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Luciani KR, Johal PK, Chao T, Thiessen KA, Schütz CG. Adult self-reported childhood maltreatment types are associated with treatment satisfaction and alcohol relapse in patients with comorbid substance use and mental health disorders. Am J Addict 2024; 33:516-524. [PMID: 38504581 DOI: 10.1111/ajad.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with comorbid substance use and mental health disorders (concurrent disorders; CD) report poor treatment outcomes, high prevalence of childhood maltreatment, and mostly negative experiences with treatment. No studies to date have examined childhood maltreatment and treatment outcomes in CD. This study investigated self-reported childhood maltreatment as it relates to treatment satisfaction and substance use relapse among CD patients. METHODS The 258 CD inpatients completed a self-report questionnaire package, comprising the Childhood Trauma Questionnaire and the Inpatient Consumer Survey (ICS). Childhood maltreatment was assessed according to five subtypes and self-perceived treatment satisfaction was rated across six ICS domains. Psychiatric diagnoses, substance use status and relapse data were retrieved via patient medical charts. RESULTS Emotional neglect was associated with lower ratings across all ICS domains and physical neglect was associated with a lower rating for 'outcome of care'. Childhood sexual abuse was associated with a greater likelihood of alcohol relapse. No other relationships were statistically significant. DISCUSSION AND CONCLUSIONS The presence of childhood neglect (but not abuse) was more associated with overall treatment dissatisfaction, and sexual abuse alone increased the likelihood of alcohol relapse. These findings suggest some early adverse experiences in CD patients may increase negative experiences in treatment while others contribute to the risk of substance use. Broader longitudinal research is needed to examine the trajectory leading to negative outcomes. SCIENTIFIC SIGNIFICANCE This is the first study to report differential patterns of association by type of childhood maltreatment on negative outcomes in treatment among CD patients.
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Affiliation(s)
- Karling R Luciani
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Priya K Johal
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Chao
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karina A Thiessen
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health & Substance Use Services Research Institute, PHSA, Vancouver, British Columbia, Canada
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2
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Skrobinska L, Newman-Taylor K, Carnelley K. Secure attachment imagery facilitates help-seeking and help-acceptance in psychosis. Psychol Psychother 2024; 97:549-561. [PMID: 38943487 DOI: 10.1111/papt.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES People with psychosis delay accessing recommended treatments, resulting in poor healthcare outcomes and increased risk of relapse. Means of improving help-seeking and help-acceptance could reduce duration of untreated psychosis (DUP). This study examined the role of attachment style in help-seeking and help-acceptance in psychosis. DESIGN We used an experimental design to test the effect of attachment imagery priming on help-seeking and help-acceptance intentions, in a sample with self-reported psychosis. The independent variables were attachment imagery condition (secure vs. avoidant) and time (pre- vs. post-prime). The dependent variables were state paranoia, help-seeking intentions and help-acceptance intentions. METHODS We used an online research platform to recruit people with psychosis (n = 61). Participants were randomly allocated to the secure or avoidant attachment priming condition. All completed measures of state paranoia, help-seeking, and help-acceptance, before and after priming. RESULTS In comparison with the avoidant condition, secure attachment imagery resulted in reduced paranoia and increased help-seeking and acceptance intentions, all with large effect sizes. CONCLUSIONS This is the first study to use an experimental design to assess the role of attachment style in help-seeking and help-acceptance in a clinical sample. Attachment style is causally linked to behavioural intentions that contribute to DUP. Clinicians should assess attachment and help-seeking and acceptance, highlight these in formulation, and prioritise in treatment planning. Interventions that enhance help-seeking and acceptance could improve access to recommended treatments and reduce DUP.
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Affiliation(s)
- Laura Skrobinska
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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3
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Adams GC, Wrath AJ, Mela M, DesRoches A, Adams S, Andreen A, McKenna A. Childhood trauma as a mediator between attachment and recidivism risk: A study of Canadian offenders with mental disorders. BEHAVIORAL SCIENCES & THE LAW 2023; 41:96-108. [PMID: 36856141 DOI: 10.1002/bsl.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 06/03/2023]
Abstract
The current study aimed to explore the relationships between attachment and childhood trauma on recidivism risk in a sample of Canadian offenders with mental disorder (OMDs). N = 56 OMDs completed the Adverse Childhood Experiences (ACE) questionnaire, a measure of adult attachment (Experiences in Close Relationships Scale), and interview to determine recidivism risk (Level of Service/Case Management Inventory; LS/CMI). The variables of interest had small to moderate correlations. Multivariable regression analysis found that ACE scores but not attachment insecurity were associated with LS/CMI scores. Mediation analyses demonstrated that ACE scores fully mediated the association between attachment anxiety and attachment avoidance and recidivism risk. Results demonstrate that as exposure to diverse ACEs increased so did the risk to recidivate and this exposure mediated the relationship between attachment insecurity and recidivism risk. This study highlights the necessity of addressing both attachment insecurity and the experience of ACE when providing psychiatric services to OMDs.
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Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrew J Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mansfield Mela
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrea DesRoches
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stephen Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne McKenna
- Community Advisor, Saskatoon, Saskatchewan, Canada
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4
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Recollection of childhood trauma changes according to the shift in individual attachment rather than psychiatric diagnosis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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5
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Damiano RF, Fricchione G, Miguel EC. Love, compassion, and attachment in psychiatric care: perspectives for research and clinical practice. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022; 46:e20220557. [PMID: 36355861 PMCID: PMC11332676 DOI: 10.47626/2237-6089-2022-0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/17/2022] [Indexed: 02/17/2024]
Affiliation(s)
- Rodolfo Furlan Damiano
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Gregory Fricchione
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Euripedes Constantino Miguel
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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6
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Morvillers JM, Roy C, Laouénan C, Goutté N. [Therapeutic alliance between sectorial psychiatry inpatients and nurses and aides: A prospective, observational and cross-sectional study]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:854-863. [PMID: 35786001 PMCID: PMC9561694 DOI: 10.1177/07067437221111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization. OBJECTIVE The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry. METHOD This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients. RESULTS The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up. CONCLUSION Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place.
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Affiliation(s)
| | - Carine Roy
- Département d’Epidémiologie, Biostatistiques et Recherche Clinique,
Hôpital Bichat Claude Bernard, Paris
| | - Cédric Laouénan
- Département d’Epidémiologie, Biostatistiques et Recherche Clinique,
Hôpital Bichat Claude Bernard, Paris
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7
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Hall DL, Levine BJ, Jeter E, Chandler A, Tooze JA, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Smith ML, Penedo F, Mohr DC, Cella D, Wagner LI. A spotlight on avoidance coping to manage fear of recurrence among breast cancer survivors in an eHealth intervention. J Behav Med 2022; 45:771-781. [PMID: 35930212 PMCID: PMC9362703 DOI: 10.1007/s10865-022-00349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
Background Fear of recurrence (FoR) is prevalent among breast cancer survivors (BCS) and may be exacerbated by avoidance coping. This study examined BCS with avoidance coping and their engagement in a FoR eHealth intervention (FoRtitude). Methods BCS (N = 196) with elevated FoR participated in FoRtitude. Patient-reported measures assessed avoidance coping with FoR and baseline emotional and behavioral health. Intervention engagement was measured quantitatively (e.g., website logins, telecoaching attendance) and qualitatively (i.e., telecoaching notes). Results 38 BCS (19%) endorsed avoidance coping, which was associated with more severe post-traumatic anxiety-related symptoms and worse global mental health (ps < .05), but not anxiety (p = .19), depression (p = .11), physical health (p = .12), alcohol consumption (p = .85), or physical activity (p = .39). Avoidance coping was not associated with engagement levels (ps > .05) but did characterize engagement-related motivators and barriers. Conclusions Avoidance coping was not a barrier to FoRtitude engagement. eHealth delivery is a promising modality for engaging survivors with avoidance coping in FoR interventions.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School, Massachusetts General Hospital, 100 Cambridge St., 16th floor, Boston, MA, 02114, USA.
| | - Beverly J Levine
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Elizabeth Jeter
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Allison Chandler
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Janet A Tooze
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | | | | | | | | | | | | | | | | | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston Salem, NC, USA
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Social anxiety disorder with comorbid major depression - why fearful attachment style is relevant. J Psychiatr Res 2022; 147:283-290. [PMID: 35114512 DOI: 10.1016/j.jpsychires.2022.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 11/22/2022]
Abstract
Individuals with social anxiety disorder (SAD) often suffer from comorbid major depressive disorder (MDD), which goes along with increased clinical and functional impairment. There has been little research on underlying differences regarding childhood adversities and attachment styles between individuals with SAD with and without comorbid MDD. In the present study, the consecutive sample comprised 612 SCID-diagnosed participants. Of these, n = 472 (62.3% women, 40.7 ± 13.8 years) showed SAD and comorbid MDD (SAD-MDD group) and n = 140 (47.9% women, 43.7 ± 14.7 years) showed just SAD (SAD group). The two groups were compared regarding SAD symptom severity (Social Phobia Inventory; SPIN), childhood adversities (Adverse Childhood Experience Questionnaire; ACE) and attachment styles (Attachment Style Questionnaire, ASQ). The SAD-MDD group reported significantly more severe SAD symptoms (p = .002, d = 0.30), more childhood adversities (p < .001, d = 0.35) and a higher level of fearful attachment style (p < .001, d = 0.30). Group significantly moderated the association between fearful attachment style and SAD symptom severity (β = .292, p < .05) but not between preoccupied attachment style and SAD symptom severity (β = -.184, p = .124; R2adj = .168, p < .05). Fearful attachment style mediated the association between childhood adversities and SAD symptom severity in the SAD-MDD group. Our study could identify a specific significance of fearful attachment style for the association between negative childhood experiences and social anxiety symptoms in SAD-MDD. Findings have specific implications for the therapeutic relationship.
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Sood M, Carnelley KB, Newman-Taylor K. How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:781-815. [PMID: 35178714 PMCID: PMC9542899 DOI: 10.1111/bjc.12361] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Background The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis. Method We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association. Results We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self‐ and other‐beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment‐secure people with psychosis are more likely to seek help and engage with services than attachment‐insecure people. Conclusions Attachment styles impact help‐seeking behaviours in people with psychosis and are likely to influence paranoia via self‐ and other‐beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia. Practitioner points Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment‐secure are more likely to seek help and engage with services than those who are attachment‐insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help‐seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.
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Affiliation(s)
- Monica Sood
- School of Psychology, University of Southampton, UK
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10
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Novakov I, Kuruzović N. The relationship between attachment styles, psychopathology and quality of social interaction: A study on a clinical sample. PSIHOLOSKA ISTRAZIVANJA 2022. [DOI: 10.5937/psistra25-36956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study is to examine the differences between four attachment styles in relation to symptoms of psychopathology and the quality of social interaction, as well as to determine the role of attachment and psychopathology in predicting positive and negative social exchange. A total of 57 participants from the neuropsychiatric department of the Service for Specialist-Consultative Health Activities of the Health Centre in Novi Sad took part in the research. Respondents were mostly female (61%), aged 17 to 68 (M=40.13, SD=12.35). The Relationship Questionnaire (RQ) was used for attachment styles assessment. Psychopathological symptoms were measured using the Cornell Index (CI-N4), and the quality of social relationships was evaluated via the Network of Relationship Inventory (NRI). The highest rate of symptoms was detected in subjects with a preoccupied style, followed by those whose style was identified as fearful. The same two styles showed the least positive social exchange. Statistically significant differences on most scales from CI-N4 were found mainly between the secure and preoccupied subjects, while subjects with the avoidant pattern did not demonstrate significant differences in psychopathology and social functioning compared to secure participants. Secure affective attachment and low aggressive-antisocial indicators (impulsiveness, aggression, and paranoia) were the most important predictors of positive social exchange. Understanding psychopathological manifestations of different insecure attachment styles can contribute to the efficiency of psychodiagnostic and psychotherapeutic processes. Furthermore, the fact that insecure attachment and aggressive-antisocial factor predominantly compromise positive social interaction can facilitate goal setting during psychological treatment within the clinical spectrum.
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11
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Gleeson A, Curran D, Reeves R, J Dorahy M, Hanna D. A meta-analytic review of the relationship between attachment styles and posttraumatic growth. J Clin Psychol 2021; 77:1521-1536. [PMID: 34013521 DOI: 10.1002/jclp.23156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/06/2021] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present review aimed to examine the relationship between attachment styles and posttraumatic growth in adults exposed to traumatizing events. METHOD A systematic literature search resulted in the inclusion of 14 studies in the review. Four correlational meta-analyses of the relationship between the attachment styles of secure, dismissive, preoccupied, and fearful, and posttraumatic growth, were conducted. RESULTS These revealed a significant small positive relationship between secure attachment and posttraumatic growth (r = 0.21, p < 0.001); a significant small negative relationship between dismissive attachment and posttraumatic growth (r = -0.12, p < 0.001), and a weak relationship between preoccupied attachment and posttraumatic growth (r = -0.04, p = 0.235), and fearful attachment and posttraumatic growth (r = 0.08, p = 0.248). CONCLUSIONS The relationship between attachment styles and posttraumatic growth is modest and may be better explained by other variables. Nonetheless, findings provide useful information for clinicians regarding the potential small impact of attachment style following traumatizing exposure. Implications for future research are highlighted with respect to methodological rigor and the role of other potentially influential variables.
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Affiliation(s)
| | - David Curran
- School of Psychology, Queen's University, Belfast, UK
| | - Rachel Reeves
- School of Psychology, Queen's University, Belfast, UK
| | - Martin J Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Donncha Hanna
- School of Psychology, Queen's University, Belfast, UK
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12
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Exploring the Impact of Religion and Spirituality on Mental Health and Coping in a Group of Canadian Psychiatric Outpatients. J Nerv Ment Dis 2020; 208:918-924. [PMID: 32969867 DOI: 10.1097/nmd.0000000000001243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Research has shown that religious/spiritual (R/S) beliefs can impact mental health. In addition, individual attachment impacts R/S views and mental health. Still, clinical studies are lacking. This study explores the presence of R/S beliefs and attachment insecurity in psychiatric outpatients and the implication for mental health. Ninety psychiatric outpatients reported their R/S beliefs and were categorized into two groups: religious/spiritual (+R/S) or nonreligious/spiritual (-R/S). The groups were compared on attachment, psychiatric symptoms, religious coping, and life satisfaction. Multivariate linear regression was also performed. The +R/S group had significantly higher religious coping and lower attachment insecurity, depression severity, and social anxiety. Attachment insecurity was associated with negative religious coping. Higher attachment avoidance was associated with lower life satisfaction and higher social anxiety. Many patients in psychiatric care hold R/S views and use religious coping. Their R/S beliefs and attachment characteristics might influence each other and impact their mental illness.
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13
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Adams GC, Skomro R, Wrath AJ, Le T, McWilliams LA, Fenton ME. The relationship between attachment, treatment compliance and treatment outcomes in patients with obstructive sleep apnea. J Psychosom Res 2020; 137:110196. [PMID: 32726733 DOI: 10.1016/j.jpsychores.2020.110196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common condition with numerous health and psychological consequences. While treatment with Continuous Positive Airway Pressure (CPAP) is highly effective, it seems to be impacted by interpersonal aspects of the patient. The current study explores the role of two major interpersonal descriptors (attachment and relationship satisfaction) on treatment initiation and compliance with CPAP. The benefit of CPAP treatment on sleep measures and psychological functioning is also examined. METHODS Participants in stable relationships, diagnosed with OSA following an inpatient polysomnography test (N = 83), were recruited. Participants were appraised on their decision to initiate treatment and completed interpersonal measures (couples' satisfaction, attachment dimensions) as well as sleep measures and mental health measures. Participants were invited to repeat the measures after 3 months (N = 31 agreed). Associations between interpersonal measures and CPAP initiation and compliance as well as the impact of CPAP on sleep and all psychological measures was assessed. RESULTS Individuals with high attachment anxiety pursued OSA treatment based on a mutual decision with the partner, while individuals with lower attachment anxiety made the decision themselves. Couples' satisfaction was positively associated with CPAP compliance over 3 months. CPAP compliance significantly improved sleep measures, mood and anxiety symptoms. CONCLUSION The study brings evidence for a positive role of interpersonal factors in the initiation and compliance with OSA treatment as well as longitudinal benefits on sleep, mood and anxiety levels. The results can inform clinical approaches meant to increase treatment engagement and adherence in OSA patients through psychoeducation.
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Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Robert Skomro
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Andrew J Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Thuy Le
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lachlan A McWilliams
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatoon, Canada
| | - Mark E Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Ramsauer B, Mühlhan C, Lotzin A, Achtergarde S, Mueller J, Krink S, Tharner A, Becker-Stoll F, Nolte T, Romer G. Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity. Attach Hum Dev 2019; 22:705-726. [PMID: 31726954 DOI: 10.1080/14616734.2019.1689406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.
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Affiliation(s)
- Brigitte Ramsauer
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Christine Mühlhan
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Jessica Mueller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stephanie Krink
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | | | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
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Gandhi A, Luyckx K, Molenberghs G, Baetens I, Goossens L, Maitra S, Claes L. Maternal and peer attachment, identity formation, and non-suicidal self-injury: a longitudinal mediation study. Child Adolesc Psychiatry Ment Health 2019; 13:7. [PMID: 30675177 PMCID: PMC6339302 DOI: 10.1186/s13034-019-0267-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is defined as the repetitive, direct, and deliberate destruction of one's body tissue without an intention to die. Existing cross-sectional research indicates that the association between maternal/peer attachment and NSSI is mediated by identity synthesis and confusion. However, longitudinal confirmation of the aforementioned mediation models is necessary as cross-sectional models are known to be biased. Consequently, the aim of the present study was to investigate whether identity formation mediates the association between attachment and NSSI in a longitudinal design. METHODS Three waves of self-report questionnaires data (1 year apart) were collected on maternal and peer attachment, identity, and NSSI from students of a high school in Belgium (at Time 1: Mean age = 15.0 years, SD = 1.85, range = 11-19 years, 50.6% female). Both cross-lagged (between-person) and parallel process latent growth curve (within-person) mediation analyses were used to test the mediation models. RESULTS Findings of the cross-lagged analyses indicated unidirectional associations among the study variables, that is, from attachment to identity to NSSI. Parallel process latent growth mediation analyses showed that the association between the slope of maternal attachment and the slope of NSSI was mediated by the slopes of identity synthesis and confusion. Peer attachment models did not fit the data. CONCLUSION The current work demonstrated that dysfunctional maternal and peer attachment may lead to disturbances in identity formation, which, in turn, may lead to increased NSSI. Additionally, within-person analysis indicated that the growth rate of maternal attachment predicted the growth rate of NSSI through the growth rate of identity synthesis and confusion. The clinical relevance of these findings is discussed.
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Affiliation(s)
- Amarendra Gandhi
- 0000 0001 0668 7884grid.5596.fFaculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium
| | - Koen Luyckx
- 0000 0001 0668 7884grid.5596.fFaculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium ,0000 0001 2284 638Xgrid.412219.dUNIBS, University of the Free State, Bloemfontein, South Africa
| | - Geert Molenberghs
- 0000 0001 0604 5662grid.12155.32Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Imke Baetens
- 0000 0001 2290 8069grid.8767.eDepartment of Clinical and Life Span Psychology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Lien Goossens
- 0000 0001 2069 7798grid.5342.0Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Shubhada Maitra
- 0000 0004 1937 0757grid.419871.2Center for Health and Mental Health, Tata Institute of Social Sciences, Mumbai, India
| | - Laurence Claes
- 0000 0001 0668 7884grid.5596.fFaculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium ,0000 0001 0790 3681grid.5284.bFaculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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