Attachment and psychosomatic medicine: developmental contributions to stress and disease

The role of perceived negative partner behavior in daily snacking behavior: A dynamical systems approach

Past work suggested that psychological stress, especially in the context of relationship stress, is associated with increased consumption of energy-dense food and when maintained for long periods of time, leads to adverse health consequences. Furthermore, this association is moderated by a variety of factors, including emotional over-eating style. That being said, few work utilized a dynamical system approach to understand the intraindividual and interindividual fluctuations within this process. The current study utilized a 14-day daily diary study, collected between January-March 2020, where participants reported their partner's negative relationship behavior and their own snacking behavior. A differential equation model was applied to the daily dairy data collected. Results showed that snacking behavior followed an undamped oscillator model while negative relationship behavior followed a damped coupled oscillator model. In other words, snacking behavior fluctuated around an equilibrium but was not coupled within dyadic partners. Negative relationship behavior fluctuated around an equilibrium and was amplified over time, coupled within dyadic partners. Furthermore, we found a two-fold association between negative relationship behavior and snacking: while the association between the displacement of negative relationship behavior and snacking was negative, change in negative relationship behavior and snacking were aligned. Thus, at any given time, one's snacking depends both on the amount of negative relationship behaviors one perceives and the dynamical state a dyad is engaging in (i.e., whether the negative relationship behavior is "exacerbating" or "resolving"). This former association was moderated by emotional over-eating style and the latter association was not. The current findings highlight the importance of examining dynamics within dyadic system and offers empirical and methodological insights for research in adult relationships.

Gestational diabetes perception profiles based on attachment style: a cross-sectional study

AIMS

Gestational diabetes (GDM) is a prevalent complication in pregnancy that requires effective self-management, which can be influenced by illness perceptions. Moreover, behavioral regulation can be affected by attachment styles. Thus, our study aimed to identify common GDM perception profiles and test their association with attachment styles.

METHODS

In this cross-sectional study, 446 women completed the Relationship Questionnaire (RQ), the Brief Illness Perception Questionnaire (BIPQ), and additional items about GDM diagnosis, information, competence, adherence, behavioral change. Latent profile analysis (LPA) was conducted to determine GDM perception profiles. Multinomial logistic regression followed to calculate the association between GDM perception profiles and attachment styles.

RESULTS

Three distinct profiles emerged: coping (n = 172, 38.6%)-characterized by the most positive GDM perception, burdened (n = 222, 49.8%)-indicating the emotional burden of the disease, and resourceless (n = 52, 11.7%)-reporting lack of resources (i.e. information, competence). Women with insecure attachment styles were more likely to develop a burdened GDM perception profile. Specifically, the expression of a fearful (OR = 1.184 [95%CI: 1.03; 1.36], p = 0.016) and a preoccupied (OR = 1.154 [95%CI: 1.01; 1.32], p = 0.037) attachment style increased the likelihood for a burdened perception profile, while a secure attachment style (OR = 10.791 [95%CI: 0.65; 0.96], p = 0.017) decreased likelihood for developing resourceless GDM perception profile.

CONCLUSIONS

Three GDM perception profiles were identified and the role of attachment styles in shaping these perceptions was confirmed. Further studies are needed to investigate whether a tailored treatment approach based on the predominant attachment style could lead to more positive GDM perceptions, improved glycemic control, and better perinatal outcomes.

A Pilot Study on the Influence of Maternal Attachment Representations on Maternal Heart Rate Mediated by Perceived Stress

Past findings have suggested that there is a link between attachment representations and reactions towards stress (subjective and physiological). The aim of this study was to examine the mediating effect of perceived stress on the association between attachment representation and physiological changes, specifically heart rate. As part of a long-term study investigating the transgenerational transmission of childhood maltreatment, n = 163 mothers participated in multiple assessments. The Adult Attachment Projective Picture System (AAP) was used to measure maternal attachment representation, categorizing individuals as securely or insecurely attached. Perceived daily stress was assessed using the Perceived Stress Scale 14 (PSS-14), and maternal baseline heart rate (HR) was measured via electrocardiography during a laboratory visit. The results revealed that the representation of secure attachment had a significant reducing effect on both the mother's perceived daily stress and heart rate. Furthermore, the association between secure attachment representation and heart rate was mediated by perceived stress. This study emphasizes the role of attachment representation in maternal well-being, highlighting its impact on stress and physiological responses.

Associations between participation and personal factors in community-dwelling adults post-stroke

PURPOSE

To examine associations between post-stroke participation and personal factors, including demographic characteristics, self- and threat appraisals, and personality variables.

METHODS

An exploratory cross-sectional study with purpose-designed survey was completed online or via mail. The survey was comprised of demographic and health-related questions and multiple questionnaires, including the Stroke Impact Scale Version 3.0 (SISv3) (participation/perceived recovery), Community Integration Questionnaire (CIQ) (participation), Head Injury Semantic Differential III (pre- vs post-stroke self-concept/self-discrepancy), Appraisal of Threat and Avoidance Questionnaire (threat appraisal), Life Orientation Test - Revised (optimism) and Relationships Questionnaire (adult attachment style) that measured variables of interest. Sixty-two participants, aged 24-96 years who had experienced a stroke (one or multiple events) and had returned to community living, completed the survey. Associations were examined using correlations, and univariate and multiple linear regression analyses.

RESULTS

Regression analysis showed that greater participation, measured using the CIQ, was associated with younger age, female gender, lower self-discrepancy and higher perceived recovery, explaining 69% of the variability in CIQ participation. Further, greater participation on the SISv3 was associated with lower self-discrepancy and higher perceived recovery, explaining 64% of the variability in SISv3 participation.

CONCLUSIONS

Results indicate that personal factors, particularly self-appraisals like self-concept/self-discrepancy, in combination with perceived recovery may be important in explaining a large portion of variance in post-stroke participation. Specifically, findings highlight the interrelatedness of self-concept change, perceived recovery and post-stroke participation. Further longitudinal research is needed to clarify the directionality of these associations throughout the hospital-to-home transition.

The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.

Attitudes to ageing amongst health care professionals: a qualitative systematic review

OBJECTIVES

Older adults utilising healthcare may be vulnerable to systemic bias regarding ageing potentially affecting care. Primary aim is to systematically review the qualitative literature examining attitudes to ageing amongst health care professionals (HCPs). Secondary aim is to describe and compare attitudes to ageing between different professional groups.

METHODS

Studies examining attitudes to ageing of HCPs were identified using four databases. Original qualitative research with HCPs was included, excluding studies examining students alone, reviews, and grey literature. Three authors undertook standardised data extraction and quality rating for each study and thematic synthesis, with a fourth senior author reviewing. Quality appraisal followed the Attree and Milton guidelines (2006), including studies rated A-C.

RESULTS

Of 5869 citations, 13 met initial inclusion criteria. Synthesis of the 12 studies graded A-C followed (excluding one study rated-D). Nurses, doctors, and social workers were most frequently investigated. Identified themes included Attitudes towards older persons, The role of the older persons' family, Behaviour of HCPs towards older persons, Behaviour of older persons towards HCPs, and Definitions of an older person. An overarching theme emerged of the systemic context of attitudes to ageing. Common attitudes were found across disciplines, with doctors emphasising complexity and dependency and nurses the burden of care.

CONCLUSIONS

HCP's attitudes to ageing vary and are shaped by professional experiences and systemic factors. HCP attitudes may affect responses to and care of the older person. Therefore, interprofessional research, and systemic and service changes across disciplines are required to foster real and sustainable attitudinal change to support older peoples' care.

The Influence of Perceived Security in Childhood on Adult Self-Concept: The Mediating Role of Resilience and Self-Esteem

Secure attachment, developed through consistent relationships with attachment figures in childhood, is a crucial factor in fostering healthy interpersonal relationships and a positive self-perception. Part of the positive parenting approach and the theory of affect is taken as a basis to assess how perceived security, as an indicator of secure attachment, predicts adult self-concept through the mediating effects of resilience and positive self-esteem. A quantitative, cross-sectional, and nonprobabilistic study was conducted with 383 participants. We unveiled significant positive associations between perceived security, self-concept, resilience, and positive self-esteem. Path analysis demonstrated that resilience and positive self-esteem sequentially mediate the relationship between perceived security during childhood and adult self-concept. Findings suggest that the ability to cope with adversity and personal acceptance underlie the impact of perceived security on self-concept. It is recommended to promote family intervention programs framed within positive parenting that focus on fostering secure attachment given its influence on adult life. It is also deemed essential to incorporate the promotion of resilience and self-esteem into programs aimed at youths, and adult role models can enhance their self-perception and resilience in the face of potential effects stemming from insecure parenting practices.

A theoretical and clinical perspective of an embodied view in psychotherapy of somatic symptoms disorders

In this paper, we offer some ideas for the treatment of somatoform patients and related pathologies based on the concept of embodiment. Embodiment refers to the interplay between body and mind in behavior. The word refers to giving a body to something, "incarnate". Spinoza wrote extensively about the topic in the 17th century. In the 20th century, picking up on Spinoza's work, Damasio presented extensive and important neuro-scientific evidence that feelings can be direct perceptions of internal body states, substantiating the growing understanding of emotions and feelings as a core component of the embodied experience. Here, we summarize the evidence for the intersection of emotion and cognition in the body, which impinges on the effectiveness of using the body and movement in psychotherapy and the management of somatic symptoms and related disorders. We present evidence indicating that movement would be a way to reach unconscious processes dealing with body-mind interaction and body awareness.

Attachment style and post-bariatric surgery health behaviours: the mediating role of self-esteem and health self-efficacy

BACKGROUND

Attachment avoidance and anxiety have been linked to overweight and poor health behaviours, yet the mechanisms that underpin the relationship between attachment and health behaviours are not fully understood. Self-esteem and self-efficacy have been found to differ between attachment styles, rendering these variables potential mediators of the relationship. This longitudinal study investigated the serial mediation between preoperative attachment and 2-year post-operative health behaviours through self-esteem and health self-efficacy.

METHODS

Participants were 263 bariatric surgery patients (75.7% females, aged 47.7 ± 10.4 years, BMI 38.9 ± 3.6 kg/m2) assessed before the operation and again one and two years after the surgery. Patients completed the Experiences for Close Relationships Brief Scale, Rosenberg Self-esteem scale, Weight Efficacy Lifestyle Questionnaire, Bariatric Surgery Self-Management Questionnaire, Exercise Self-Efficacy Scale and the Exercise Behaviour Scale.

RESULTS

Higher preoperative attachment anxiety and avoidance were associated with lower self-esteem one year after bariatric surgery and poorer health self-efficacy two years after the surgery. Self-esteem and health self-efficacy mediated the relationships between preoperative anxious and avoidant attachment and 2- year post-operative diet adherence and physical activity.

CONCLUSIONS

Helping patients to feel more worthy and reinforcing their beliefs about their own competences could lead to higher engagement with healthy lifestyle and adherence to treatment protocols, ultimately helping patients to achieve their goals for bariatric surgery.

CLINICAL TRIAL REGISTRATION

BARIA: Netherlands Trial Register: NL5837 (NTR5992) https://www.trialregister.nl/trial/5837 . Diabaria: ClinicalTrials.gov identifier (NCT number): NCT03330756.

Attachment, Feeding Practices, Family Routines and Childhood Obesity: A Systematic Review of the Literature

Childhood obesity is considered a major public health problem. To help prevention and intervention programs targeting families with obese children, this paper is aimed at synthesizing multifactorial and transactional data resulting from studies and reviews assessing relational factors between the child and his or her parents and the child's obesity risk, including the child's and CG's attachment quality, parental feeding practices, and family routines. It is also aimed at assessing the mediation of these links by specific self-regulatory capacities across different developmental periods (0-2, 2-8, and 8-18 years old). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were applied in the review methodology. Ten papers were analyzed, including seven empirical studies and three reviews proposing etiological models of childhood obesity. The quality of empirical studies was assessed, and a synthetical model of the results was proposed. This literature review showed that the caregiver's (CG) and the child's attachment quality, along with controlling or permissive feeding practices, and few family routines are mostly mediated by appetite dysregulation and emotional regulation strategies with the development of child obesity. New research topics are proposed to understand other facets of childhood obesity, as well as how to better prevent and treat it.

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.

On the interplay of borderline personality features, childhood trauma severity, attachment types, and social support

BACKGROUND

Adverse childhood experiences (ACE) have consistently been associated with borderline personality disorder (BPD). Still, it is not yet entirely understood if and how different types of ACE (emotional, physical, sexual abuse, neglect) relate to different BPD subdomains (affective instability, identity disturbance, negative relationships, self-harm). Insecure attachment and lower perceived social support are associated with both ACE and BPD and may therefore contribute to their relationship. No study so far integrated all these variables in one model, while accounting for their mutual influence on each other. We investigated the interplay of BPD subdomains, ACE, attachment, and perceived social support using a graph-theoretical approach.

METHODS

An international sample of 1692 participants completed the Childhood Trauma Questionnaire (CTQ), the Borderline Feature Scale from the Personality Assessment Inventory (PAI-BOR), the Adult Attachment Scale (AAS), and Multidimensional Scale of Perceived Social Support (MSPSS) via an online survey. We estimated a partial correlation network including subscales of the CTQ and the PAI-BOR as nodes. We extended the network by including subscales of the AAS and MSPSS as additional nodes.

RESULTS

Emotional abuse was the most central node in both networks and a bridge between other types of ACE and BPD features. All domains of BPD except affective instability were associated with emotional abuse. Identity disturbances was the most central node in the BPD network. The association between ACE and BPD features was partly but not fully explained by attachment and social support.

CONCLUSION

Our findings suggest that emotional abuse is an important link in the association between ACE and BPD features, also when taking attachment and social support into account. Findings further suggest an outstanding role of identity disturbance, linking emotional abuse to affective instability and being strongly associated with attachment anxiety.

Periodontal maintenance: individual patient responses and discontinuations

Aim

There is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting.

Methods

A sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation.

Results

For both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints.

Conclusion

Considering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT.

Trial registration: The clinical trial was retrospectively registered in the DRKS—German Clinical Trials Register (https://www.drks.de) with registration DRKS00030092 (26/08/2022).

Attachment and patient activation as predictors of the interest and use of telemedical health applications –results of an observational study in primary health care

Background

Telemedicine applications are becoming more accepted and offer great potential to support physicians and patients. However, there is an increasing need for research, especially in personal predictors that determine the interest and use of telemedicine and e-health applications. This study aims to identify if attachment and patient activation are potential predictors of the interest in and the use of e-health applications in primary care patients.

Methods

We used data from the cross-sectional observational Weimar TelMed study on 192 patients treated by general practitioners from a practice of family medicine in Thuringia, the middle of Germany. The adult attachment was measured using the ECR-RD12 and patient activation with the PAM-13D. Multiple regression analysis by the General Linear Model was used to evaluate the association between attachment, patient activation, and interest in and use of e-health applications.

Results

Patient activation was associated with a higher interest in e-health care. The attachment dimension avoidance was a potential predictor of interest in e-health and e-health-care use.

Conclusion

Adult attachment is an essential predictor of different ways of healthcare use. While avoidant patients evade contact with general practitioners, self-determined access via e-health seems to improve the health care of these patients. A personalized view might be a basis for the evaluation of individual approaches in Primary Care.

Affective Touch and Regulation of Stress Responses

Much has been documented on the association between stress and health. Both direct and indirect pathways have been identified and explored extensively, helping us understand trajectories from healthy individuals to reductions in well-being, and development of preclinical and disease states. Some of these pathways are well established within the field; physiology, affect regulation, and social relationships. The purpose of this review is to push beyond what is known separately about these pathways and provide a means to integrate them using one common mechanism. We propose that social touch, specifically affective touch, may be the missing active ingredient fundamental to our understanding of how close relationships contribute to stress and health. We provide empirical evidence detailing how affective touch is fundamental to the development of our stress systems, critical to the development of attachment bonds and subsequent social relationships across the life course. We will also explore how we can use this in applied contexts and incorporate it into existing interventions.

Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease

Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.

Coping Strategies Preferred by Patients Treated for Osteoporosis and Analysis of the Difficulties Resulting from the Disease

Osteoporosis has been recognized as a civilization disease. This chronic condition needs a long-term management plan with a holistic approach to patients. The specificity of the patient’s response to the disease and coping strategies are very important in the treatment process. The aim of this research was to analyze the strategies of coping with disease preferred by patients treated for osteoporosis, and to determine the relationship between the self-assessment of patients’ health, time of treatment, sociodemographic variables, and strategies of coping with a chronic disease such as osteoporosis. The study was conducted from August 2016 to July 2018 at an osteoporosis clinic in eastern Poland. Coping Orientations to Problems Experienced (COPE) by C.S. Carver, M. F. Scheier, and J. K. Weintraub in the Polish adaptation and our own questionnaire were used. The study participants were 312 patients treated for osteoporosis. The respondents treated in the osteoporosis clinic used the strategies of seeking support and focusing on emotions to the greatest extent, and avoidance strategies the least. Sociodemographic features and self-assessment of health condition significantly differentiate the strategies of coping with the disease. The analysis showed that the higher the assessment of the individual perception of one’s own health, the more often the respondents used active coping strategies.

Impact of the COVID‐19 pandemic on inflammatory bowel disease: The role of emotional stress and social isolation

Inflammatory bowel disease (IBD) is a chronic health condition exacerbated by negative emotional stress experiences. In the current study, we examined whether the outbreak of the COVID-19 pandemic coincided with an increase in stress experiences and accordingly an aggravation of disease activity in IBD patients. Sixty-three IBD patients (30 Crohn's disease or CD, 33 ulcerative colitis) completed an online survey during the COVID-19-related lockdown, assessing clinical disease activity, disease-related quality of life, presence of functional gastrointestinal symptoms, social isolation and stress experiences. Scores were then compared to pre-lockdown baseline screening. The pandemic yielded a significant baseline-to-lockdown increase in emotional stress and social isolation. Stress increments, particularly those occasioned by interpersonal tension and excessive interpersonal proximity, were associated with a worsening of functional gastrointestinal symptoms. Exacerbations of loneliness coincided with an escalation of CD activity, functional gastrointestinal symptoms and a decline in subjective health. Lastly, COVID-19 anxiety was significantly related to CD symptom severity and social dysfunction. The findings show that shifts in IBD expression are closely linked to changes in emotional stress experiences and interpersonal relatedness. As such, they contribute to a better understanding of inter-individual differences in IBD progression and provide leads for therapeutic interventions.

Adult attachment anxiety is associated with night eating syndrome in UK and US-based samples: Two cross-sectional studies

Previous research has shown that "attachment anxiety" is a robust predictor of disinhibited eating behaviours and that this relationship is underpinned by difficulties in managing emotion. Night eating syndrome (NES), a proposed eating disorder characterized by evening hyperphagia, nocturnal awakenings to eat, and morning anorexia, is also associated with eating to manage emotion. Across two studies (N = 276 &N = 486), we considered a relationship between attachment anxiety and NES. In Study 1, we hypothesised (pre-registered) that attachment anxiety would predict NES score and that this relationship would be mediated by disinhibited eating. Participants were asked to complete questionnaire measures of attachment orientation, disinhibited eating (emotional and uncontrolled eating) and NES. Our parallel mediation model confirmed a direct relationship between attachment anxiety and NES (p < .001) and showed an indirect path via both emotional (95% CI: 0.15-0.63) and uncontrolled eating (95% CI: 0.001-0.36). In Study 2, we showed that fear of negative evaluation of eating significantly mediated a reversed relationship between attachment anxiety and NES (95% CI: 0.02-0.04). Finally, across both studies we used a novel tool to assess "eating to cope". We showed a relationship with emotional eating but failed to show a robust relationship with NES. Attachment orientation may represent a potential intervention target for night eating syndrome. Future research should consider a longitudinal approach to strengthen our understanding of directionality amongst these factors.

Patient characteristics as predictors of sleep disturbances in multimorbid primary care patients - A secondary analysis

OBJECTIVE

The aim of the study was to identify patient characteristics (adult attachment, health status, number and severity of chronic conditions, social support) predictive sleep disturbances after 12 months.

METHODS

In a secondary analysis of a prospective longitudinal study dealing with adult attachment and self-management, attachment- and health-related characteristics, socio-demographic data at baseline and symptoms of insomnia at the follow up (12 month later) was recorded by 219 patients between the ages of 50 and 85 years with multimorbidity in primary care. Adult attachment was measured by the ECR-RD12. The overall health status was measured using a visual analogue scale (VAS) and a standardized list of chronic conditions. The number and severity of chronic diseases (CIRS-G) was assessed by general practitioners (GPs). Sleep disturbances was measured by the ISI 12 month later.

RESULTS

Approximately 19% of the respondents were found to have clinically relevant symptoms of insomnia, and a further 34% to be subclinical insomnia. Attachment-related anxiety, a poorer perceived social support, the number of chronic conditions and a better general health status could predict higher levels of sleep disturbance after 12 month.

CONCLUSION

Sleep disorders can play a major role in patients with multimorbidity. Attachment anxiety and lack of social support may also be possible risk factors for the development of sleep disturbances.

Influence of Adult Attachment on COVID-19 Vaccination Intention: The Mediating Roles of Help-Seeking Style and Professional Help-Seeking Behavior

Vaccination against COVID-19 is regarded as one of the most promising interventions to control the pandemic. This study aimed to examine whether adult attachment affects an individual’s COVID-19 vaccination intention and whether this relationship is mediated by help-seeking style and professional help-seeking behavior. A total of 401 Chinese adults participated in this online cross-sectional survey. The questionnaires for adult attachment (Depend, Close, and Anxiety), help-seeking style (dependency, autonomy, and avoidance), professional help-seeking behavior, and COVID-19 vaccination intention were rated on five-point or seven-point Likert scales, with satisfactory reliability (Cronbach’s α values were all >0.80). Structural equation modelling was used to construct path models based on the above elements. Higher scores in the Depend (Effect = 0.047, SE = 0.018, 95% CI = [0.019, 0.093]) and Close dimensions of attachment (Effect = 0.028, SE = 0.014, 95% CI = [0.007, 0.065]) predicted a stronger dependency-oriented help-seeking style, which thus predicted greater vaccination intention. Higher scores in the Close dimension (Effect = 0.007, SE = 0.004, 95% CI = [0.001, 0.018]) and lower scores in the Anxiety dimension of attachment (Effect = −0.003, SE = 0.002, 95% CI = [−0.008, −0.001]) predicted a stronger autonomy-oriented help-seeking style and further predicted more professional help-seeking behaviors, which promoted greater COVID-19 vaccination intention. The results of this study indicate that help-seeking moderates the relationship between adult attachment and COVID-19 vaccination intention. Guiding help-seeking behavior for individuals with different attachment styles may be an entry point for improving COVID-19 vaccination intention.

Attachment Relationships as Determinants of Physical Health

Childhood adversity alters the relational world of the child and inhibits the development of secure attachment bonds. The purpose of this article is to survey recent evidence that attachment insecurity has the potential to impair physical health throughout the lifespan. It is proposed that attachment insecurity contributes to disease risk through a range of mechanisms which include (1) disturbances in arousal and recovery within physiological systems that respond to stress; (2) physiological links between the mediators of social relationships, stress, and immunity; (3) links between relationship style and various health behaviors; and (4) disease risk factors that serve as external regulators of dysphoric affect, such as nicotine and alcohol. The evidence for these mechanisms, particularly the evidence that has accumulated since the model was first proposed in 2000, is presented and discussed.

A two-generation study: The transmission of attachment and young adults' depression, anxiety, and social media addiction

Social media use is on the rise among young adults (YA) and evidence suggests a positive association between social media addiction (SMA) and the psychological symptoms of depression and anxiety globally. However, the contribution of attachment and its transgenerational influence on YAs' SMA and psychological symptoms have not been widely explored. Thus, we examined how parental reports of attachment (anxiety and avoidance) can directly and through YAs' attachment predict YAs' SMA, depression and anxiety symptoms. A sample of 375 YAs (M_Age = 21.22) and their parents completed the Emotions in Close Relationships-Revised Questionnaire (Fraley et al., 2000), and the Brief Symptom Inventory (Deragotis, 1992). The SMA Scale (Sahin, 2018) was responded to by only YAs. We tested the pattern of associations in a path model. Parental attachment anxiety predicted YAs' attachment anxiety and only paternal attachment avoidance predicted YAs' attachment avoidance. YAs' attachment anxiety and avoidance predicted their depression and anxiety. However, YAs' attachment anxiety uniquely predicted their SMA. Both parents' attachment anxiety indirectly predicted the link between YAs' attachment anxiety and depression, but only paternal attachment avoidance indirectly predicted the association between YAs' attachment avoidance and depression. Furthermore, paternal attachment avoidance indirectly predicted the association between YAs' attachment avoidance and anxiety symptoms. Maternal attachment anxiety indirectly predicted SMA via YAs' attachment anxiety. While parental anxiety and paternal avoidance may impact YAs' symptoms, YAs' and maternal attachment anxiety can shape SMA. The findings about the differential role of attachment in YAs' psychological symptoms and SMA can facilitate further research and interventions.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

[The Influence of Attachment Characteristics and Disease-Specific Predictors on Health-Related Quality of Life in Elderly Patients with Multimorbidity]

OBJECTIVE

Our aim was to further investigate factors influencing multimorbid primary care patients in relation to mental and physical quality of life.

METHODS

219 elderly patients over 50 years with multiple chronic conditions were assessed for quality of life, attachment, depression, and health status at baseline and follow-up after 12 months. Multivariate analyses were performed to identify potential predictors.

RESULTS

Depression, age, and avoidance had a negative influence, and health a positive influence, on physical quality of life. Mental quality of life was negatively influenced by attachment-related anxiety and depression. Relevant predictors that predicted quality of life in one year were health status, depression, and attachment-related anxiety.

CONCLUSION

To maintain quality of life, mental health and attachment needs of multimorbid patients should be considered.

Attachment and symptom reporting in adolescents and young adults after a concussion

BACKGROUND

The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion.

METHODS

This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions.

RESULTS

In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)).

CONCLUSION

Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.

Evaluation of a short version of the Experiences in Close Relationships-Revised questionnaire (ECR-RD8): results from a representative German sample

BACKGROUND

Attachment insecurity is a prominent risk factor for the development and course of psychiatric and psychosomatic disorders. The Experiences in Close Relationships - Revised (ECR-R) questionnaire is a widely used self-report to assess attachment related anxiety and avoidance. However, its length has the potential to restrict its use in large, multi-instrument studies. The aim of this study was to develop and evaluate a brief version of the ECR-R, and provide norm values for the German population.

METHODS

A screening version of the original ECR-R was developed through principal components analysis of datasets from several previous studies. In a representative sample of 2428 randomly selected individuals from the German population, we compared fit indices of different models by means of confirmatory factor analyses (CFA). We investigated the convergent validity of the screening version in an independent convenience sample of 557 participants. Correlations between the short and the full scale were investigated in a re-analysis of the original German ECR-R evaluation sample.

RESULTS

CFA indicated a satisfactory model fit for an eight-item version (ECR-RD8). The ECR-RD8 demonstrated adequate reliability. The subscales correlated as expected with another self-report measure of attachment in an independent sample. Individuals with higher levels of attachment anxiety, but especially higher levels of attachment avoidance were significantly more likely to not be in a relationship, across all age groups. Correlations between the short and the full scale were high.

CONCLUSIONS

The ECR-RD8 appears to be a reliable, valid, and economic questionnaire for assessing attachment insecurity. In addition, the reported population-based norm values will help to contextualize future research findings.

The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints

BACKGROUND AND GOAL

The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics.

STUDY

This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients.

RESULTS

About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits.

CONCLUSIONS

Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.

Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor

The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (n = 111, ages 7-12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.

Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes

We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).

The impact of life events on later life: a latent class analysis of the English Longitudinal Study of Ageing

BACKGROUND

Inequalities in life events can lead to inequalities in older age. This research aimed to explore associations between life events reported by older people and quality of life (QoL) and functional ability.

METHODS

Participants were grouped according to eight life events: parental closeness, educational opportunities in childhood, financial hardship, loss of an unborn child, bereavement due to war, involvement in conflict, violence and experiencing a natural disaster. Linear and logistic regressions were used to explore associations between these groups and the main outcomes of functional ability and QoL.

RESULTS

7555 participants were allocated to four LCA groups: 'few life events' (n = 6,250), 'emotionally cold mother' (n = 724), 'violence in combat' (n = 274) and 'many life events' (n = 307). Reduced QoL was reported in the 'many life events' (coefficient - 5.33, 95%CI -6.61 to -4.05), 'emotionally cold mother' (-1.89, -2.62 to 1.15) and 'violence in combat' (-1.95, -3.08 to -0.82) groups, compared to the 'few life events' group. The 'many life events' group also reported more difficulty with activities of daily living.

CONCLUSIONS

Policies aimed at reducing inequalities in older age should consider events across the life course.

Psychological Distress in Hospitalized Patients Awaiting Organ Transplantation: Case Examples, Thematic Exploration, and Suggestions for Intervention

Organ transplantation is a life-saving mechanism with a large public health burden given the necessity of individuals to donate their organs in the event of their own death. Understanding the psychological and medical sequelae of individuals receiving an organ transplant is invaluable in a successful transplant. The waiting period for transplantation is the most psychologically difficult period, and is an important window during which to intervene psychologically and medically. Patients who are hospitalized during this waiting period make up the most vulnerable population given the psychological difficulties of not only awaiting transplant but of a prolonged and difficult hospitalization. This paper is a first step in understanding the psychological landscape of hospitalized patient's awaiting transplant and the potential research avenues and intervention strategies that may be utilized in order to decrease the psychological burden as well as influence successful medical outcomes in organ transplantation.

Somatoform complaints in middle childhood A developmental path-analysis

Repeatedly occurring somatoform complaints often cause disruptions in children’s daily life, both in family and school settings. Associated with these complaints, there is an increased demand for medical help in the affected children. Despite the frequent occurrence of somatoform complaints in childhood, only a small number of studies have focused on this subject, and the development and maintenance of somatoform complaints have not sufficiently explained to date. Previous research suggests that many different factors are involved, including insecure attachment, a lack of emotion regulation (ER) strategies, and psychiatric behavior problems. The aim of this study is to examine possible pathways describing the interplay of aforementioned factors, in order to contribute to a deeper understanding of the underlying mechanisms. A nonexperimental cross-sectional study was conducted. Questionnaires were completed by 221 children (female n = 115; Mage = 9.70 years, SDage = .56) reporting on their attachment and ER strategies, and their parents reported on the behavior problems and somatoform complaints. Path analysis revealed a good model fit (Χ2 = p .798, Χ2/df = .415, NFI = .994, CFI = 1.000, RMSEA = .000). Results revealed that attachment anxiety predicted maladaptive ER strategies, and attachment avoidance predicted emotion control. In turn significant paths were found between ER strategies, behavior problems, and somatoform complaints. This study provides a first insight into the underlying mechanisms describing the occurrence of somatoform complaints. Results revealed two developmental pathways, based on attachment quality and mediated through different emotion regulation strategies.

Clinical Trial Registration: The project “Impact factors and conditions of somatoform symptoms in childhood within familial and school contexts” is listed in the German Clinical Trails Register (DRKS-ID: DRKS00012444) and the WHO International Clinical Trials Registry Platform.

The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study

Background

While there is increasing evidence for the relevance of psychosocial variables such as dental fear or psychological attachment in dentistry, much less is known about the mechanisms that determine the strength of those associations. One potential moderator is the occurrence of a comorbid chronic disease such as psoriasis, which is linked to relevant disease parameters such as periodontal inflammation. The aim of the study was to test a moderation model of the relationship between dental fear, psychological attachment and psoriasis on periodontal health.

Methods

A total of 201 patients (100 with psoriasis, 101 without psoriasis) were included in a questionnaire-based, cross-sectional study. Dental status was measured with the Community Periodontal Index (CPI), dental fear was measured with the Hierarchical Anxiety Questionnaire (HAQ), and psychological attachment was measured with the Relationship Questionnaire (RQ). In addition to the examination of main effects, bootstrapping-based analyses were conducted to test the moderating influence of psychological attachment on the association between CPI and dental fear, gain moderated by group (with vs. without psoriasis).

Results

Controlling for several covariates, higher CPI scores were associated with higher levels of dental fear only in individuals without psoriasis under conditions of higher levels of psychological attachment anxiety and lower levels of attachment avoidance.

Conclusion

In individuals without psoriasis, psychological attachment can moderate the association between periodontal health and dental fear. This may provide a useful framework for reducing dental fear through interventions on the level of the dentist-patient relationship.

Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity

Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.

Psychological aspects in early adjustment after severe burn injury

Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. Health status perception is one of the main health outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, suggesting that early screening for psychological vulnerabilities may be beneficial. The aim of our study was to identify the personality, clinical, and sociodemographic characteristics related to patient´s subjective perception of health, depression, and anxiety, in a sample of 52 adult patients with severe burn injury shortly before discharge from specialty Burn clinic. Subjective health perception was predicted by depression (β = -.143, t(47) = -3.94, P < .001) and neuroticism (β = -.106, t(43) = -4.83, P < .001), and it correlated positively with extraversion (r = .2858, P = .0465) and conscientiousness (r = .3663, P = .0096). Depression was predicted by neuroticism (F(1,49) = 18.4; P < .001) and correlated with attachment avoidance (r = .29, P = .0383) and negatively with extraversion (r = -.32, P = .0220). Anxiety was related to attachment anxiety (F(1,49) = 4.25; P = .045), neuroticism (F(1,49) = 15.75; P < .001), and agreeableness (r = -.36, p = .0101). Unemployed patients experienced higher levels of depression and anxiety. This research suggests that personality traits and adult attachment may play an important role in the acute phase of the recovery from a severe burn injury. These findings can be relevant for early intervention and holistic rehabilitation.

Depressive Symptoms and Quality of Life in a Sample of Italian Women with a Diagnosis of Fibromyalgia: The Role of Attachment Styles

BACKGROUND

Women with fibromyalgia (FM) commonly suffer from depression, pervasive fatigue, and pain. The attachment style has been hypothesized to be an important factor for understanding the experience of these symptoms. Therefore, the present cross-sectional study is aimed at investigating the effect of attachment styles in women with a diagnosis of FM on depressive symptoms and quality of life.

METHOD

Participants were 453 Italian women with a physician's diagnosis of FM with a mean age of 47 years (SD = 10.9). To assess attachment styles, quality of life, and depressive symptoms, women responded, respectively, to the Relationship Questionnaire, the World Health Organization Quality of Life Questionnaire, and the Beck Depression Inventory II.

RESULTS

Our results showed that the incidence of depressive symptoms was elevated, with 59% of women reporting moderate to severe symptoms. Also, the statistical analyses showed that both preoccupied and avoidant/dismissing attachments were related with depression symptoms and low perception of QoL.

CONCLUSIONS

Our study demonstrates that, when evaluating the impact of FM on the QoL of women, it is important to consider the complexity of the variables that are at play. Insecure attachment styles and depressive symptoms seem to increase the likelihood of the psycho-social-somatic malaise in FM women.

Food Addiction and Tobacco Use Disorder: Common Liability and Shared Mechanisms

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.

Adult attachment styles and mothers' life satisfaction in relation to eating behaviors in the families with overweight and obese children

Family plays a significant role in shaping children's eating behaviors. The aim of the study was to assess whether mothers' attachment style, their life satisfaction and their own body weight can be associated with family eating behaviors. The results from 52 dyads (mothers/children) covered by the Metabolic Disease Clinic were analyzed. A targeted sample selection was used, taking into account the weight (overweight/obesity) and age (≥11 years) criteria of the child. The results have shown that the mother's body weight is a significant determinant of her child's body weight. The anxiety-ambivalent attachment style in mothers is a significant predictor of behaviors aimed at regulating and controlling affective states by food. A decrease in the knowledge of nutrition is associated with an increase in the level of anxiety-ambivalent and avoidant style. The avoidant attachment style is significantly associated with the nutrition organisation and control. Dysfunctional eating behaviors predominate among mothers with a lower level of life satisfaction. The lower the level of life satisfaction, the greater the tendency to regulate affective states and family relationships through nutrition, and to manifest improper organisation of nutrition. Mothers with obesity, compared to mothers with overweight and with normal body weight show a higher level of regulating emotions through food, improper organisation of nutrition and lower control in this area. The research results indicateshow significant relationships between insecure attachment styles, life satisfaction, and the mother's weight with eating behaviors unfavorable to health. It is therefore necessary to include family factors in the process of creating effective intervention strategies.

Adult attachment dimensions and recollections of childhood family context: associations with dispositional optimism and pessimism

The present study tested the theoretically inferred but not yet empirically tested association between dispositional optimism–pessimism and attachment security among 423 Finnish women and men. A second‐order latent variable representing a generalized representation of attachment insecurity in close relationships that included two latent constructs, the one representing romantic adult attachment dimensions and the other representing recollections of attachment‐related childhood family relationship, was associated with greater pessimism; the adult attachment dimension of high anxiety had unique and additional explanatory power, not accounted for by the generalized representation of attachment‐related insecurity. The model explained 48% of the variance in pessimism. The results clearly emphasize that additional studies are needed to clarify the role of interpersonal processes in dispositional optimism–pessimism. Copyright © 2004 John Wiley & Sons, Ltd.

Unmet Supportive Care Needs Among Women With Breast and Gynecological Cancer: Relevance of Attachment Anxiety and Psychological Distress

OBJECTIVE

Attachment anxiety and avoidance are known risk factors for the development of unmet needs and poor well-being among patients with chronic diseases. Few studies have addressed this in individuals with cancer. We aimed to explore the relationship between supportive care needs, attachment styles and distress in women with breast and gynecological cancer.

METHODS

Using a cross-sectional paper-pencil (n = 157) and online survey (n = 614), a total of 771 patients with breast or gynecological cancer completed a set of validated questionnaires. From September 2013 to January 2014, consecutive inpatients and outpatients of the university hospital Tuebingen were included in the study. Further, participants were recruited through social media, patient internet platforms, self-help group leaders and patient networks. We used the Supportive Care Needs Survey (SCNS-SF-34) with the need dimensions: health system, patient care, psychological, physical, and sexual needs, as well as the Experiences in Close Relationships-Revised Questionnaire, and the Distress Thermometer. A multiple linear regression model was used to analyze the influence of attachment styles (anxiety and avoidance) on the SCNS-SF-34 dimensions. A moderation analysis was used to explore the influence of the interaction between attachment anxiety and distress for all SCNS-SF-34 dimensions.

RESULTS

Attachment anxiety was a significant determinant and led to higher unmet supportive care needs in all dimensions, whereas attachment avoidance was not significant. Distress did moderate the relationship between attachment anxiety and psychological and health system needs and led to a higher unmet needs development. For the other SCNS-SF-34 dimensions, distress was not confirmed as a moderator.

CONCLUSION

Our findings highlight attachment anxiety as a risk factor for the development of unmet supportive care needs and potentially impaired psychological adjustment to cancer. Further studies are needed to elucidate the interactions between attachment styles, distress and supportive care needs among cancer patients.

Applying Psychotherapeutic Principles to Bolster Resilience Among Health Care Workers During the COVID-19 Pandemic

The COVID-19 pandemic has affected the entire globe with overwhelming speed and impact. The pandemic is both highly threatening and poorly understood, typical of deeply distressing conditions. Stress associated with uncertain recommendations from authorities, fear of illness and contagion for oneself and one's loved ones, extended periods of isolation, moral conflicts, financial instability, perception of discrimination and/or stigma, and ongoing loss and grief imperil mental health and resilience among the general population and high-risk groups. Health care workers (HCWs) face additional challenges that increase their vulnerability to distress and burnout. Bolstering resilience among HCWs can allow them to continue working with the intensity and focus their jobs require, which in turn supports the overall functioning of the health care system. Given their training in understanding wellness, distress, and psychotherapeutic treatment, mental health clinicians are well positioned to respond to this need. By studying the lessons from past and present experiences with public health emergencies and by incorporating principles from psychotherapeutic literature and training, clinicians can help facilitate an informed and effective response. The goal of this article is to discuss the development of a resilience coaching model that is rooted in principles from psychotherapeutic literature and practice to support psychological well-being among hospital-based HCWs. This model, developed to support the authors' health care colleagues working in a Toronto hospital, is generalizable, can be adapted for use by any mental health clinician, and makes explicit how previous training in psychotherapy may be applied to coaching and supporting frontline HCWs.

Pandemic and mental health of the front-line healthcare workers: a review and implications in the Indian context amidst COVID-19

Pandemic, being unprecedented, leads to several mental health problems, especially among the front-line healthcare workers (HCW). Front-line HCWs often suffer from anxiety, depression, burnout, insomnia and stress-related disorders. This is mediated to a large extent by the biopsychological vulnerabilities of the individuals; socioenvironmental factors such as the risk of exposure to infection, effective risk communication to HCWs, availability of personal protective equipment, job-related stress, perceived stigma and psychological impact of the isolation/quarantine and interpersonal distancing also play the major roles. Despite the huge magnitude of mental health problems among the front-line HCWs, their psychological health is often overlooked. Some of the potential measures to reduce the mental health problems of the front-line HCWs are effective communication, tangible support from the administration/seniors, mental health problem screening—and interventional—facilities, making quarantine/isolation less restrictive and ensuring interpersonal communication through the various digital platforms, proactively curtailing the misinformation/rumour spread by the media and strict legal measures against violence/ill treatment with the HCWs, and so on. India, along with other countries who lately got affected by the COVID-19, must learn from the experiences of the other countries and also from the previous pandemics as to how to address the mental health needs of their front-line HCWs and ensure HCWs’ mental well-being, thereby improving their productivity. Current review attempts to highlight the mental health aspects of the pandemic on the front-line HCWs, discusses some of the contentious issues and provides future directions particularly concerning COVID-19 in the Indian context and other low-resource countries.