A systematic review of adult attachment and social anxiety

A Comprehensive Scoping Review of Empirical Studies on Earned Secure Attachment

Earned-Secure Attachment (ESA) can be defined as the process by which individuals with insecure childhood attachment rise above malevolent childhood experiences to develop secure relationships pattern in adulthood. To our knowledge, no previous review has summarized findings from empirical literature about this topic. To fill this gap, we conduct a preregistered scoping review (research published until 2023) following the PRISMA Extension for Scoping Reviews, to find how ESA has been defined, assessed, and studied in the empirical literature. Four databases were searched (Scopus, PsycInfo, PubMed and Web of Science), 24 studies were included in the review and were assessed using the Mixed Methods Appraisal Tool. Findings from our review reveal a more formal than substantial agreement on the conceptualization of ESA and the conclusions that can be made, considering the heterogeneity of our results, are only preliminary. Developmental factors, the association between ESA and depressive symptoms and the role of fathers remain poorly defined, although the importance of secondary attachment figures and reflective functioning as factors that may contribute to earned-security in attachment is clear. Recommendations and future steps for researchers and practitioners are highlighted.

A multilevel approach to social support as a determinant of mental health during COVID-19

The COVID-19 pandemic has detrimentally affected the mental health of lower income communities. We sought to investigate the relationship among multilevel social support, specifically individual-, network-, and neighborhood-level social supports, COVID-19-related stressors, and probable diagnoses of depression, anxiety, and posttraumatic stress (PTS), within a racially diverse and predominantly low-socioeconomic status population. We used multiple logistic regressions to assess the odds of diagnosis for high versus low social support and stressor levels. Participants who endorsed high levels of stress had significantly higher odds of probable diagnoses. Participants who endorsed low individual-level social support had higher odds of probable depression and anxiety. Those who endorsed low neighborhood-level social support had higher odds of probable depression and probable PTS. Network-level social support was not significantly associated with the health indicators of interest. Results indicate the importance of both individual- and neighborhood-level support to protect mental health during COVID-19.

Factors predicting self-compassion among patients with breast cancer undergoing chemotherapy in Thailand: A cross-sectional study

Background

Breast cancer is the most common female malignancy. Although chemotherapy is the primary treatment for breast cancer, it frequently has several detrimental side effects. Patients with breast cancer require self-compassion to regulate their emotions in order to cope with their suffering. Factors affecting self-compassion have mostly been investigated in the context of chronic diseases in general, not specifically in relation to patients receiving chemotherapy for breast cancer.

Objective

This cross-sectional study sought to describe the self-compassion level and to examine the predictive ability of self-critical judgment, body image, stress, attachment style, social support, hope, and self-reassuring on self-compassion among patients with breast cancer undergoing chemotherapy.

Methods

The participants were 210 Thai women with breast cancer who received chemotherapy in northern Thailand and were selected using proportionate random sampling. Data were collected from December 2021 to January 2023 using validated instruments. Data were analyzed using descriptive statistics and hierarchical regression analysis.

Results

Self-compassion was moderate (Mean = 2.91, SD = 0.91). Self-critical judgment (β = 0.487, p <0.001) and hope (β =0.128, p = 0.032) could predict self-compassion in patients with breast cancer undergoing chemotherapy and explained 40.1% of the variance.

Conclusion

The study's findings highlight the importance of addressing self-critical judgment and fostering hope in patients with breast cancer undergoing chemotherapy to enhance their self-compassion. Nurses and other healthcare providers can use the findings to provide interventions to promote self-compassion.

Efficacy and safety of different cycles of neoadjuvant immunotherapy in resectable non-small cell lung cancer: A systematic review and meta-analysis

Background

There is no standard consensus on the optimal number of cycles of neoadjuvant immunotherapy prior to surgery for patients with locoregionally advanced non-small cell lung cancer (NSCLC). We carried out a systematic review to evaluate the efficacy and safety of neoadjuvant immunotherapy with different treatment cycles in order to provide valuable information for clinical decision-making.

Methods

PubMed, Embase, the Cochrane Library and ClinicalTrials.gov were systematically searched before May 2023. The included studies were categorized based on different treatment cycles of neoadjuvant immunotherapy to assess their respective efficacy and safety in patients with resectable NSCLC.

Results

Incorporating data from 29 studies with 1331 patients, we found major pathological response rates of 43 % (95%CI, 34-52 %) with two cycles and 33 % (95%CI, 22-45 %) with three cycles of neoadjuvant immunotherapy. Radiological response rates were 39 % (95%CI, 28-50 %) and 56 % (95%CI, 44-68 %) for two and three cycles, respectively, with higher incidence rates of severe adverse events (SAEs) in the three-cycle group (32 %; 95%CI, 21-50 %). Despite similar rates of R0 resection between two and three cycles, the latter showed a slightly higher surgical delay rate (1 % vs. 7 %). Neoadjuvant treatment modes significantly affected outcomes, with the combination of immunotherapy and chemotherapy demonstrating superiority in improving pathological and radiological response rates, while the incidence of SAEs in patients receiving combination therapy remained within an acceptable range (23 %; 95%CI, 15-35 %). However, regardless of the treatment mode administered, an increase in the number of treatment cycles did not result in substantial improvement in pathological response rates.

Conclusion

There are clear advantages of combining immunotherapy and chemotherapy in neoadjuvant settings. Increasing the number of cycles of neoadjuvant immunotherapy from two to three primarily may not substantially improve the overall efficacy, while increasing the risk of adverse events. Further analysis of the outcomes of four cycles of neoadjuvant immunotherapy is necessary.

The Reciprocal Relations between Parental Psychological Control and Social Anxiety and the Mediating Role of Self-Concept Clarity Among Chinese Early Adolescents

Although parental psychological control has been well-documented as a significant predictor of social anxiety among adolescents, few studies examine how changes in parental psychological control and adolescent social anxiety are reciprocally related at the within-person level, especially in Chinese culture. This longitudinal study examined reciprocal relations between parental psychological control and social anxiety, and the potential mediating role of self-concept clarity, by disentangling between- and within-person effects. A total of 4731 students (44.9% girls; Mage = 10.91 years, SD = 0.72) participated in a four-wave longitudinal study with 6-month intervals. Results from random intercept cross-lagged panel modeling indicated that parental psychological control directly predicted social anxiety, and vice versa. Parental psychological control indirectly predicted social anxiety via self-concept clarity, and social anxiety also indirectly predicted parental psychological control via self-concept clarity. These findings reveal a vicious cycle of mutual influence between parental psychological control and adolescent social anxiety in Chinese youth, and highlight the crucial role of self-concept clarity in the interplay between parenting and adolescent social functioning.

Physical Activity Levels and Factors Affecting Them in Hospitalized Children With Leukemia

BACKGROUND

Physical activity promotes healthy physical and mental development in children with leukemia. However, the level of physical activity in hospitalized children with leukemia and the factors that influence it are unknown.

OBJECTIVES

The aims of this study were to understand the physical activity level of hospitalized children with leukemia and to explore the factors influencing it to provide a reference for physical activity assessment and intervention in such children.

METHODS

A total of 133 hospitalized children with leukemia completed a general information questionnaire, the Chinese University of Hong Kong Physical Activity Rating for Children and Youth, and the Children's Social Anxiety Scale. A cross-sectional study was used to explore the effects of different variables on the children's activity levels.

RESULTS

Among the study participants, 44.4% had a low-intensity activity level, 35.3% had a moderate-intensity activity level, and 20.3% had a high-intensity activity level, with a total physical activity rating of 3 (1, 6). Chemotherapy phase (P = .007), screen time (P = .001), and social anxiety (P = .012) were identified as influential factors.

CONCLUSIONS

Our results showed that children with hospitalized leukemia had lower-intensity physical activity levels, especially in the chemotherapy phase of induction remission. Furthermore, screen time and social anxiety had negative effects on the children's activity levels.

IMPLICATIONS FOR PRACTICE

According to the physical activity level of the children and the influencing factors, healthcare professionals should gradually improve children's mobility and promote their physical and mental health development through guidance and encouragement, and the development of personalized activity intervention programs.

Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

Attachment, Minority Stress, and Health Outcomes Among Conservatively Religious Sexual Minorities

Sexual minority (SM) members of the Church of Jesus Christ of Latter-day Saints (LDS) face increased exposure to minority stressors as well as concerns of attachment injuries relative to their heterosexual counterparts. The Integrated Attachment and Sexual Minority Stress Model outlines the mutually reinforcing associations between adult attachment and sexual minority stress, positing that adult attachment is both influenced by experiences of minority stress and simultaneously capable of shaping minority stress experiences in adulthood. The present study explored how adult attachment style directly and indirectly affects minority stressors and health outcomes for LDS SMs. A sample of 602 LDS SMs completed a quantitative survey assessing attachment, minority stress, and health. Results indicated that an insecure attachment style related to increased minority stressors and depression, whereas a secure attachment style related to decreased minority stressors and increased life satisfaction. Further, attachment moderated the relationship between minority stressors and health outcomes, such that experiences of minority stress were related to a decrease in life satisfaction only for securely attached LDS SMs. However, securely attached LDS SMs still reported better health than insecurely attached LDS SMs, even when reporting high degrees of minority stressors. These findings add to the growing body of literature suggesting that attachment style has direct and indirect effects on health outcomes for SMs, including those from conservative religious backgrounds.

Four-week intranasal oxytocin administration reduces attachment avoidance in older women

The neuropeptide oxytocin (OT) serves as a critical modulator of social cognition and social behavior. Adult attachment is an affiliative process crucial for social interaction across adulthood. Insecure adult attachment comprises two broad dimensions, attachment anxiety and attachment avoidance. Both these dimensions of attachment are currently understudied regarding OT modulation, and especially in older adults. The present study determined the effects of chronic intranasal OT administration on adult attachment in generally healthy older women and men (aged 55-95 years). Embedded in a larger project, participants were randomly assigned to self-administer 24 international units of either OT or a placebo (P) intranasally twice daily for four weeks. The Experiences in Close Relationships Scale assessed adult attachment (anxiety and avoidance) pre- and post-treatment. There was no significant pre- to post-treatment change in attachment avoidance overall, but the treatment x timepoint x sex interaction was significant, in that women (but not men) in the OT (vs. P) group reported decreased attachment avoidance. No comparable effects were observed for attachment anxiety. Results suggest that older women may benefit from chronic intranasal OT treatment by experiencing less attachment avoidance in their adult relationships.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization

BACKGROUND

Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals.

METHOD

Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style.

RESULTS

Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother.

CONCLUSION

Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Alexinomia: The fear of using personal names

Introduction

Preliminary research based on everyday observations suggests that there are people, who experience severe fear when addressing others with their personal names. The aim of this study was to explore the extent to which this hitherto little-known psychological phenomenon really exists and to investigate its characteristic features, considering the everyday experience of not being able to use names and its impact on affected individuals and their social interactions and relationships.

Methods

In this mixed-methods study based on semi-structured interviews and psychometric testing, 13 affected female participants were interviewed and evaluated using self-report measures of social anxiety, attachment-related vulnerability, and general personality traits. An inductive content analysis and inferential statistical methods were used to analyze qualitative and quantitative data, respectively.

Results

Our findings show that affected individuals experience psychological distress and a variety of negative emotions in situations in which addressing others with their name is intended, resulting in avoidance behavior, impaired social interactions, and a reduced quality of affected relationships.

Discussion

The behavior can affect all relationships and all forms of communication and is strongly linked to social anxiety and insecure attachment. We propose calling this phenomenon Alexinomia, meaning “no words for names”.

GAZING INTO THE ABYSS: TOWARD A PHILOSOPHICAL UNDERSTANDING OF ANXIETY AND FEAR

OBJECTIVE

The aim: This paper deals with anxiety or fear-related disorders and philosophical interpretations of the phenomena of fear and anxiety.

PATIENTS AND METHODS

Materials and methods: The authors used integrative anthropological approach, interpretive research paradigm, hermeneutical approach. The data collec¬tion was carried out using Scopus, Web of Science, PubMed, Google Scholar databases. Research papers were identified according to search terms: "anxiety or fear-related disorders", "fear", "anxiety", "phobia", "psychology", "psychotherapy", "mental health", "philosophy", "being-in-the-world", "human existence".

CONCLUSION

Conclusion: It is obvious that philosophical interpretations of the phenomena of fear and anxiety cannot be defined in clinical terms, especially given the fact that modern psychology, psychotherapy, and psychiatry are shifting towards evidence-based practices. Furthermore, there are significant differences in determining the causes that provoke mental health disorders (nature, nurture, their interaction or something else) and accordingly in choosing treatment methods. Apparently, the position of the researchers/practitioners will be determined by their understanding of the root cause. However, more and more researchers are coming to the conclusion that the contemporary world demonstrates the urgent need for an integral, holistic paradigm of a human as an undivided, alive and organic, ideal and material being that should be understood in the context, taking into account the socio-cultural, biological, narrative, self-relational dimensions and his/her ability to transcend them. That is why the most effective way to help people with anxiety or fear-related disorders is to develop "the optimal combination of social assistance, psychological therapy, transpersonal experience, and medical treatment. It should be based on a new transdisciplinary paradigm and implemented by an interdisciplinary team of specialists". In this process, a special role should be assigned to philosophy, which is able to expand horizons and find an approach to the core of a human being.

Bağlanma Stilleri ve Sosyal Fobi Arasındaki İlişkide Kişilerarası İlişkiler ve Benliğin Ayrımlaşmasının Aracı Rolü

Bu çalışmanın amacı sosyal fobi, bağlanma stilleri, kişilerarası ilişkiler ve benliğin ayrımlaşması arasındaki ilişkilerin incelenmesi ve bağlanma stilleri ile sosyal fobi arasındaki ilişkide kişilerarası ilişkiler ve benliğin ayrımlaşmasının aracı rolünün belirlenmesidir. İstanbul ilinde yapılan araştırmaya, 18-70 yaş aralığında (30.60±11.66) olan 197 (%62.7) kadın ve 117 (%37.3) erkek olmak üzere toplam 314 kişi dahil edilmiştir. Veri toplama aracı olarak Liebowitz Sosyal Fobi Ölçeği, Kişilerarası İlişki Boyutları Ölçeği, İlişki Ölçekleri Anketi ve Benliğin Ayrımlaşması Ölçeği kullanılmıştır. Paralel aracılık rolleri Hayes’in PROCESS makro eklentisiyle Bootstrap yöntemi temel alınarak test edilmiştir Korelasyon analizi sonuçlarına göre değişkenler arasında zayıf ve orta düzeyde anlamlı ilişkiler bulunmuştur. Aracılık analizi bulguları ise güvenli bağlanma ve sosyal fobi-kaygı arasındaki ilişkide onay bağımlılığı, başkalarına güven ve duygusal tepkiselliğin paralel aracılık etkisinin olduğu; güvenli bağlanma ve sosyal fobi-kaçınma arasındaki ilişkide onay bağımlılığı ve başkalarına güvenin paralel aracılık etkisi olduğu; kayıtsız bağlanma ve sosyal fobi-kaygı ve kaçınma arasındaki ilişkide başkalarına güven ve duygusal tepkiselliğin paralel aracılık etkisi olduğu; korkulu bağlanma ve sosyal fobi-kaygı ve kaçınma arasındaki ilişkide onay bağımlılığı ve başkalarına güvenin paralel aracılık etkisinin olduğu; saplantılı bağlanma ve sosyal fobi-kaygı arasındaki ilişkide onay bağımlılığı, başkalarına güven ve duygusal tepkiselliğin paralel aracılık etkisi, saplantılı bağlanma ve sosyal fobi-kaçınma arasındaki ilişkide ise onay bağımlılığı ve başkalarına güvenin paralel aracılık etkisinin olduğu tespit edilmiştir. Toplam 8 anlamlı modelin, varyansın %4 ila %19’unu açıkladığı görülmüştür. Çalışmanın bulgularının bağlanma ve sosyal fobi arasındaki ilişkiye aracılık eden değişkenlerin belirlenmesi ve bu değişkenlere yönelik klinik müdahalelerin geliştirilmesi konularında çıkarımlar yapılmasına katkı sağlayabileceği söylenebilir.

Social anxiety mediates the effect of attachment to parents on friendships and loneliness during the college transition

The main goal of this study was to investigate direct and indirect effects of attachment to parents on the formation of friendships, satisfaction with friends, and loneliness over the transition to college. Social anxiety and gender were tested as a possible mediator and moderator respectively. A total of 210 college freshmen at a large university in Spain participated in at a baseline assessment and a six-month follow-up assessment. Results demonstrated indirect effects of attachment to parents on ease forming friendships, satisfaction with friends, and loneliness through social anxiety, and a direct effect of attachment to loneliness. Gender did not play a moderating role. Taken together, these results suggest that programs to support the development of healthy social relationships across the college transition may be particularly beneficial for youth with challenges in familial relationships, and that screening for social anxiety may identify those students who would particularly benefit from support.

Romantic relationship quality and functioning for individuals with clinical and sub-clinical social anxiety: a scoping review

BACKGROUND

Social Anxiety Disorder (SAD) is associated with pervasive functional impairments and chronicity. Romantic relationship functioning and quality for individuals with SAD has been previously explored but existing studies have not been synthesised.

AIMS

This scoping review charted existing literature regarding the quality and functioning of romantic relationships for people with SAD and high sub-clinical social anxiety (SA).

METHODS

The review used a scoping approach to explore the current evidence base relating to SA, romantic relationship quality and functioning. Articles published in English after 1980 that reported either clinical or high sub-clinical SA were eligible. Double screening, data extraction, quality assessment, and thematic analysis of studies was conducted.

RESULTS

50 studies from 46 articles were identified, involving a range of community, college, adolescent, and clinical samples. Thematic analysis identified four themes; Relationship Quality, Satisfaction and Commitment; Communication and Self-Disclosure; Conflict, Social Support and Trust; Intimacy, Closeness and Sexual Satisfaction.

CONCLUSIONS

The review highlights that evidence relating to romantic relationship functioning for individuals with SAD and high sub-clinical SA is heterogeneous, with relationship initiation in particular relatively under-explored. Further research is required to elucidate key constructs and interpersonal processes related to relationship functioning, and to inform treatment approaches with this group.

Social anxiety disorder with comorbid major depression - why fearful attachment style is relevant

Individuals with social anxiety disorder (SAD) often suffer from comorbid major depressive disorder (MDD), which goes along with increased clinical and functional impairment. There has been little research on underlying differences regarding childhood adversities and attachment styles between individuals with SAD with and without comorbid MDD. In the present study, the consecutive sample comprised 612 SCID-diagnosed participants. Of these, n = 472 (62.3% women, 40.7 ± 13.8 years) showed SAD and comorbid MDD (SAD-MDD group) and n = 140 (47.9% women, 43.7 ± 14.7 years) showed just SAD (SAD group). The two groups were compared regarding SAD symptom severity (Social Phobia Inventory; SPIN), childhood adversities (Adverse Childhood Experience Questionnaire; ACE) and attachment styles (Attachment Style Questionnaire, ASQ). The SAD-MDD group reported significantly more severe SAD symptoms (p = .002, d = 0.30), more childhood adversities (p < .001, d = 0.35) and a higher level of fearful attachment style (p < .001, d = 0.30). Group significantly moderated the association between fearful attachment style and SAD symptom severity (β = .292, p < .05) but not between preoccupied attachment style and SAD symptom severity (β = -.184, p = .124; R²_adj = .168, p < .05). Fearful attachment style mediated the association between childhood adversities and SAD symptom severity in the SAD-MDD group. Our study could identify a specific significance of fearful attachment style for the association between negative childhood experiences and social anxiety symptoms in SAD-MDD. Findings have specific implications for the therapeutic relationship.

The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis

INTRODUCTION

Loneliness is a negative experience arising from a mismatch between perceived and actual social relationships. Several dimensions of loneliness have been suggested, namely intimate, relational and collective loneliness. Loneliness has been linked to poorer mental health, with its co-occurrence with depression, social anxiety, and paranoia most widely reported. While expressions of these symptoms are heterogeneous across individuals in the non-clinical population, it remains unclear how these symptoms co-occur with one another and with various dimensions of loneliness. It is also of interest how trait factors such as core schemas about self/others may moderate these relationships between loneliness and co-occurring symptoms.

METHODS

A demographically diverse sample of young adults was recruited from multiple sources. The validated sample consisted of 2,089 participants (68.4% female), who completed an online survey consisting of questionnaires assessing levels of multidimensional loneliness, depression, social anxiety, paranoia, core schemas, and demographic characteristics. Latent profile analysis (LPA) was used to identify distinct profiles of loneliness and the three symptoms. Positive and negative core schemas about self and others were modeled as predictors of these profiles.

RESULTS

Five distinct profiles were identified. Profile 1 had low levels across all symptoms and dimensions of loneliness (n = 1,273, 60.9%). Profiles 2-5 were elevated on dimensions of loneliness, and were heightened in depression (n = 189, 9.0%), social anxiety (n = 206, 9.9%), paranoia (n = 198, 9.5%), and all symptoms (n = 223, 10.7%), respectively. Relative to Profile 1, the other four profiles scored higher on negative-self (adjusted ORs = 1.36-1.49, ps < 0.001) and negative-other schemas (adjusted ORs = 1.24-1.44, ps < 0.001), and lower on positive-self (adjusted ORs = 0.82-0.85, ps < 0.001) and positive-other schemas (adjusted ORs = 0.81-0.90, ps < 0.001).

CONCLUSION

More marked intimate, relational and collective loneliness were evident across profiles that had heightened depression, social anxiety and/or paranoia, suggesting that loneliness may serve as a general risk factor for these psychopathologies. Our findings shed light on the heterogeneity of the co-occurrence of loneliness and various mental health difficulties in non-clinical young adults. Core schemas are suggested to be putative psychological mechanisms underlying their co-occurrence and even development.

The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology

Insecure attachment is linked to mentalizing difficulties and psychopathology. The current study aimed to examine if failures in mentalization, as observed in the form of uncertainty about mental states, mediated the relationship between attachment styles and global psychopathology in a group of 812 adults (66.5% females) from the community. Participants completed measures on attachment styles, uncertainty about mental states, and clinical symptoms. The authors found that uncertainty about mental states was a partial mediator of the associations between attachment styles and psychopathology. Furthermore, the findings supported the role of secure attachment in protecting from mentalization failures and psychopathology; on the contrary, increased scores on attachment styles involving a negative view of the self (preoccupied and fearful attachment styles) predicted high levels of uncertainty about mental states and psychopathology. Accordingly, clinicians may wish to promote mentalizing abilities in individuals who display a negative view of the self embedded in their attachment styles.

Relationship Between Parental Marital Conflict and Social Anxiety Symptoms of Chinese College Students: Mediation Effect of Attachment

Social anxiety has been a common problem among college students and has an adverse impact on their adaptation outcomes. Among influential factors, parental marital conflict and attachment (parental and peer attachment) have been found to be related to social anxiety symptoms of college students; however, little is known how parental marital conflict and attachment jointly contribute to social anxiety symptoms of college students. The current study explored this issue. Self-reported questionnaires of perception of children of interparental conflict scale, inventory of parent and peer attachment, and the social interaction anxiety scale were administered to 707 undergraduate students (Mean age = 19.27, SD = 0.97). Results indicated that perceived parental marital conflict was positively correlated with social anxiety symptoms and was negatively associated with parental and peer attachment. Parental and peer attachments were negatively correlated with social anxiety symptoms. Mediation analyses indicated that perceived parental marital conflict exerted its indirect effect on social anxiety symptoms through a serial multiple mediation role of parental and peer attachment. The present findings highlight the serial multiple mediation role of parental and peer attachment in the relationship between perceived parental marital conflict and social anxiety symptoms of college students.

Attachment as a framework to facilitate empowerment for people with severe mental illness

OBJECTIVES

Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact.

DESIGN

We used a cross-sectional design.

METHODS

In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed.

RESULTS

Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not.

CONCLUSIONS

Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI.

PRACTITIONER POINTS

Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.

The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample

BACKGROUND

Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD).

OBJECTIVE

To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD.

METHOD

The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants.

RESULTS

Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment.

CONCLUSIONS

These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.

Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence

Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.

The correlates of social phobia in OCD: Findings from a large clinical sample

OBJECTIVES

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients.

METHODS

We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses.

RESULTS

Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients.

CONCLUSION

Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD.

PRACTITIONER POINTS

Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.

The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder

Introduction

The aim of our study is to compare the attachment characteristics and the theory of mind abilities measured by the Eyes Test between social anxiety disorder (SAD) patients and healthy controls. Another aim of our study is to investigate the relationship between attachment characteristics, theory of mind abilities and disease severity in patients with SAD.

Method

47 consecutive patients with SAD and 50 healthy controls were recruited for the study. Sociodemographic data form, SCID-I Structured Clinical Interview form Patient Version, Beck Depression Inventory (BDI), Reading Mind in the Eyes Test (Eye Test), Liebowitz Social Anxiety Scale (LSAS), Experiences in Close Relationship Inventory (ECR) and State-Trait Anxiety Inventory (STAI) were administered to all participants.

Results

The BDI, LSAS anxiety and avoidence, ECR and anxiety and avoidance, STAI state and trait anxiety scores of the SAD group were higher than the controls, but the Eyes Test scores were lower. It was observed that the Eyes Test score difference between the two groups survived when controlled for BDI and STAI state and trait anxiety scores. In the SAD group, both ECR anxiety and avoidance scores were associated with LSAS anxiety and avoidance scores. Eyes Test scores were associated with LSAS anxiety and avoidance scores. In regression analysis, it was observed that the Eyes Test, ECR anxiety and avoidance scores effected both the LSAS anxiety and the LSAS avoidance scores.

Conclusion

In SAD patients, the theory of mind functions was impaired when compared to healthy controls, and this difference has been found to be independent of anxiety or depression levels. Attachment anxiety and avoidance dimensions have negative effects on SAD disease severity. The fact that the theory of mind ability is inversely related with SAD severity suggests that interventions to improve social cognition might have a potential to decrease the severity of disease in SAD.

Differential effects of adult attachment in cognitive-behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self-rating and an observer rating

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis

INTRODUCTION

Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.

METHODS

One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.

RESULTS

Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.

CONCLUSIONS

The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.

Coping strategies among adults with ADHD: The mediational role of attachment relationship patterns

BACKGROUND

For adults with attention/hyperactivity disorder (ADHD), research is scarce on their coping with stress (despite studies demonstrating other self-regulation deficits) and their attachment patterns (despite rare research in younger persons with ADHD showing high vulnerability to insecure attachments). Attachment was linked with coping and self-regulation in general populations but not yet in ADHD. This study explored the possible mediational role of attachment patterns in explaining associations between adults' ADHD symptoms and dysregulated coping.

METHODS

Participants comprised 62 adults (32 females, 30 males) ages 21-40 years (M = 27.60, SD = 4.80) in two groups: 31 adults with formally diagnosed ADHD and 31 demographically matched adults without ADHD. Instruments included computerized neuropsychological tests (sustained/executive attention) and self-reports (ADHD, coping, attachment).

RESULTS

Disorder status was verified via ADHD-symptom self-reports and computerized testing. Preliminary analyses revealed significant intergroup differences on coping strategies and attachment. PROCESS analyses (Hayes, 2013) pinpointed attachment measures' mediating role (especially attachment anxiety) regarding ADHD's association with coping.

CONCLUSIONS

Significantly more maladaptive attachment and coping outcomes emerged for adults with ADHD than controls. Attachment insecurity's role in mediating ADHD's association with coping was partially supported. Possible unique adaptive value of attachment relationships was discussed for coping with stressors in adulthood with ADHD.

Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis

OBJECTIVES

The use of trajectories and analysis of change patterns is a promising way toward better differentiation of subgroups in psychotherapy studies. Research on change patterns in social anxiety disorder (SAD) are still rare, although SAD is one of the most common mental disorders. In a secondary analysis of data from the SOPHO-NET-trial (ISRCTN53517394) this study aimed to investigate change patterns and their predictors in a sample of SAD patients.

METHODS

Patients with SAD (N = 357) were randomly assigned to cognitive-behavioral or psychodynamic therapy. The Liebowitz Social Anxiety Scale (LSAS) was assessed at 1^st session (pre), 8th session, 15th session and at the end of treatment (post). We used latent state variables and latent class analysis for the classification of change patterns and logistic regression for the identification of different predictors.

RESULTS

Analyses revealed three typical patterns: (i.) responders with a high initial impairment (N = 57), (ii.) responders with a moderate initial impairment (N = 225), and (iii.) patients with a high initial impairment and no remission (N = 75). Among other significant predicators, patient´s attachment anxiety and therapeutic alliance at session eight contributed to the prediction of change patterns.

DISCUSSION

Psychotherapy of SAD should consider patient's attachment and focus on the establishment of a solid therapeutic alliance in an early therapy stage.

Cortisol response to stress: The role of expectancy and anticipatory stress regulation

An exacerbated physiological response to stress is associated with the development of stress-related disorders (e.g., depression and anxiety disorders). Recently, it has been proposed that individuals with high expectancies of being able to deal with stressful situations will activate regulatory mechanisms during the anticipation of the stressful event that would improve stress regulation. To test this hypothesis, 52 women in young adulthood (M = 21.06; SD = 2.58) anticipated and performed a laboratory-based stress task after receiving positive or negative bogus feedback on their abilities to deal with stressful events. Heart rate variability and salivary cortisol were assessed throughout the experimental protocol. Participants receiving positive bogus feedback (i.e., High Expectancy group) showed a more positive anticipatory cognitive stress appraisal (i.e., they anticipated the stress task as less threatening/challenging, and they perceived that they were more able to deal with it), and they showed a lower cortisol response to stress. Moreover, a more positive anticipatory cognitive stress appraisal was associated with better anticipatory stress regulation (indexed as less decrease in heart rate variability), leading to a lower cortisol response. Our results indicate that people with positive expectancy initiate mechanisms of anticipatory stress regulation that enhance the regulation of the physiological stress response. Expectancy and anticipatory stress regulation may be key mechanisms in the development and treatment of stress-related disorders.

Personality functioning in anxiety disorders

PURPOSE OF REVIEW

The alternative model for personality disorders in DSM-5 and the upcoming ICD-11 stimulated an increased interest in the concept of personality functioning for the diagnosis of personality disorders. Furthermore, the impact of personality functioning on other mental disorders has become the focus of recent research efforts. The purpose of this review is to provide a comprehensive and critical study of the empirical literature on the relationship between personality functioning and anxiety disorders.

RECENT FINDINGS

Recent studies predominantly show a positive association of anxiety symptoms and disorders with an impairment in personality functioning. However, no evidence was found for different levels of personality functioning according to the type of anxiety disorder. Anxiety disorders can occur at all levels of personality organization.

SUMMARY

Anxiety disorders are associated with significant impairment in personality functioning. As the underlying personality structure is known to play a crucial role for treatment outcome, the evaluation of personality functioning should be a central part of a comprehensive diagnostic process and treatment planning in patients with anxiety disorders.

Positive Self-Relation Scale - development and psychometric properties

PURPOSE

Self-relation is a profound connection that influences one's life. As such, it presents an important topic for various areas of research and psychotherapy. The goal of this study was to develop and evaluate a brief scale that would assess positive aspects of self-relation.

SAMPLE AND METHODS

The Positive Self-Relation Scale (PSRS) consists of 16 items divided into 4 subscales - Self-Acceptance, Self-Confidence, Authenticity and Assertiveness, and Fulfilled Experience. Two samples were used for the evaluation of its content and factor structure. The final sample's data used for validation assessment. This sample consisted of 1234 adults from a general population (mean age 34.8±14.2 years, 70.8% women). All participants completed PSRS. Subgroups also filled in Rosenberg Self-Esteem Scale (RSES), Adult Dispositional Hope Scale (ADHS), Beck Depression Inventory-II (BDI-II), Liebowitz Social Anxiety Scale (LSAS), and Dissociative Experiences Scale (DES).

RESULTS

Differences in scores among demographic groups were small to none. Internal consistency was good (Composite Reliability Coefficients - the whole scale: 0.93; the subscales: 0.73-0.80). Temporal stability, assessed 2 weeks apart, was satisfactory (intraclass correlation coefficients - the whole scale: 0.86, the subscales: 0.60-0.82). Factor loadings in confirmatory factor analysis were 0.45-0.80, fit indices mostly showed an adequate model. The correlation coefficients between PSRS and RSES/ADHS were strong (r=0.79/0.55). The scale also strongly correlated with LSAS, BDI-II, and DES (r=-0.61/-0.48/-0.30, all ps<0.001).

CONCLUSION

PSRS showed adequate psychometric properties in the general population. Future studies should include clinical samples. The areas of application lie mainly in research and psychotherapy.

Perspectives on restoring health shared by Cree women, Alberta, Canada

The purpose of this study was to explore nehiyaw iskwêwak (Cree women's) perceptions and beliefs about how to restore balance to health. Fifteen indigenous women from Northern Alberta, Canada, participated in a 3-day cultural retreat on beauty and art in British Columbia, Canada, in May 2015. At the end of the retreat, these women were invited to participate in a talking circle and asked, 'What does restoring balance look like?' A constructivist grounded theory approach was used to explore individual and collective perspectives on restoring health. Nehiyaw iskwêwak provided a vision of health using metaphors from the natural environment. Starting points and core characteristics of health were grounded in relationship with self, others, place and the land, suggesting interventions grounded in land-based pedagogy and focused on restoring relationship and secure attachment might be effective for this population. Nehiyaw iskwêwak also said interventions should start at the individual level; as the individual restores balance mentally, emotionally, physically and spiritually, a long-term ripple effect can be initiated through the generations and community when these women in turn support the strengthening and nurturing of relations (e.g. parents, siblings, friends, children, grandchildren) for the next seven generations.

Psychological burden and resilience factors in patients with Alveolar Echinococcosis - A cross-sectional study

BACKGROUND

Alveolar echinococcosis (AE) is a parasitic zoonosis resembling malignancy due to its clinically silent infiltrative growth, predominately in the liver. The comorbid psychological burden and fear of disease progression in AE patients have hardly been examined to date. The aim of this study was to evaluate depression, anxiety, quality of life, and fear of disease progression in AE patients.

METHODOLOGY/PRINCIPAL FINDINGS

In a cross-sectional study, n = 57 AE patients were invited to report on depression (PHQ-9), anxiety (GAD-7), somatic symptom load (SSS 8), trauma symptoms (PTSS-10), quality of life (SF-12) and on fear of disease progression (FoP-Q-SF) using validated psychometric instruments. Furthermore, attachment style was assessed (RQ-2). N = 47 patients completed the questionnaires (response rate 82.5%). Depression, anxiety, and somatic symptom load were above norm sample means, while physical quality of life was below norm sample means. Existing traumatic symptoms were comparable to those in cancer patients, while fear of disease progression even exceeded cancer patient scores. Patients with a secure attachment style showed less pronounced psychological burden than patients with other attachment styles. Adequate, guideline-based depression and anxiety treatment was very rarely installed.

CONCLUSION/SIGNIFICANCE

The present study revealed remarkable levels of psychological burden in AE patients. In our study sample, we discovered high depression and anxiety levels, a significant reduction of physical quality of life, and fear of disease progression. These results show how important it is for AE patients to be thoroughly assessed with regard to psychological symptoms and mental disorders so that those in need can receive sufficient psychosocial support and treatment according to official guidelines.

Adult attachment and social anxiety: The mediating role of emotion regulation strategies

Despite extensive evidence relating attachment dimensions to maladaptive interpersonal behaviours and dysfunctional emotion regulation strategies, few studies have explored social anxiety in the context of adult attachment dimensions. The aim of the present study was to investigate whether attachment-related anxiety and avoidance are associated with symptoms of social anxiety and whether cognitive emotion regulation strategies (reappraisal and suppression) play a role in the relationship between adult attachment and social anxiety. A sample of 253 adults (male n = 47, 18.6%; female n = 202, 79.8%; gender not disclosed n = 4, 1.6%) ranging in age from 18 to 74 years (M = 33.12, SD = 11.56) completed an online questionnaire that consisted of the Experience in Close Relationships–Revised Questionnaire (ECR-R); The Inventory of Interpersonal Situations Discomfort scale (IIS-D); and The Emotion Regulation Questionnaire (ERQ). Results indicated that both attachment anxiety and attachment avoidance have a direct effect on indices of social anxiety symptomology. Reappraisal partially mediated the relationship between attachment anxiety and social anxiety. However, the relationship between attachment avoidance and social anxiety was not mediated by the use of reappraisal and suppression. Findings of the study have implications for the development of clinical interventions targeting mediators of psychological distress associated with social anxiety.

Personality Dynamics, Motivation, and the Logic of Explanation

Dynamic personality approaches provide an important step forward for twenty-first century personality theories because they promise greater explanatory power compared with latent trait approaches. Nevertheless, whether dynamic personality theories satisfactorily address motivated action remains unclear. To address this, this article discusses the logic of explanation and problems with latent trait approaches in terms of circularity and reification. The article then assesses explanation within dynamic personality accounts and the putative role of motivation. While dynamic personality approaches avoid many of the problems associated with latent trait accounts, a satisfactory account of motivational systems and “human nature” is currently missing. Suggestions for addressing the dynamics of human nature in terms of criteria for motivational systems are discussed. Attachment theory is offered as one possible foundation for addressing the motivational dynamics of personality.

The relationship between intolerance of uncertainty in chiropractic students and their treatment intervention choices

Background

Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students’ intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief.

Method

Between October and November of 2016, students from two Australian chiropractic programs (N = 444) answered a questionnaire on measures of IU levels, patient case scenarios for neck and low back pain, and questions about self-ratings of their future chiropractic abilities and perceived need for the adoption of a chiropractic technique system. Associations were tested by the IU score and the therapeutic choices relating to a) a neck pain case scenario, b) a low back pain scenario, c) various technique systems, and d) the self-rated competence level treating the IU score both as a continuous and a categorical variable.

Results

There was an overall response rate of 53%. Those students who were high in levels of IU were significantly more likely to make incorrect clinical decisions than those with normal or low levels of IU for the neck pain case scenario. No differences were found on the low back pain scenario, on preferences to use a technique system in the future, or on predicted self-rating of competence after graduation.

Conclusions

Psychological factors, such as IU, may have an impact on chiropractic students’ clinical decisions. However, it does not impact on all aspects of practice. This finding has implications for chiropractic educators, especially when dealing with neck pain. However, it may be relevant to continue the search for specific personality profiles in relation to various favourable and unfavourable practice patterns, as it is unknown whether these dynamics are important for other aspects of chiropractic education.

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-017-0150-2) contains supplementary material, which is available to authorized users.