternal sensitive, safety-promoting style. In adolescence, we used an attachment induction paradigm that exposed children to both live and reminders of attachment safety signals and measured oxytocin and cortisol baseline and response, to test how maternal safety signals impact hormonal reactivity in children reared under high- versus low-stress conditions. Only safety-promoting mothers exhibited a stress-buffering function, but their effect was system-specific and depended on the rearing context. For oxytocin, safety-promoting mothers normalized the deficient baseline oxytocin levels observed in ELS youth by implicating a plasticity-by-affiliation mechanism. For cortisol, safety-promoting mothering reduced the initial stress response only among youth reared in low-stress contexts via the typical buffering-by-safety mechanism. Results suggest that human attachments require internalized security evolving over time to trigger a stress buffering function. Under conditions of chronic early stress, the stressful rearing context overrides the maternal safety signals, normative stress buffering mechanisms fail, and safety-promoting mothers switch to an immature, affiliation-based mechanism that relies on maternal presence.

Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity

Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.

Fathers' attachment representations and infant feeding practices

This study examined how fathers' adult attachment representations, assessed before the birth of their first child, predict feeding practices with their 8-month-old infants. Fathers have been underrepresented in child feeding research, particularly in longitudinal and observational studies. Feeding is a key parenting task of infancy and a growing number of studies have begun to explore the connection between attachment and parental feeding practices and behavior, revealing a clear link between mothers' adult attachment and how they feed their children. This is the first longitudinal examination of attachment as a prenatal predictor of fathers' infant feeding behavior. Participants were 118 first-time fathers and their infants. Adult Attachment Interviews were conducted in the third trimester of pregnancy, and father-infant feeding interactions were observed at home when the infant was 8-months-old. Videotaped feedings were coded using Chatoor's Feeding Scale (1997). Compared to other fathers, (1) those with secure attachment representations were more attuned to their infants during feeding, (2) those with dismissing representations were less attuned, and (3) those with unresolved trauma displayed more controlling behaviors. Fathers were more controlling with their sons than their daughters across all attachment representations. Study results suggest that father's infant feeding behaviors may influence by their own attachment representations. The links to fathers' controlling feeding practices are noteworthy because of the negative implications controlling parental feeding practices can have on child outcomes. The prediction of paternal feeding behaviors from assessments conducted prenatally has important intervention implications.

Subjective nearness-to-death and negative attitudes toward persons with disability: Attachment patterns moderate

We examined whether subjective nearness-to-death is associated with negative attitudes toward people with disabilities, and whether attachment patterns moderate this connection. A total of 462 Israeli adults, average age 57 years, completed scales measuring subjective nearness-to-death, negative attitudes toward people with disability, and attachment patterns. High levels of subjective nearness-to-death were associated with negative attitudes toward people with disability, and attachment patterns were significant moderators. Findings point to the theoretical importance of both perceptions of death and personal resources for coping with subjective nearness-to-death in relation to attitudes toward individuals with disabilities.