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Kani AS, Çinçin A, Özercan A, Şenoğuz UD, Örnek E, Dokuz G, Topçuoğlu V, Sayar K. Exploring the role of adult attachment, major depression and childhood trauma in arterial stiffness: A preliminary study. J Psychosom Res 2023; 171:111386. [PMID: 37269643 DOI: 10.1016/j.jpsychores.2023.111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Prior research indicates a noteworthy and intricate connection between depression and subclinical atherosclerosis. Nevertheless, the biological and psychological mechanisms that underlie this association are not yet fully understood. To address this gap, this exploratory study aimed to examine the relationship between active clinical depression and arterial stiffness (AS), with a particular focus on the potential mediating roles of attachment security and childhood trauma. METHODS In this cross-sectional study, we examined 38 patients with active major depression free of dyslipidemia, diabetes mellitus, hypertension, and obesity and 32 healthy controls. All participants underwent blood tests, psychometric assessments, and AS measurements using the Mobil-O-Graph arteriograph system. AS severity was evaluated using an augmentation index (AIx) normalized to 75 beats/min. RESULTS In the absence of defined clinical cardiovascular risk factors, there was no significant difference in AIx between individuals with depression and healthy controls (p = .75). Patients with longer intervals between depressive episodes had lower AIx (r = -0.44, p < .01). Insecure attachment and childhood trauma did not significantly associate with AIx in patients. Whereas insecure attachment was positively correlated with AIx only in healthy controls (r = 0.50, p = 01). CONCLUSIONS Our analysis of established risk factors for atherosclerosis revealed that depression and childhood trauma had no significant relationship with AS. However, we did identify a novel finding: insecure attachment was significantly associated with AS severity in healthy adults without defined cardiovascular risk factors for the first time. To our knowledge, this is the first study to demonstrate this relationship.
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Affiliation(s)
- Ayşe Sakallı Kani
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Altuğ Çinçin
- Department of Cardiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ahmet Özercan
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Uzay Dural Şenoğuz
- Department of Psychology, Istanbul Medeniyet University Faculty of Arts and Humanities, Istanbul, Turkey
| | - Erdem Örnek
- Department of Psychology, Istanbul Medeniyet University Faculty of Arts and Humanities, Istanbul, Turkey
| | - Gonca Dokuz
- Department of Psychiatry, Bezmialem Vakıf University, Istanbul, Turkey
| | - Volkan Topçuoğlu
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kemal Sayar
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
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Kidd T, Dferevine SL, Walker SC. Affective Touch and Regulation of Stress Responses. Health Psychol Rev 2022; 17:60-77. [PMID: 36346350 DOI: 10.1080/17437199.2022.2143854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Tara Kidd
- School of Psychology, Liverpool John Moore University, Liverpool, U.K
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Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men. Psychoneuroendocrinology 2022; 145:105899. [PMID: 36108460 DOI: 10.1016/j.psyneuen.2022.105899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/25/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022]
Abstract
Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.
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Laflamme SZ, Bouchard K, Sztajerowska K, Lalande K, Greenman PS, Tulloch H. Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease. PLoS One 2022; 17:e0269366. [PMID: 36121800 PMCID: PMC9484654 DOI: 10.1371/journal.pone.0269366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Simone Zofia Laflamme
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karolina Sztajerowska
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul S. Greenman
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Baliyan S, Cimadevilla JM, Pulopulos MM, Castillejo L, Sandi C, Venero C. Pre-pandemic Psychobiological Features Predict Impact of COVID-19 Confinement on Loneliness. Front Psychol 2022; 13:874232. [PMID: 35572252 PMCID: PMC9096268 DOI: 10.3389/fpsyg.2022.874232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic led to various government-imposed limitations on social interaction and strict home confinement. Such involuntary social-distancing policies can exacerbate feelings of loneliness and alter emotional well-being. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential mechanism for loneliness' deleterious health effects. In this study, we explored whether pre-pandemic diurnal cortisol output (AUC G ), a measure of HPA axis function, may predict the propensity to changes in loneliness during long-term COVID-19 home confinement and if extraversion would moderate this relationship. This association has been explored by analysing the impact of COVID-19 pandemic and strict home confinement on social and emotional loneliness in 45 Spanish young adults. Diurnal cortisol levels were measured from five saliva samples obtained across a day just before the pandemic, and data about participants' perceived loneliness, empathic state, extraversion, and prospective volunteering were obtained both before and during the confinement. Participants' social and family loneliness increased during long-term strict home confinement, while prospective volunteering tendencies and extraversion decreased. Importantly, after adjusting for relevant confounders, moderation analyses revealed that in young adults with high pre-pandemic extraversion, a higher AUC G predicted a larger increase in social loneliness during confinement, while in individuals with low extraversion, AUC G was negatively related to change in loneliness. Our findings highlight the utility of pre-pandemic diurnal cortisol output in predicting the social impact of COVID-19 home confinement, presenting this hormone as a potential biomarker for a priori identification of at-risk groups during public health crises.
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Affiliation(s)
- Shishir Baliyan
- COGNI-UNED, Department of Psychobiology, Faculty of Psychology, UNED, Madrid, Spain
| | | | - Matias M. Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Leyre Castillejo
- COGNI-UNED, Department of Psychobiology, Faculty of Psychology, UNED, Madrid, Spain
| | - Carmen Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - César Venero
- COGNI-UNED, Department of Psychobiology, Faculty of Psychology, UNED, Madrid, Spain
- Instituto Mixto de Investigación-Escuela Nacional de Sanidad, Madrid, Spain
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Müller M, Zietlow AL, Klauser N, Woll C, Nonnenmacher N, Tronick E, Reck C. From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study. Front Psychol 2022; 12:807157. [PMID: 35126257 PMCID: PMC8810635 DOI: 10.3389/fpsyg.2021.807157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver–infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3–8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12–24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3–8 months of age predict insecure attachment in children aged 12–24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12–24 months of age were 48% less likely to achieve an interactive reparation at 3–8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12–24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children.
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Affiliation(s)
- Mitho Müller
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
- *Correspondence: Mitho Müller,
| | - Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Nathania Klauser
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Woll
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nora Nonnenmacher
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Edward Tronick
- Child Development Unit, Developmental Brain Sciences Program, Department of Psychology, University of Massachusetts Boston – Harvard Medical School, Boston, MA, United States
| | - Corinna Reck
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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Achour M, Souici D, Bensaid B, Binti Ahmad Zaki N, Alnahari AAA. Coping with Anxiety During the COVID-19 Pandemic: A Case Study of Academics in the Muslim World. JOURNAL OF RELIGION AND HEALTH 2021; 60:4579-4599. [PMID: 34514548 PMCID: PMC8435299 DOI: 10.1007/s10943-021-01422-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 05/03/2023]
Abstract
The COVID-19 pandemic has been a global phenomenon defined by uncertainty, fear and grief which has resulted in record high levels of stress and anxiety in the first half of 2020. It also led to an increased interest in the study of the role of belief, religion, and spirituality as responses to coping with and responding to the pandemic throughout different societal domains. This study explores the impact of anxiety and stress caused by the pandemic on Muslim academics' subjective well-being. It also explores correlations between coping and spirituality by assessing Muslim academics' coping strategies in overcoming stress and anxiety. To this end, this study sampled 480 Muslim academics ages 25-60 years residing in Muslim countries. The findings show a negative yet significant correlation between anxiety and well-being while also showing a positive and significant correlation between coping strategies and subjective well-being. The research also points to the role of coping strategies in reducing anxiety and stress, the resulting improvements in well-being for Muslim academics, and the mediating effect of coping strategies between anxiety, stress, and well-being for Muslim academics.
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Affiliation(s)
- Meguellati Achour
- Laboratory of Economic Studies On Industrial Zones in Light of the New Role of the University, Department of Management, Faculty of Economics, Business and Management Sciences, University of Mohamed, El Bachir El-Ibrahimi, Bordj-Bou Arreridj, El Anceur, Algeria
| | - Dahmane Souici
- Department of Psychology, Educational Sciences and Orthophony, Faculty of Human and Social Sciences, University of Batna 1, Batna, Algeria
| | | | - Nurulhuda Binti Ahmad Zaki
- Fiqh and Usul Department, Academy of Islamic Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
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8
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Attachment anxiety and resilience: The mediating role of coping. Acta Psychol (Amst) 2021; 221:103447. [PMID: 34808486 DOI: 10.1016/j.actpsy.2021.103447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022] Open
Abstract
In recent research, attachment has been addressed as a core factor that potentially contributes to resilience. However, there is still much to investigate regarding the mechanisms of this relationship. Emotion-focused coping and problem-focused coping strategies may be promising pathways via which attachment associates with resilience. The present study evaluated the role of attachment insecurity (i.e., attachment anxiety and avoidance) in resilience among a Turkish sample during the COVID-19 pandemic. We hypothesized that individuals with high levels of attachment anxiety would experience lower resilience via emotion-focused coping strategies. On the other hand, we did not have a specific hypothesis for attachment avoidance due to contrasting research findings of previous studies. Participants reported their attachment orientation, resilience, and coping strategies. Attachment anxiety was directly and, through both coping strategies, indirectly linked to resilience however attachment avoidance was only indirectly related to resilience through problem-focused coping. The findings indicate that low levels of attachment anxiety and the ability to use problem-focused coping strategies may be associated with greater resilience. The fostering of attachment security may thus reduce the use of emotion-focused strategies and may promote resilience among individuals with high levels of attachment anxiety. Moreover, our study is one of the first to investigate attachment orientations in relevance with coping and resilience during the ongoing pandemic This research has implications regarding the potentials of introducing psycho-educational trainings for better coping strategies in crisis like COVID-19 pandemic.
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Fontenelle LF, Muhlbauer JE, Albertella L, Eppingstall J. Traumatic and stressful life events in hoarding: the role of loss and deprivation. Eur J Psychotraumatol 2021; 12:1947002. [PMID: 34367527 PMCID: PMC8312593 DOI: 10.1080/20008198.2021.1947002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although past research shows hoarding to be associated with stressful life events involving loss and/or deprivation, the temporal relationship between the onset of symptoms and these events is not completely clear. OBJECTIVES In a cross-sectional online study, we examined the relationship between the number of events involving loss or deprivation before/simultaneously vs. after the onset of hoarding and various hoarding-related beliefs, such as emotional attachment to possessions, and symptom severity. Further, we examined whether perceived social support moderated the influence of these events on emotional attachment to objects. METHODS One hundred seventeen subjects with hoarding problems responded to a series of instruments to assess the history and timing of traumatic and stressful loss and/or deprivation in relation to the onset of hoarding, and self-report tools evaluating the severity of hoarding, beliefs/motivations, depression, anxiety, general distress, and perceived social support. RESULTS The number of events involving loss or deprivation occurring before hoarding was related to increased emotional attachment to possessions, whereas events happening after the onset of hoarding were related to increased concerns about memory as drivers of hoarding symptoms. Events happening before hoarding did not interact with perceived social support to influence emotional attachment to objects. CONCLUSIONS The timing of traumatic and stressful life events related to loss and deprivation is associated with different hoarding phenotypes, including beliefs/motivations for hoarding. If confirmed by longitudinal studies, these findings may be relevant for therapeutic and preventive measures.
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Affiliation(s)
- Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Julia E Muhlbauer
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Jan Eppingstall
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
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Attachment impacts cortisol awakening response in chronically depressed individuals. Psychoneuroendocrinology 2020; 120:104778. [PMID: 32585509 DOI: 10.1016/j.psyneuen.2020.104778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 05/01/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Early life experiences shape individual attachment, creating a template for regulating emotions in interpersonal situations, likely to persist across the lifespan. Research has shown that individual attachment creates vulnerability for depression, and also impacts the Hypothalamic-Pituitary-Adrenal (HPA) axis. Still, the relationship between attachment and the HPA axis in depressed individuals is unclear. Cortisol awakening response (CAR) has been recently investigated as a possibly useful physiological marker related to attachment insecurity and depression risk. However, research exploring the relationship between the CAR and attachment in individuals with chronic depression in either the presence or the absence of comorbid anxiety is lacking. The purpose of the current study was to fill this gap, by comparing the CAR in individuals with chronic depression with/without comorbid anxieties and controls. In addition, we also wanted to explore the relationship between attachment and the CAR in this group and to explore their predictive role for later depression severity. METHODS Individuals experiencing a current depressive episode at least six months in length (cMDD; n = 63) and healthy controls (HC; n = 57) were enrolled in the study (total n = 120). Participants completed a structured clinical diagnostic interview (SCID-I) as well as measures of depression severity (Beck Depression Inventory-II (BDI-II) and Hamilton Rating Scale for Depression) and attachment dimensions (Experiences in Close Relationships scale; ECR) at baseline. In addition, participants provided salivary samples at four time points (i.e. 0 (S1), 30, 45 and 60 min) following awakening on two consecutive days. S1 cortisol, the area under the curve with respect to ground (AUCg) and increase (AUCi) were calculated based on the average values across both days. The HC and cMDD groups were compared on all measures. The CAR for individuals with cMDD alone (n = 14) and individuals with cMDD with two or more comorbid anxiety disorders (cMDD ≥ 2Anx; n = 30) were also compared. A subset of participants (n = 59) agreed to return for follow up one year later. Participants returning for follow up repeated the BDI-II and ECR. No salivary samples were collected at follow-up. RESULTS The cMDD group had significantly lower S1 cortisol and AUCg compared to the HC group (both p ≤ 0.02). cMDD and cMDD ≥ 2Anx groups did not differ in their CAR. Regression analyses revealed that depression severity and the attachment interaction term was associated with lower S1 and AUCg cortisol (p < 0.01). Greater attachment avoidance was positively associated with S1 cortisol (p = 0.02), while mean awakening time on sample days was negatively associated with S1 cortisol. We also found a significant interaction between the attachment dimensions such that at low levels of attachment anxiety, attachment avoidance had a positive relationship with S1 cortisol and AUCg. The opposite relationship existed when attachment anxiety was high. Higher baseline BDI-II score and higher baseline attachment anxiety were predictive of higher scores on the BDI-II one-year later (both p < 0.05). CONCLUSIONS The current findings bring evidence that depression severity is associated with blunting of the CAR irrespective of the comorbid status with anxiety disorders. In addition, attachment avoidance may protect against the CAR blunting in individuals with low attachment anxiety. However, individuals with high attachment anxiety and avoidance might have additional CAR blunting. Attachment anxiety might be a good predictor of future depression severity.
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Abstract
OBJECTIVE Childhood attachment experiences affect adult emotion regulation and ability to cope with stressors. Therefore, insecure attachment may influence the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and a dysregulation of HPA axis has been found in insecure attached healthy individuals. The effects of attachment on HPA axis activity have never been investigated in eating disorders (EDs). Therefore, we assessed the relationships between insecure attachment and the cortisol awakening response (CAR) in adults with EDs. METHODS Seventy-eight patients with EDs (43 with anorexia nervosa, 35 with bulimia nervosa) were recruited. They completed the Experience in Close Relationships questionnaire, which provides a rating of two insecure attachment dimensions (anxiety and avoidance) and collected saliva samples to measure the CAR. Differences in the CAR between groups with high and low attachment anxiety and between groups with high and low attachment avoidance were evaluated by repeated measures two-way analysis of variance. RESULTS Patients with high attachment anxiety showed a reduced CAR compared with those with low attachment anxiety (F1,76 = 7.31, p = .008). The CAR did not differ between the groups with high and low attachment avoidance (F1,76 = 0.01, p = .93). Patients with high levels of insecure attachment showed a more severe eating-related psychopathology. CONCLUSIONS Our data show, for the first time, a specific association of the anxious attachment with the HPA axis activity in EDs and suggest a possible role of attachment in the biological vulnerability to stress of adult patients with EDs.
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Sahan HE, Yildirim EA, Soylu A, Tabakci AS, Cakmak S, Erkoc SN. Comparison of functional dyspepsia with organic dyspepsia in terms of attachment patterns. Compr Psychiatry 2018; 83:12-18. [PMID: 29501961 DOI: 10.1016/j.comppsych.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/28/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022] Open
Abstract
AIM Functional dyspepsia, originates from gastroduodenal region, is described as resistant and recurring dyspeptic symptoms with unknown etiology. Although there is some evidence in support of a relationship between functional dyspepsia and psychopathology, attachment patterns of functional dyspepsia patients have not been studied yet. In our study, we aimed to compare attachment patterns of functional dyspepsia patients with organic dyspepsia patients and healthy volunteers. METHOD 43 patients diagnosed with functional dyspepsia, 38 patients with organic dyspepsia and 42 healthy volunteers matched in terms of age, sex and education were included in the study. All participants were evaluated using a socio-demographic and clinical data questionnaire, the State and Trait Anxiety Inventory, the Experiences in Close Relationships Questionnaire and the Adult Attachment Scale. RESULTS There was no difference in sociodemographic features among the three groups. Functional dyspepsia group exhibited significantly higher Trait Anxiety scores compared to organic dyspepsia and control groups. Control group showed significantly higher secure attachment styles compared to functional dyspepsia and organic dyspepsia groups, there was no difference between groups in non-secure attachment styles according to triple attachment model. Dimensionally, functional dyspepsia group showed more avoidant attachment patterns than organic dyspepsia groups and organic dyspepsia group showed more avoidant attachment patterns than control group. CONCLUSION According to our findings, Functional dyspepsia patients are more anxious than organic dyspepsia patients and healthy volunteers. Non-secure attachment patterns were seen generally in all dyspeptic patients while avoidant attachment patterns are more prominent in functional dyspepsia patients.
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Affiliation(s)
- Halide E Sahan
- Van Training And Research Hospital Department Of Psychiatry, 65300 Edremit, Van, Turkey
| | - Ejder A Yildirim
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic Bakirkoy, 34147 Istanbul, Turkey.
| | - Aliye Soylu
- Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Gastroenterology, Tevfik Sağlam Cad. No: 11, Zuhuratbaba Mah., 34147 Istanbul, Turkey
| | - Abdulkadir S Tabakci
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic Bakirkoy, 34147 Istanbul, Turkey
| | - Serdal Cakmak
- Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Gastroenterology, Tevfik Sağlam Cad. No: 11, Zuhuratbaba Mah., 34147 Istanbul, Turkey
| | - Sahap N Erkoc
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Bakirkoy, 34147, Istanbul, Turkey
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13
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The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial. J Psychosom Res 2018; 108:39-46. [PMID: 29602324 DOI: 10.1016/j.jpsychores.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study. METHODS In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months. RESULTS Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048). CONCLUSION Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group. TRIAL REGISTRATION www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.
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14
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Adult attachment and physical health. Curr Opin Psychol 2018; 25:115-120. [PMID: 29734091 DOI: 10.1016/j.copsyc.2018.04.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 12/24/2022]
Abstract
This article examines how individual differences in adult attachment shape regulatory strategies and relationship behaviors, which in turn influence health-related responses, behaviors, and outcomes. We review links between attachment and physiological responses to stress (e.g., hypothalamic-pituitary-adrenal axis responses, cardiovascular responses, immune responses), health behavior (e.g., substance use, diet), and downstream health and disease outcomes. Recent evidence suggests that attachment insecurity (attachment anxiety and/or attachment avoidance) is associated with dysregulated physiological responses to stress, risky health behaviors, susceptibility to physical illness, and poorer disease outcomes. These associations depend, in part, on the relationship context, including the other partner's attachment style and behavior. We suggest that a dyadic approach considering both partners' attachment styles and behaviors will enhance interventions to promote health.
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15
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Ehrenthal JC, Levy KN, Scott LN, Granger DA. Attachment-Related Regulatory Processes Moderate the Impact of Adverse Childhood Experiences on Stress Reaction in Borderline Personality Disorder. J Pers Disord 2018; 32:93-114. [PMID: 29388902 PMCID: PMC5798009 DOI: 10.1521/pedi.2018.32.supp.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor and assayed for salivary alpha-amylase (sAA) and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance and a combination of more adverse childhood experiences and attachment insecurity resulted in higher sAA levels and differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress regulation in BPD may be moderated by attachment-related regulatory processes.
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Affiliation(s)
- Johannes C. Ehrenthal
- Department of Psychology, Pennsylvania State University
- Department of Psychology, Klagenfurt University, Austria
| | | | - Lori N. Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine
- Johns Hopkins University School of Medicine; Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Nursing
- Department of Psychology and Salivary Bioscience Laboratory, University of Nebraska
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16
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Cittern D, Edalat A. A Neural Model of Empathic States in Attachment-Based Psychotherapy. COMPUTATIONAL PSYCHIATRY (CAMBRIDGE, MASS.) 2017; 1:132-167. [PMID: 30090856 PMCID: PMC6067830 DOI: 10.1162/cpsy_a_00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 04/21/2017] [Indexed: 01/09/2023]
Abstract
We build on a neuroanatomical model of how empathic states can motivate caregiving behavior, via empathy circuit-driven activation of regions in the hypothalamus and amygdala, which in turn stimulate a mesolimbic-ventral pallidum pathway, by integrating findings related to the perception of pain in self and others. On this basis, we propose a network to capture states of personal distress and (weak and strong forms of) empathic concern, which are particularly relevant for psychotherapists conducting attachment-based interventions. This model is then extended for the case of self-attachment therapy, in which conceptualized components of the self serve as both the source of and target for empathic resonance. In particular, we consider how states of empathic concern involving an other that is perceived as being closely related to the self might enhance the motivation for self-directed bonding (which in turn is proposed to lead the individual toward more compassionate states) in terms of medial prefrontal cortex-mediated activation of these caregiving pathways. We simulate our model computationally and discuss the interplay between the bonding and empathy protocols of the therapy.
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Affiliation(s)
- David Cittern
- Algorithmic Human Development, Department of Computing, Imperial College London, London, United Kingdom
| | - Abbas Edalat
- Algorithmic Human Development, Department of Computing, Imperial College London, London, United Kingdom
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17
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Ullmann E, Licinio J, Barthel A, Petrowski K, Stalder T, Bornstein SR, Kirschbaum C. Persistent LHPA Activation in German Individuals Raised in an Overprotective Parental Behavior. Sci Rep 2017; 7:2778. [PMID: 28584276 PMCID: PMC5459846 DOI: 10.1038/s41598-017-01718-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
Parental upbringing may affect their offspring’s mental state across the entire lifespan. Overprotective parental child-rearing style may increase the disease burden in the offspring. Furthermore, this child-rearing style may also play a pathogenetic role by transmitting trauma- and stressor-related disorders (TSRD) across generations. Studies with animals have demonstrated that the mother’s immediate and expansive protection of the newborn decreases the limbic-hypothalamic-pituitary-adrenal (LHPA) axis activity in the offspring. However, few studies have investigated how stress impact humans raised in an overprotective manner. In a cross-sectional study with 40 healthy students recalling their overprotective upbringing, we show an increase in the dehydroepiandrostendione (DHEA) concentration and a reduction in the cortisol/DHEA-ratio in hair. Additionally, this child rearing style was associated with heightened indications of mental burden, depressiveness, and sense of coherence. Our results provide insight into the roots and consequences of psychological trauma across several generations. Further investigations focusing particularly on multigenerational transmission in extremely burdened families will augment our results.
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Affiliation(s)
- E Ullmann
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany. .,Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany.
| | - J Licinio
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Psychiatry, Flinders University, School of Medicine, Adelaide, Australia.,South Ural State University, Biomedical School, Chelyabinsk, Russian Federation
| | - A Barthel
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Medicover, Bochum, Germany
| | | | - T Stalder
- Department of Psychology, TU Dresden, Dresden, Germany.,Clinical Psychology, University of Siegen, Siegen, Germany
| | - S R Bornstein
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Faculty of Life Sciences & Medicine, Rayne Institute, Endocrinology and Diabetes, Kings College London, London, UK
| | - C Kirschbaum
- Department of Psychology, TU Dresden, Dresden, Germany
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18
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Abstract
Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.
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Affiliation(s)
- Xavier F Jimenez
- Department of Psychiatry and Psychology, Cleveland Clinic Foundation, USA
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19
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Kidd T, Poole L, Ronaldson A, Leigh E, Jahangiri M, Steptoe A. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. Br J Health Psychol 2016; 21:796-811. [PMID: 26999442 PMCID: PMC5082502 DOI: 10.1111/bjhp.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. RESULTS Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. CONCLUSION These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, UK
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, UK
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20
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Costa-Martins JM, Moura-Ramos M, Cascais MJ, da Silva CF, Costa-Martins H, Pereira M, Coelho R, Tavares J. Adult attachment style and cortisol responses in women in late pregnancy. BMC Psychol 2016; 4:1. [PMID: 26754482 PMCID: PMC4709978 DOI: 10.1186/s40359-016-0105-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023] Open
Abstract
Background Recent research has documented the association between attachment and cortisol rhythms. During pregnancy, when attachment patterns are likely to be activated, elevated levels of cortisol are associated with negative effects for the mother and the foetus. The aim of the present study was to examine the association of adult attachment style and cortisol rhythms in pregnant women. Methods Eighty women in the third trimester of pregnancy participated in the study. Adult attachment was assessed using the Adult Attachment Scale – Revised (AAS-R). Participants collected 4 samples of salivary cortisol at two different days; 3 samples were collected in the morning immediately after wakeup and one sample was collected by bedtime. Results Results found group significant differences in the cortisol diurnal oscillation (F(1,71) = 26.46, p < .001,), with secure women reporting a steep decrease in cortisol from awakening to bedtime, while women with fearful avoidant attachment reported no changes. No group differences were found regarding the cortisol awakening response. Conclusions These results highlight the importance of considering attachment patterns during pregnancy, suggesting fearful avoidant attachment style as a possible risk factor for emotional difficulties and dysregulation of the neuroendocrine rhythms.
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Affiliation(s)
- José Manuel Costa-Martins
- Department of Anaesthesiology, Maternity Hospital Alfredo da Costa, Rua Viriato, 1069-089, Lisbon, Portugal.
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Maria João Cascais
- Clinical Pathology, Biochemistry, Maternity Hospital Alfredo da Costa, Rua Viriato, 1069-089, Lisbon, Portugal
| | | | | | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Rui Coelho
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Jorge Tavares
- Anaesthesiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
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21
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Cassedy HF, Enander RA, Robinson RC, Evans HM, Frank B, Tucker C, Miltenberger PD, Pitts S, Stringer CA. Attachment Theory as a Model of Doctor-Patient Interaction. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/jabr.12036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hannah F. Cassedy
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - Richard A. Enander
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - Richard C. Robinson
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - H. Monroe Evans
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | | | - Christy Tucker
- Department of Obstetrics and Gynecology; Baylor University Medical Center
| | | | - Sandra Pitts
- Department of Obstetrics and Gynecology; Baylor University Medical Center
| | - C. Allen Stringer
- Department of Obstetrics and Gynecology; Baylor University Medical Center
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22
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Gander M, Buchheim A. Attachment classification, psychophysiology and frontal EEG asymmetry across the lifespan: a review. Front Hum Neurosci 2015; 9:79. [PMID: 25745393 PMCID: PMC4333768 DOI: 10.3389/fnhum.2015.00079] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/31/2015] [Indexed: 01/18/2023] Open
Abstract
In recent years research on physiological response and frontal electroencephalographic (EEG) asymmetry in different patterns of infant and adult attachment has increased. We review research findings regarding associations between attachment classifications and frontal EEG asymmetry, the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenocortical axis (HPA). Studies indicate that insecure attachment is related to a heightened adrenocortical activity, heart rate and skin conductance in response to stress, which is consistent with the hypothesis that attachment insecurity leads to impaired emotion regulation. Research on frontal EEG asymmetry also shows a clear difference in the emotional arousal between the attachment groups evidenced by specific frontal asymmetry changes. Furthermore, we discuss neurophysiological evidence of attachment organization and present up-to-date findings of EEG-research with adults. Based on the overall patterns of results presented in this article we identify some major areas of interest and directions for future research.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of InnsbruckInnsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of InnsbruckInnsbruck, Austria
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23
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Biological stress regulation in female adolescents: a key role for confiding. J Youth Adolesc 2014; 44:1066-77. [PMID: 25200034 DOI: 10.1007/s10964-014-0182-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/27/2014] [Indexed: 01/20/2023]
Abstract
Attachment behaviors play a critical role in regulating emotion within the context of close relationships, and attachment theory is currently used to inform evidence-based practice in the areas of adolescent health and social care. This study investigated the association between female adolescents' interview-based attachment behaviors and two markers of hypothalamic-pituitary-adrenal axis activity: cortisol and dehydroepiandrosterone (DHEA). Unlike the classic stress hormone cortisol, there is very limited investigation of DHEA-a quintessential developmental hormone-in relation to attachment, especially in adolescents. Fifty-five healthy females mean age 14.36 (±2.41) years participated in the attachment style interview. A smaller cortisol awakening response was related to anxious attachment attitudes, including more fear of rejection, whereas greater morning basal DHEA secretion was only predicted by lower levels of reported confiding in one's mother. These attachment-hormone relationships may be developmental markers in females, as they were independent of menarche status. These findings highlight that the normative shifts occurring in attachment to caregivers around adolescence are reflected in adolescents' biological stress regulation. We discuss how studying these shifts can be informed by evolutionary-developmental theory.
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24
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Kidd T, Poole L, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Attachment anxiety predicts IL-6 and length of hospital stay in coronary artery bypass graft surgery (CABG) patients. J Psychosom Res 2014; 77:155-7. [PMID: 25077858 PMCID: PMC4121675 DOI: 10.1016/j.jpsychores.2014.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The mechanisms underlying the association between adult attachment and health are not well understood. In the current study, we investigated the relationship between attachment anxiety, attachment avoidance, inflammation, and length of hospital stay in coronary artery bypass graft (CABG) surgery patients. METHOD 167 CABG patients completed an attachment questionnaire prior to surgery, and blood samples were taken before and after surgery to assess inflammatory activity. RESULTS We found that attachment anxiety predicted higher plasma interleukin 6 (IL-6) concentration, and this association was mediated by self-reported sleep quality. Anxious attachment also predicted longer hospital stays following CABG surgery, even after controlling for demographic and clinical factors. CONCLUSION These data suggest that increased levels of IL-6 may be a process linking adult attachment anxiety with health outcomes.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
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