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Hennig-Fast K, Meissner D, Steuwe C, Dehning S, Blautzik J, Eilert DW, Zill P, Müller N, Meindl T, Reiser M, Möller HJ, Falkai P, Driessen M, Buchheim A. The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study. Brain Sci 2023; 13:1125. [PMID: 37626482 PMCID: PMC10452454 DOI: 10.3390/brainsci13081125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. METHODS We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. RESULTS A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. CONCLUSION Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.
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Affiliation(s)
- Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Dominik Meissner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Carolin Steuwe
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Janusch Blautzik
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Dirk W. Eilert
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Thomas Meindl
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Anna Buchheim
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
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2
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Santoro G, Midolo LR, Costanzo A, Schimmenti A. The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology. Bull Menninger Clin 2021; 85:358-384. [PMID: 34851682 DOI: 10.1521/bumc.2021.85.4.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, Enna, Italy
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3
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The Impact of Repeated Attachment Priming on Paranoia, Mood and Help-Seeking Intentions in an Analogue Sample. Brain Sci 2021; 11:brainsci11101257. [PMID: 34679322 PMCID: PMC8533775 DOI: 10.3390/brainsci11101257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Attachment security priming effects therapeutic change in people with depression and anxiety. Preliminary studies indicate that visualising secure attachment memories also reduces paranoia in non-clinical and clinical groups, probably due to a decrease in cognitive fusion. Benefits to clinical populations depend on the sustainability of these effects and the impact on help-seeking behaviours. The combination of paranoia and an insecure-avoidant attachment style is likely to be a particular barrier to help seeking. We used a longitudinal experimental design to test the impact of repeated attachment priming on paranoia, mood and help-seeking intentions and whether cognitive fusion mediates these effects. Seventy-nine people with high levels of non-clinical paranoia, aged 18-50 years (M = 20.53, SD = 4.57), were randomly assigned to a secure or insecure-avoidant priming condition. Participants rehearsed the visualisation prime on four consecutive days and were assessed on standardised measures of paranoia, positive and negative affect, help-seeking intentions and cognitive fusion. A series of mixed-model analyses of variance showed that security priming decreases paranoia, negative affect and cognitive fusion and increases positive affect and help seeking, compared to insecure-avoidant priming. Examining the impact of primed attachment (rather than measured attachment style) allows us to draw conclusions about the causal processes involved; mediation analyses showed indirect effects of the primes on paranoia and negative affect through cognitive fusion. With a growing understanding of (1) the impact of security priming on paranoia, affect and help-seeking behaviours, (2) causal mechanisms and (3) sustainability of effects, security priming may be developed into a viable intervention for clinical populations.
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4
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Antonucci LA, Raio A, Pergola G, Gelao B, Papalino M, Rampino A, Andriola I, Blasi G, Bertolino A. Machine learning-based ability to classify psychosis and early stages of disease through parenting and attachment-related variables is associated with social cognition. BMC Psychol 2021; 9:47. [PMID: 33757595 PMCID: PMC7989088 DOI: 10.1186/s40359-021-00552-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, specifically for individuals diagnosed with psychosis (PSY). Furthermore, evidence highlighted a tight relationship between attachment style and social cognition abilities, a key PSY behavioral phenotype. The aim of this study is to generate a machine learning algorithm based on the perceived quality of parenting and attachment style-related features to discriminate between PSY and healthy controls (HC) and to investigate its ability to track PSY early stages and risk conditions, as well as its association with social cognition performance. Methods Perceived maternal and paternal parenting, as well as attachment anxiety and avoidance scores, were trained to separate 71 HC from 34 PSY (20 individuals diagnosed with schizophrenia + 14 diagnosed with bipolar disorder with psychotic manifestations) using support vector classification and repeated nested cross-validation. We then validated this model on independent datasets including individuals at the early stages of disease (ESD, i.e. first episode of psychosis or depression, or at-risk mental state for psychosis) and with familial high risk for PSY (FHR, i.e. having a first-degree relative suffering from psychosis). Then, we performed factorial analyses to test the group x classification rate interaction on emotion perception, social inference and managing of emotions abilities. Results The perceived parenting and attachment-based machine learning model discriminated PSY from HC with a Balanced Accuracy (BAC) of 72.2%. Slightly lower classification performance was measured in the ESD sample (HC-ESD BAC = 63.5%), while the model could not discriminate between FHR and HC (BAC = 44.2%). We observed a significant group x classification interaction in PSY and HC from the discovery sample on emotion perception and on the ability to manage emotions (both p = 0.02). The interaction on managing of emotion abilities was replicated in the ESD and HC validation sample (p = 0.03). Conclusion Our results suggest that parenting and attachment-related variables bear significant classification power when applied to both PSY and its early stages and are associated with variability in emotion processing. These variables could therefore be useful in psychosis early recognition programs aimed at softening the psychosis-associated disability. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00552-3.
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Affiliation(s)
- Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Via Scipione Crisanzio 42, 70122, Bari, Italy. .,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Alessandra Raio
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Marco Papalino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rampino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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5
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Mertens YL, Racioppi A, Sheinbaum T, Kwapil T, Barrantes-Vidal N. Dissociation and insecure attachment as mediators of the relation between childhood emotional abuse and nonclinical paranoid traits. Eur J Psychotraumatol 2021; 12:1888539. [PMID: 33968322 PMCID: PMC8079066 DOI: 10.1080/20008198.2021.1888539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Research suggests dissociation and insecure attachment serve as explanatory mechanisms in the pathway from childhood trauma to paranoia. However, past work has not examined these mechanisms concurrently in nonclinical populations. Objective: The current study sought to examine dissociation and insecure attachment as parallel mediators of the association between childhood emotional abuse and paranoid traits. Furthermore, a serial mediation model with insecure attachment preceding dissociation in the explanatory pathway was explored. Methods: Eighty-nine nonclinically ascertained young adults were assessed for childhood emotional abuse, dissociation, attachment styles, and paranoid traits. Parallel and serial mediation models were tested. Results: The association of childhood emotional abuse with both interview-based and self-reported paranoid traits was significantly mediated by dissociation and preoccupied attachment. Fearful attachment was a significant mediator in the model for self-reported paranoid traits. No evidence for a serial mediation effect was found. Conclusions: The present findings extend support for dissociation and attachment insecurity as mechanisms underlying the link between childhood emotional maltreatment and paranoid traits. Longitudinal research is needed to inform whether insecure attachment contributes to dissociation along the pathways to paranoid traits.
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Affiliation(s)
- Yoki Linn Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Anna Racioppi
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain
| | - Tamara Sheinbaum
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Thomas Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Department of Clinical Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain.,Departament de Salut Mental, Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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6
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van Bussel EMM, Nguyen NHM, Wierdsma AI, van Aken BC, Willems IEMG, Mulder CL. Adult Attachment and Personal, Social, and Symptomatic Recovery From Psychosis: Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:641642. [PMID: 33716835 PMCID: PMC7943841 DOI: 10.3389/fpsyt.2021.641642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Despite growing evidence for the role of attachment in psychosis, no quantitative review has yet been published on the relationship in this population between insecure attachment and recovery in a broad sense. We therefore used meta-analytic techniques to systematically appraise studies on the relationship between attachment and symptomatic, social and personal recovery in clients with a psychotic disorder. Using the keywords attachment, psychosis, recovery and related terms, we searched six databases: Embase, Medline Epub (OVID), Psycinfo (OVID), Cochrane Central (trials), Web of Science, and Google Scholar. This yielded 28 studies assessing the associations between adult attachment and recovery outcome in populations with a psychotic disorder. The findings indicated that insecure anxious and avoidant attachment are both associated with less symptomatic recovery (positive and general symptoms), and worse social and personal recovery outcomes in individuals diagnosed with a psychotic disorder. The associations were stronger for social and personal recovery than for symptomatic recovery. Attachment style is a clinically relevant construct in relation to the development and course of psychosis and recovery from it. Greater attention to the relationship between attachment and the broad scope of recovery (symptomatic, social, and personal) will improve our understanding of the illness and efficacy of treatment for this population.
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Affiliation(s)
- E M M van Bussel
- Geestelijke gezondheidszorg Oost Brabant, Institute for Mental Health, Oss, Netherlands
| | - N H M Nguyen
- Geestelijke gezondheidszorg Oost Brabant, Institute for Mental Health, Oss, Netherlands
| | - A I Wierdsma
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands
| | - B C van Aken
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands
| | - I E M G Willems
- GGZ Breburg, Institute for Mental Health, Tilburg, Netherlands
| | - C L Mulder
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands.,Parnassia Psychiartric Institute, Rotterdam, Netherlands
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7
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Pearse E, Bucci S, Raphael J, Berry K. The relationship between attachment and functioning for people with serious mental illness: a systematic review. Nord J Psychiatry 2020; 74:545-557. [PMID: 32692588 DOI: 10.1080/08039488.2020.1767687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS Functional impairment is a hallmark feature of severe mental health problems (SMI). Attachment theory is a key psychological theory of interpersonal functioning and difficulties in attachment are common in SMI and may help explain functioning problems in SMI. This systematic review aimed to synthesise and critically appraise existing literature exploring associations between adult attachment style and functioning in SMI samples. METHOD Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines we systematically searched five databases using strings of terms relating to both attachment and social functioning. Inclusion criteria were samples diagnosed with SMI and validated measure tools. RESULTS Ten studies met inclusion criteria. Considerable heterogeneity was found across studies in relation to construct measurement, sample size, and gender distribution. However, as predicted there was some evidence to suggest that secure attachment is associated with better functioning, and insecure attachment (specifically anxious style) is associated with impairments in functioning. CONCLUSION Findings highlight the importance of considering attachment in relation to functional outcome when working with people with SMI, particularly when assessing, formulating, and delivering psychological interventions.
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Affiliation(s)
- Elisabeth Pearse
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sandra Bucci
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jessica Raphael
- Research and Development, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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8
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Scott M, Rossell SL, Meyer D, Toh WL, Thomas N. Childhood trauma, attachment and negative schemas in relation to negative auditory verbal hallucination (AVH) content. Psychiatry Res 2020; 290:112997. [PMID: 32470717 DOI: 10.1016/j.psychres.2020.112997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Auditory verbal hallucinations (AVHs, or hearing voices) are particularly characterized by negative content such as criticism and threats. The extent of negative content is a major predictor of distress, yet there is limited research on what contributes to the content of AVHs. The current study aimed to assess the relationships between childhood trauma, attachment styles (anxious and avoidant) and negative self schemas as plausible mechanisms underlying negative AVH content. Structural equation modelling was used to test a theoretical model, including these constructs, in a transdiagnostic sample of 140 people with AVHs. Findings indicated that collectively, emotional trauma during childhood, insecure anxious attachment and negative self schemas predicted the proportion of negative AVH content experienced by voice hearers. Whereby, trauma predicted attachment, which predicted schemas and in turn negative AVH content. This study marks an important step towards understanding the underlying mechanisms involved in negative AVHs. The results highlight the importance of recognising early experiences of trauma, adult attachment styles and self schemas in developing formulations and effective treatments for negative and distressing AVHs. Psychological interventions that target these underlying mechanisms of negative AVHs may lead to a reduction in negative content, thereby reducing voice related distress.
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Affiliation(s)
- Monique Scott
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Alfred Health, Melbourne, Australia.
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9
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Cognitive Fusion Mediates the Impact of Attachment Imagery on Paranoia and Anxiety. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10127-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Paranoia, in both clinical and non-clinical groups, is characterised by unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but little is known about the mechanisms of change. Cognitive fusion describes the extent to which we can ‘step back’ from compelling beliefs, to observe these as mental events, and is implicated in psychopathology cross-diagnostically.
Aims
This study extends previous research demonstrating the impact of attachment imagery on paranoia and anxiety to determine whether cognitive fusion mediates these relationships.
Method
We utilised a randomized experimental design and recruited an analogue sample with high levels of non-clinical paranoia to test the impact of imagery and the role of cognitive fusion.
Results
Secure attachment imagery resulted in reduced paranoia and anxiety compared to threat/insecure imagery. Cognitive fusion mediated the relationships between imagery and paranoia, and imagery and anxiety.
Conclusions
Secure attachment imagery is effective in reducing paranoia and anxiety and operates via cognitive fusion. In clinical practice, these interventions should seek to facilitate the ability to ‘step back’ from compelling threat beliefs, in order to be most beneficial.
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10
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Impact of attachment imagery on paranoia and mood: evidence from two single case studies. Behav Cogn Psychother 2020; 48:572-583. [DOI: 10.1017/s1352465820000351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractBackground:Cognitive behavioural therapy (CBT) for psychosis currently yields modest outcomes and must be improved. Attachment imagery may be an effective means of reducing severity of paranoid beliefs and associated affect. Experimental studies have demonstrated these effects in non-clinical groups. The impact in clinical populations remains untested.Aims:This study assessed the impact of a brief attachment imagery task on paranoia and mood, in two people with a diagnosis of schizophrenia.Method:Two single case studies are presented. Both participants were working age adults with persecutory delusions. The study utilised an A-B-A design. Participants were recruited for a 6-week period, with a 2- and 3-week baseline respectively, 1-week intervention phase, and follow-up phase matched to duration of baseline. Trait paranoia and attachment were measured at the start of the baseline. State paranoia and affect were measured daily over the 6-week period.Results:For both participants, the baseline phase was characterised by high and variable levels of paranoia, which reduced during the intervention phase, with a return to baseline scores at follow-up. We found a similar pattern for negative affect, and the reverse pattern for positive affect.Conclusions:Attachment imagery may function as an effective emotion regulation strategy for people with psychosis. Continued use is likely to be needed to maintain gains. This brief task could prove valuable to people needing skills to manage paranoia and mood, and give clinicians confidence that people can manage short-term distress in CBT for psychosis, for example when addressing past trauma.
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11
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Pollard C, Bucci S, MacBeth A, Berry K. The revised Psychosis Attachment Measure: Measuring disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:335-353. [PMID: 32415698 PMCID: PMC7496745 DOI: 10.1111/bjc.12249] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. Methods Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. Results An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. Conclusions These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.
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Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Angus MacBeth
- School of Health in Social Science, University of Edinburgh, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
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12
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Abstract
BACKGROUND There is a consensus that adoptees and immigrants both experience more mental health problems than their peers. The two groups share many risk factors for psychosis, but an increased risk for psychotic illness has only been demonstrated for immigrants. AIMS The aim of this review is to describe psychosis risk factors in adoptees, with a focus on difficulties with identity formation, identification with in-groups, attachment to parents, and coping with loss and with discrimination. METHOD The literature in these five areas is reviewed as it pertains to adoption and psychosis. RESULTS There are no clear findings because the relevant studies have not been done, but the literature suggests that adopted children face challenges very similar to those of immigrants to a new country. CONCLUSION The immigration field and the adoption field have much to learn from each other. It is recommended that a prevention strategy analogous to increased neighbourhood ethnic density be implemented with adoptees - that they be intentionally exposed from early childhood and throughout adolescence to age peers who share a similar background and with whom they can readily identify. It is also recommended that immigrants be welcomed into their host country with the same open arms as adoptive parents welcome their new children.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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13
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Murphy R, Goodall K, Woodrow A. The relationship between attachment insecurity and experiences on the paranoia continuum: A meta‐analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:290-318. [DOI: 10.1111/bjc.12247] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Karen Goodall
- School of Health in Social Science University of Edinburgh UK
| | - Amanda Woodrow
- School of Health and Social Care Edinburgh Napier University UK
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14
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França G, Laranjeira E, Silva F, Monteiro L, Moreira AM, Carvalho S. Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. Psychiatr Q 2020; 91:31-43. [PMID: 31768908 DOI: 10.1007/s11126-019-09675-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.
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Affiliation(s)
- Gustavo França
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal.
| | - Erika Laranjeira
- Center for Economics and Finance, Oporto University, Porto, Portugal
| | - Fabio Silva
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Lília Monteiro
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Ana Maria Moreira
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Serafim Carvalho
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
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Stuke F, Bröcker AL, Bayer S, Heinz A, Bermpohl F, Lempa G, von Haebler D, Montag C. Between a rock and a hard place: Associations between Mentzos' "dilemma", self-reported interpersonal problems, and psychosocial functioning in individuals with non-affective psychoses. Clin Psychol Psychother 2020; 27:528-541. [PMID: 32100357 DOI: 10.1002/cpp.2437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/13/2023]
Abstract
Primary aim of this study was to determine the extent and type of self-reported interpersonal problems in patients with non-affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma", which describes an insufferable inner tension caused by an individual's struggle of being torn between "self-oriented" and "object-oriented" tendencies. In a cross-sectional study among 129 patients with non-affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' "dilemma" were obtained during a clinical research visit. Self-report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP-64D) and compared with a German representative standard sample. Second, IIP-64D scores were compared between groups with or without Mentzos' "dilemma". Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP-64D scores differed significantly from healthy controls, except for "self-centred" and "intrusive" interpersonal styles. Participants with a potential "psychotic dilemma" scored significantly higher on the subscales: "domineering", "self-centred", "cold", and "socially avoidant" than the group without a "psychotic dilemma". The total amount of interpersonal problems, and particularly high scores on the IIP-64D "socially avoidant" subscale, predicted psychosocial dysfunction, whereas a "cold" interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma".
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Affiliation(s)
- Frauke Stuke
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Lena Bröcker
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samuel Bayer
- International Psychoanalytic University Berlin (IPU), Berlin, Germany
| | - Andreas Heinz
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Dorothea von Haebler
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,International Psychoanalytic University Berlin (IPU), Berlin, Germany
| | - Christiane Montag
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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16
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Lavin R, Bucci S, Varese F, Berry K. The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:39-65. [PMID: 31390076 PMCID: PMC7028113 DOI: 10.1111/bjc.12231] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality. Method We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre‐registered the review protocol and followed PRISMA guidelines. Results Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia. Conclusions The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia. Practitioner points There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
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Affiliation(s)
- Rachel Lavin
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
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17
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Chatziioannidis S, Andreou C, Agorastos A, Kaprinis S, Malliaris Y, Garyfallos G, Bozikas VP. The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis. Psychiatry Res 2019; 276:223-231. [PMID: 31112856 DOI: 10.1016/j.psychres.2019.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 01/21/2023]
Abstract
Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma.
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Affiliation(s)
- Stylianos Chatziioannidis
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece.
| | - Christina Andreou
- University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Agorastos Agorastos
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Stergios Kaprinis
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Yanni Malliaris
- EDO the Hellenic Bipolar Organization and BipolarLab.com, Asimaki Fotila Street 3, 11473, Pedion Areos, Athens, Greece
| | - George Garyfallos
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Vasilios P Bozikas
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
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18
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Empatía y mindfulness como factores mentalizadores intervinientes en las relaciones entre el apego y la sensibilidad interpersonal en mujeres. ANSIEDAD Y ESTRÉS 2019. [DOI: 10.1016/j.anyes.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Dudley J, Eames C, Mulligan J, Fisher N. Mindfulness of voices, self-compassion, and secure attachment in relation to the experience of hearing voices. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:1-17. [PMID: 28801978 PMCID: PMC5811822 DOI: 10.1111/bjc.12153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/05/2017] [Indexed: 12/04/2022]
Abstract
Objectives Developing compassion towards oneself has been linked to improvement in many areas of psychological well‐being, including psychosis. Furthermore, developing a non‐judgemental, accepting way of relating to voices is associated with lower levels of distress for people who hear voices. These factors have also been associated with secure attachment. This study explores associations between the constructs of mindfulness of voices, self‐compassion, and distress from hearing voices and how secure attachment style related to each of these variables. Design Cross‐sectional online. Method One hundred and twenty‐eight people (73% female; Mage = 37.5; 87.5% Caucasian) who currently hear voices completed the Self‐Compassion Scale, Southampton Mindfulness of Voices Questionnaire, Relationships Questionnaire, and Hamilton Programme for Schizophrenia Voices Questionnaire. Results Results showed that mindfulness of voices mediated the relationship between self‐compassion and severity of voices, and self‐compassion mediated the relationship between mindfulness of voices and severity of voices. Self‐compassion and mindfulness of voices were significantly positively correlated with each other and negatively correlated with distress and severity of voices. Conclusion Mindful relation to voices and self‐compassion are associated with reduced distress and severity of voices, which supports the proposed potential benefits of mindful relating to voices and self‐compassion as therapeutic skills for people experiencing distress by voice hearing. Practitioner points Greater self‐compassion and mindfulness of voices were significantly associated with less distress from voices. These findings support theory underlining compassionate mind training. Mindfulness of voices mediated the relationship between self‐compassion and distress from voices, indicating a synergistic relationship between the constructs. Although the current findings do not give a direction of causation, consideration is given to the potential impact of mindful and compassionate approaches to voices.
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Affiliation(s)
- James Dudley
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Catrin Eames
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | | | - Naomi Fisher
- Faculty of Health and Medicine, Lancaster University, Lancashire, UK
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20
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Pearce J, Simpson J, Berry K, Bucci S, Moskowitz A, Varese F. Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences. Clin Psychol Psychother 2017; 24:1304-1312. [DOI: 10.1002/cpp.2100] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/17/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Josie Pearce
- School of Health and Medicine, Division of Health Research; Lancaster University; Lancaster UK
| | - Jane Simpson
- School of Health and Medicine, Division of Health Research; Lancaster University; Lancaster UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
| | | | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
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21
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Berry K, Varese F, Bucci S. Cognitive Attachment Model of Voices: Evidence Base and Future Implications. Front Psychiatry 2017; 8:111. [PMID: 28713292 PMCID: PMC5491615 DOI: 10.3389/fpsyt.2017.00111] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/08/2017] [Indexed: 01/26/2023] Open
Abstract
There is a robust association between hearing voices and exposure to traumatic events. Identifying mediating mechanisms for this relationship is key to theories of voice hearing and the development of therapies for distressing voices. This paper outlines the Cognitive Attachment model of Voices (CAV), a theoretical model to understand the relationship between earlier interpersonal trauma and distressing voice hearing. The model builds on attachment theory and well-established cognitive models of voices and argues that attachment and dissociative processes are key psychological mechanisms that explain how trauma influences voice hearing. Following the presentation of the model, the paper will review the current state of evidence regarding the proposed mechanisms of vulnerability to voice hearing and maintenance of voice-related distress. This review will include evidence from studies supporting associations between dissociation and voices, followed by details of our own research supporting the role of dissociation in mediating the relationship between trauma and voices and evidence supporting the role of adult attachment in influencing beliefs and relationships that voice hearers can develop with voices. The paper concludes by outlining the key questions that future research needs to address to fully test the model and the clinical implications that arise from the work.
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Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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22
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Castilho P, Martins MJ, Pinto AM, Viegas R, Carvalho S, Madeira N. Understanding the effect of attachment styles in paranoid ideation: The mediator role of experiential avoidance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Pilton M, Bucci S, McManus J, Hayward M, Emsley R, Berry K. Does insecure attachment mediate the relationship between trauma and voice-hearing in psychosis? Psychiatry Res 2016; 246:776-782. [PMID: 27817908 DOI: 10.1016/j.psychres.2016.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/25/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
This study extends existing research and theoretical developments by exploring the potential mediating role of insecure attachment within the relationship between trauma and voice-hearing. Fifty-five voice hearers with a psychosis-related diagnosis completed comprehensive assessments of childhood trauma, adult attachment, voice-related severity and distress, beliefs about voices and relationships with voices. Anxious attachment was significantly associated with the voice-hearing dimensions examined. More sophisticated analysis showed that anxious attachment mediated the relationship between childhood sexual and emotional abuse and voice-related severity and distress, voice-malevolence, voice-omnipotence, voice-resistance and hearer-dependence. Anxious attachment also mediated the relationship between childhood physical neglect and voice-related severity and distress and hearer-dependence. Furthermore, consistent with previous research, the relationship between anxious attachment and voice-related distress was mediated by voice-malevolence, voice-omnipotence and voice-resistance. We propose a model whereby anxious attachment mediates the well-established relationship between trauma and voice-hearing. In turn, negative beliefs about voices may mediate the association between anxious attachment and voice-related distress. Findings presented here highlight the need to assess and formulate the impact of attachment patterns upon the voice-hearing experience in psychosis and the potential to alleviate voice-related distress by fostering secure attachments to therapists or significant others.
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Affiliation(s)
- Marie Pilton
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Sandra Bucci
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - James McManus
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Mark Hayward
- School of Psychology, University of Sussex, United Kingdom; Department of Research and Development, Sussex Partnership NHS Foundation Trust, United Kingdom
| | - Richard Emsley
- Institute of Population and Health, University of Manchester, United Kingdom
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
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24
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Sitko K, Varese F, Sellwood W, Hammond A, Bentall R. The dynamics of attachment insecurity and paranoid thoughts: An experience sampling study. Psychiatry Res 2016; 246:32-38. [PMID: 27649527 DOI: 10.1016/j.psychres.2016.08.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 08/20/2016] [Accepted: 08/21/2016] [Indexed: 11/24/2022]
Abstract
It has been proposed that insecure attachment can have adverse effects on the course of psychosis once symptoms have emerged. There is longitudinal evidence that increased insecure attachment is associated with increased severity of psychotic symptoms. The present study examined whether in the flow of daily life attachment insecurity fluctuates, whether elevated stress precedes the occurrence of attachment insecurity, and whether elevated attachment insecurity precedes the occurrence of paranoia. Twenty clinical participants with a psychosis-spectrum diagnosis and twenty controls were studied over six consecutive days using the experience sampling method (ESM). The findings revealed that fluctuations in attachment insecurity were significantly higher in the clinical group, that elevated stress predicted a subsequent increase in attachment insecurity, and that elevated attachment insecurity predicted a subsequent increase in paranoia; this effect was not observed in auditory hallucinations once co-occurring symptoms were controlled for. Finally, although previous ESM studies have shown that low self-esteem precedes the occurrence of paranoia, attachment insecurity continued to predict paranoia even when self-esteem was controlled for. The findings suggest that attachment security may be associated with a lower risk of paranoia, and that psychological interventions should address attachment beliefs and work towards establishing a sense of attachment security.
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Affiliation(s)
- Katarzyna Sitko
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Filippo Varese
- Section of Clinical and Health Psychology, School of Psychological Sciences, University of Manchester, M13 9PL, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA14YG, UK
| | - Amy Hammond
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK
| | - Richard Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK
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25
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Leonhardt BL, Kukla M, Belanger E, Chaudoin-Patzoldt K, Buck KD, Minor KS, Vohs J, Hamm JA, Lysaker PH. Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study. Psychother Res 2016; 28:264-280. [DOI: 10.1080/10503307.2016.1219421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth Belanger
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | - Kyle S. Minor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Paul H. Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush VA Medical Center, Indianapolis, IN, USA
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26
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Huguelet P, Mohr S, Rieben I, Hasler R, Perroud N, Brandt PY. Attachment and coping in psychosis in relation to spiritual figures. BMC Psychiatry 2015; 15:237. [PMID: 26446496 PMCID: PMC4597457 DOI: 10.1186/s12888-015-0617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
Background Studies have found higher levels of insecure attachment in individuals with schizophrenia. Attachment theory provides a framework necessary for conceptualizing the development of interpersonal functioning. Some aspects of the attachment of the believer to his/her spiritual figure are similar to those between the child and his/her parents. The correspondence hypothesis suggests that early child-parent interactions correspond to a person’s relation to a spiritual figure. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation for the lack of felt security. The aim of this study is to explore attachment models in psychosis vs. healthy controls, the relationships between attachment and psychopathology and the attachment processes related to spiritual figures. Methods Attachment models were measured in 30 patients with psychosis and 18 controls with the AAI (Adult Attachment interview) in relationship with psychopathology. Beliefs and practices related to a spiritual figure were investigated by qualitative and quantitative analyses. Results Patients with psychosis showed a high prevalence of insecure avoidant attachment. Spiritual entities functioned like attachment figures in two thirds of cases. Interviews revealed the transformation of internal working models within relation to a spiritual figure: a compensation process was found in 7 of the 32 subjects who showed a significant attachment to a spiritual figure. Conclusions Attachment theory allows us to highlight one of the underlying dimensions of spiritual coping in patients with psychosis.
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Affiliation(s)
- Philippe Huguelet
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland. .,Department of Mental Health and Psychiatry, Division of General Psychiatry, Secteur Eaux-Vives, University Hospital of Geneva, Rue du 31 Décembre 8, 1207, Geneva, Switzerland.
| | - Sylvia Mohr
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Isabelle Rieben
- Faculty of Theology, Lausanne University, BFSH 2, 1015, Lausanne, Switzerland.
| | - Roland Hasler
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Nader Perroud
- Division of Adult Psychiatry, University Hospital of Geneva and University of Geneva, Rue du 31-Décembre 8, 1207, Geneva, Switzerland.
| | - Pierre-Yves Brandt
- Faculty of Theology, Lausanne University, BFSH 2, 1015, Lausanne, Switzerland.
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27
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Quijada Y, Kwapil TR, Tizón J, Sheinbaum T, Barrantes-Vidal N. Impact of attachment style on the 1-year outcome of persons with an at-risk mental state for psychosis. Psychiatry Res 2015; 228:849-56. [PMID: 26032461 DOI: 10.1016/j.psychres.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
Attachment theory provides key elements for understanding the psychosocial vulnerability for and response to the emergence of psychosis. This study examined (1) whether pre-treatment attachment styles are differentially associated with clinical and functional outcome in at-risk mental state (ARMS) for psychosis patients across one year of psychosocial treatment, and (2) whether clinical change is associated with changes in attachment ratings beyond the effect of baseline symptom severity. Thirty-eight ARMS patients (mean age=16.7, S.D.=5.9) identified from a psychosocial needs-adapted treatment were evaluated with the Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Relationships Questionnaire. Lower levels of insecure-avoidant attachment predicted better clinical outcomes, whereas higher levels of secure attachment predicted improvement in functioning. A decrease in preoccupied-anxious attachment was associated with symptom amelioration. The findings suggest that the intensity of insecure attachment plays a significant role in the clinical outcome of ARMS patients involved in psychosocial treatment. Reducing the levels of insecure attachment in the therapeutic setting probably favors a better course in the early phases of psychosis. Furthermore, the finding that negative models of the self and others were associated with symptom outcome is consistent with current psychosocial models of psychosis.
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Affiliation(s)
- Yanet Quijada
- Facultad de Psicología, Universidad San Sebastián, Concepción, Chile; Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Thomas R Kwapil
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Jorge Tizón
- Institut Universitari de Salut Mental Fundació Vidal i Barraquer, Universitat Ramon Llull, Barcelona, Spain
| | - Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.
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28
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Korver-Nieberg N, Berry K, Meijer C, de Haan L, Ponizovsky AM. Associations between attachment and psychopathology dimensions in a large sample of patients with psychosis. Psychiatry Res 2015; 228:83-8. [PMID: 25953341 DOI: 10.1016/j.psychres.2015.04.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 03/11/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Attachment theory is a powerful theoretical framework that complements and extents current models psychosis. We tested the hypothesis that attachment anxiety and avoidance are differentially associated with the severity of positive, negative and general psychopathology symptoms in patients with a diagnosis of psychosis. Five hundred patients with DSM-IV or ICD-10 diagnoses of psychotic disorders (schizophrenia, schizoaffective or non-affective psychosis) from independent samples from Netherlands, United Kingdom and Israel completed the Relationship Questionnaire. Psychopathology was assessed with the Positive and Negative Syndromes Scale. We used both categorical and dimensional approach to attachment data, which were analyzed using ANOVA with post-hoc tests, Pearson's correlations and multiple regression analysis. The conservative level of statistical significance was established (p < 0.001) to control for multiple testing. After adjustment for possible confounders, attachment anxiety predicted severity of positive symptoms as well as affective symptoms. Both attachment anxiety and avoidance were associated with severity of hallucinations and persecution Contrary to predictions, attachment avoidance was not associated with overall scores for negative symptoms, although there was some evidence of relatively weaker association between avoidance and social and emotional withdrawal.
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Affiliation(s)
- Nikie Korver-Nieberg
- Department Early Psychosis, Academic Psychiatric Center, Amsterdam, The Netherlands
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | - Carin Meijer
- Department Early Psychosis, Academic Psychiatric Center, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department Early Psychosis, Academic Psychiatric Center, Amsterdam, The Netherlands
| | - Alexander M Ponizovsky
- Research Unit, Mental Health Services, Ministry of Health, 39 Yirmiyahu St. P.O. Box 1176, Jerusalem 9446724, Israel.
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29
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Wickham S, Sitko K, Bentall RP. Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem. Psychol Med 2015; 45:1495-1507. [PMID: 25388512 DOI: 10.1017/s0033291714002633] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms. METHOD We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association. RESULTS Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia. CONCLUSIONS It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.
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Affiliation(s)
- S Wickham
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
| | - K Sitko
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
| | - R P Bentall
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
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30
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Abstract
BACKGROUND The capacity to manage affects is rooted in early interactions with caregivers, which in adulthood are internalized as different attachment styles. Few studies have explored associations between all four attachment styles and symptoms. AIM Our aim was to investigate the relations between the four attachment styles and psychological distress in a group of people with psychosis. METHOD In a cross-sectional study, associations between self-reported attachment style and symptoms in a psychosis group were explored. Attachment styles were measured with the Relationship Questionnaire (RQ) and symptoms were assessed with the revised version of the Symptom Checklist (SCL-90R) RESULTS: The analyses showed a significant positive association between preoccupied attachment and the severity of symptoms. Furthermore, the analyses indicated significant positive associations between preoccupied attachment and the subscales measuring depression, anxiety, interpersonal sensitivity, paranoia and psychoticism. We also found significant positive associations between fearful attachment and both interpersonal sensitivity and psychoticism. CONCLUSION The associations between attachment styles and symptoms found here are consistent with those of previous studies. It could be important for clinicians to identify patients' attachment styles. Such knowledge would help mental health professionals to understand better the patients' capacity to handle distress and help professionals to address interventions aiming to target each patient's specific needs.
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Affiliation(s)
- Jennifer Strand
- Jennifer Strand, Department of Psychology, University of Gothenburg , PO Box 500, S-405 30 Gothenburg , Sweden
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31
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Huang J, Tan SP, Walsh SC, Spriggens LK, Neumann DL, Shum DHK, Chan RCK. Working memory dysfunctions predict social problem solving skills in schizophrenia. Psychiatry Res 2014; 220:96-101. [PMID: 25110314 DOI: 10.1016/j.psychres.2014.07.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 07/19/2014] [Accepted: 07/19/2014] [Indexed: 12/21/2022]
Abstract
The current study aimed to examine the contribution of neurocognition and social cognition to components of social problem solving. Sixty-seven inpatients with schizophrenia and 31 healthy controls were administrated batteries of neurocognitive tests, emotion perception tests, and the Chinese Assessment of Interpersonal Problem Solving Skills (CAIPSS). MANOVAs were conducted to investigate the domains in which patients with schizophrenia showed impairments. Correlations were used to determine which impaired domains were associated with social problem solving, and multiple regression analyses were conducted to compare the relative contribution of neurocognitive and social cognitive functioning to components of social problem solving. Compared with healthy controls, patients with schizophrenia performed significantly worse in sustained attention, working memory, negative emotion, intention identification and all components of the CAIPSS. Specifically, sustained attention, working memory and negative emotion identification were found to correlate with social problem solving and 1-back accuracy significantly predicted the poor performance in social problem solving. Among the dysfunctions in schizophrenia, working memory contributed most to deficits in social problem solving in patients with schizophrenia. This finding provides support for targeting working memory in the development of future social problem solving rehabilitation interventions.
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Affiliation(s)
- Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Shu-ping Tan
- Psychiatry Research Center, Huilongguan Hospital, Beijing, China
| | - Sarah C Walsh
- Behavioural Basis of Health Research Program, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Lauren K Spriggens
- Behavioural Basis of Health Research Program, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - David L Neumann
- Behavioural Basis of Health Research Program, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - David H K Shum
- Behavioural Basis of Health Research Program, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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32
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Leonhardt BL, Hamm JA, Belanger EA, Lysaker PH. Childhood sexual abuse moderates the relationship of self-reflectivity with increased emotional distress in schizophrenia. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2014. [DOI: 10.1080/17522439.2014.968858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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33
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Ciocca G, Limoncin E, Di Tommaso S, Mollaioli D, Gravina GL, Marcozzi A, Tullii A, Carosa E, Di Sante S, Gianfrilli D, Lenzi A, Jannini EA. Attachment styles and sexual dysfunctions: a case–control study of female and male sexuality. Int J Impot Res 2014; 27:81-5. [DOI: 10.1038/ijir.2014.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 07/07/2014] [Accepted: 07/12/2014] [Indexed: 11/09/2022]
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34
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Gumley AI, Taylor HEF, Schwannauer M, MacBeth A. A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatr Scand 2014; 129:257-74. [PMID: 23834647 DOI: 10.1111/acps.12172] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis. METHOD The following computerised databases searched were CINAHL<1980 to December 2012; EMBASE<1980 to December 2012; Ovid MEDLINE (R)<1980 to December 2012; PsychINFO<1980 to December 2012; and Google Scholar<1980 to December 2012. RESULTS We identified 22 papers describing 21 studies comprising 1453 participants, with a mean age of 35.0 years (range of 12-71 years), of whom 68.4% (n=994) were male. Of our sample, 1112 (76.5%) had a diagnosis of schizophrenia. We found small to moderate associations between greater attachment insecurity (as reflected in anxiety and avoidance) and poorer engagement with services, more interpersonal problems, more avoidant coping strategies, more negative appraisals of parenting experiences and more severe trauma. We also found small to modest associations between attachment insecurity and more positive and negative symptoms and greater affective symptom problems. CONCLUSION Attachment theory may be useful as a means of understanding the developmental and interpersonal basis of recovery and adaptation in the context of psychosis. However, further research comprising more representative samples in their first episode and using prospective designs is required.
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Affiliation(s)
- A I Gumley
- University of Glasgow, Glasgow, UK; NHS Greater Glasgow & Clyde, Glasgow, UK
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Sheinbaum T, Bedoya E, Ros-Morente A, Kwapil TR, Barrantes-Vidal N. Association between attachment prototypes and schizotypy dimensions in two independent non-clinical samples of Spanish and American young adults. Psychiatry Res 2013; 210:408-13. [PMID: 24011849 DOI: 10.1016/j.psychres.2013.07.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 06/07/2013] [Accepted: 07/07/2013] [Indexed: 01/22/2023]
Abstract
Attachment theory offers a powerful theoretical framework for elucidating the developmental pathway through which childhood interpersonal trauma confers vulnerability to psychosis. In the present study, the association between attachment and schizotypy was explored in two independent non-clinical samples of Spanish (n=547) and American (n=1425) young adults. Participants completed the Relationship Questionnaire and the Wisconsin Schizotypy Scales. Following attachment theory and cognitive accounts of psychosis, it was hypothesized that preoccupied attachment would be associated with positive schizotypy, dismissing attachment with negative schizotypy, and fearful attachment with both schizotypy dimensions. Results confirmed these predictions, thus supporting the theoretical frameworks invoked. Also, the associations found in these non-clinical samples are consistent with those in clinical psychosis, supporting the continuum model of schizotypy and schizophrenia. Finally, there was cross-cultural consistency of these associations. Overall, the findings support the application of attachment theory for furthering our understanding of whether different insecure styles, characterized by different self and other representations and affect regulation strategies, play a role in the pathways to positive and negative symptoms.
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Affiliation(s)
- Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
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