Unresolved mourning, supernatural beliefs and dissociation: a mediation analysis

Consequences of Unexplained Experiences in the Context of Bereavement - Qualitative Analysis

Unexplained experiences are common among bereaved people and are a natural part of grieving, but their consequences may affect their coping with grief. However, professionals lack awareness of these unexplained experiences, which may lead to an unnecessary pathologising of the experiences and a lack of opportunity for the bereaved to process their experiences in a safe environment. The study involved an inductive content analysis of 408 narratives of the consequences of unexplained experiences shared by 181 bereaved individuals. The consequences of the unexplained experiences were: (1) Experiencing after-effects which may alleviate or aggravate wellbeing, as well as be life-affecting; (2) consequences related to sharing or concealing the experiences, and the reactions of others to recounting the experience; (3) documenting the experience through videography, photography and keeping mementos. In conclusion, these experiences have consequences to bereaved which needs to be taken account in support interventions aimed at bereaved individuals.

A qualitative phenomenological exploration of prolonged grief in New Delhi, India

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD.

Disorganized attachment in emerging adulthood: Measurement comparisons and relations to childhood maltreatment and emotion dysregulation

There is an abundance of research examining disorganized attachment in childhood. However, few researchers have worked to advance the study of disorganized attachment in the context of emerging adult romantic relationships. As such, consistent and clear measurement of this attachment dimension is lacking. In the current study, emerging adult college students (N = 318) completed two previously designed self-report measures for assessing adult disorganized attachment in the context of romantic relationships. The two scales were compared in a factor analytic framework to create a single cohesive measure of romantic disorganized attachment, which captures the unique features of disorganized attachment, including fear, distrust and suspicion of attachment figures, as well as odd and disoriented behaviors. The result was a 15-item measure, which showed good reliability and factorial validity, and was moderately related to existing measures of attachment anxiety and avoidance. Additionally, the new measure demonstrated good test-retest reliability in a follow-up (n = 52). Finally, path analysis was used to provide evidence that disorganized attachment mediates the relation of childhood maltreatment to difficulties in emotion regulation, above what is captured by anxious and avoidant attachment. The current findings suggest the revised measure is a reliable self-report measure of disorganized adult romantic attachment to be used to further the study of disorganized attachment in emerging adulthood.

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.

The Role of Implicit Memory in the Development and Recovery from Trauma-Related Disorders

Post-traumatic Stress Disorder is a chronic condition that occurs following a traumatic experience. Information processing models of PTSD focus on integrating situationally triggered sensory-emotional memories with consciously accessible autobiographical memories. Review of the nature of implicit memory supports the view that sensory-emotional memories are implicit in nature. Dissociation was also found to be associated with the development and severity of PTSD, as well as deficits in autobiographical memory. Moreover, disorganized attachment (DA) was associated with greater degrees of dissociation and PTSD, and like the defining neural activation in PTSD, was found to be associated with basal ganglia activity. In addition, subcortical neuroception of safety promotes a neurophysiological substrate supportive of social engagement and inhibition of fear-based responses. Furthermore, activation of representations of co-created imagined scenes of safety and secure attachment are associated with increases in this neurophysiological substrate. Repeated priming of secure attachment imagery was associated with modification of internal working models of DA along with reductions in dissociation and recovery from complex PTSD. In conclusion, it is posited that adequate recovery from extensive trauma experiences requires more than conscious elaboration of traumatic autobiographical memories and that the application of implicit nonconscious memory modification strategies will facilitate more optimal recovery.

Social Adaptation in Context: The Differential Role of Religiosity and Self-Esteem in Vulnerable vs. Non-vulnerable Populations - A Registered Report Study

There is evidence that religiosity and self-esteem are positively related, while self-esteem and religiosity in turn predict successful social adaptation. Moreover, self-esteem has been shown to be directly related to social adaptation in vulnerable contexts. In this registered report study, we tested the hypothesis that religiosity has a positive influence on social adaptation for people living in vulnerable contexts and that self-esteem is a mediator of this relationship. Evidence from this study indicates that neither there is any effect of religiosity on social adaptation nor on self-esteem, independent of whether people live in vulnerable contexts or not.

Psychophysiological responses underlying unresolved loss and trauma in the Adult Attachment Interview

Unresolved loss/trauma in the context of the Adult Attachment Interview (AAI) has been theorised to result from dissociative processing of fear-related memories and ideas. To examine the plausibility of this model, this study tested hypothesised associations between unresolved loss/trauma and indicators of autonomic nervous system (ANS) reactivity. First-time pregnant women (N = 235) participated in the AAI while heart rate (interbeat interval; IBI) and indicators of parasympathetic reactivity (respiratory sinus arrhythmia; RSA) and sympathetic reactivity (pre-ejection period; PEP, skin conductance level; SCL) were recorded. Using multilevel modelling, ANS reactivity was examined in relation to topic (loss/trauma versus other questions); discussion of actual loss/trauma; classification of unresolved/disorganised; and unresolved responses during the interview. Responses to loss/trauma questions and discussion of loss were associated with respectively larger and smaller IBIs. There was no moderation by unresolved/disorganised status. Unresolved responses about loss were associated with smaller IBIs. Participants classified as unresolved/disorganised showed decreasing PEP and blunted SCL throughout the whole interview. The findings suggest that unresolved speech about loss co-occurs with physiological arousal, although the inconclusive findings regarding parasympathetic and sympathetic nervous system responses fail to clearly support the role of fear.

Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind

Childhood adversity has been found to be an important aetiological factor in the development of personality disorder (PD) in several studies. However, the role of disorganized attachment with unresolved mental states for traumatic experiences requires further investigation. This study explores the relationship between childhood adversities, unresolved states of mind, PD diagnosis and psychiatric distress. Two hundred forty-five adult participants, 124 from a clinical PD group and 121 non-psychiatric controls were assessed using the Structured Clinical Interview for DSM-IV, the Cassel Baseline Questionnaire, the Symptom Checklist-90-R and the Adult Attachment Interview, in order to ascertain presence of PD, childhood adversity, level of psychiatric distress and unresolved states of mind. Within the overall unresolved (U-overall) attachment category, a distinction was made between unresolved for abuse (U-abuse) and unresolved for loss (U-loss). The results indicated that childhood adversity was significantly associated with unresolved states of mind, as well as with overall PD diagnosis, paranoid PD, borderline PD, avoidant PD and psychiatric distress. Mediation analyses confirmed that U-overall and U-loss were significant mediators between childhood adversity and PD diagnoses, but surprisingly, U-abuse was not a significant mediator. The strength, limitations and clinical implications of the findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

The relation of dissociation and mind wandering to unresolved/disorganized attachment: an experience sampling study

Individuals with unresolved/disorganized representations of childhood trauma (U/d attachment) report more psychological distress than others, but little is known about their everyday mentation. In the present study adults with childhood trauma (N = 45) completed the Berkeley-Leiden Adult Attachment Questionnaire-Unresolved (BLAAQ-U) and the Adult Attachment Interview (AAI), and reported everyday mentation during 5 days of experience sampling. The BLAAQ-U and the AAI showed a medium association with each other, but only the former significantly predicted negative affect, dissociation, and low control/awareness of mentation. Contrary to our predictions, U/d attachment did not significantly predict mind wandering, but the BLAAQ-U predicted endorsements of a negative mind wandering style. U/d attachment, as assessed by both instruments, was associated with the Poor attentional control style and beliefs in anomalous mental phenomena. Experience sampling is a valuable way to investigate everyday experiences in individuals with U/d attachment.

Attachment representations and autonomic regulation in maltreating and nonmaltreating mothers

This study assessed attachment representation and attachment-related autonomic regulation in a sample of 38 maltreating and 35 nonmaltreating mothers. Mothers’ state of mind regarding attachment was measured using the Adult Attachment Interview. They further watched an attachment-based comfort paradigm, during which we measured skin conductance and vagal tone. More maltreating mothers (42%) than nonmaltreating mothers (17%) had an unresolved/disoriented attachment classification. Attachment representation was related to physiology during the comfort paradigm: an unresolved state of mind and a nonautonomous classification were associated with a decrease in skin conductance during the comfort paradigm, specifically during the responsive caregiver scenario. However, physiology did not differ between maltreating and nonmaltreating mothers. The decrease in skin conductance of unresolved mothers during the comfort paradigm might be indicative of a deactivating response, which is congruent with the dissociative nature of the unresolved state of mind. The results point to the potential utility of interventions focused on attachment representations for maltreating mothers.