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

Investigating the network ties between affect, attachment, and psychopathology

OBJECTIVES

Recent years have seen an increased interest regarding theoretical and empirical associations of adult attachment security and primary affective traits concerning psychiatric disorders. In this study, network analysis technique is applied to dissect the links between both psychodynamic personality constructs and an array of psychopathological symptoms.

METHODS

A total sample of 921 (69.9 % female) participants from the general population was investigated. A regularized cross-sectional partial correlation network between attachment (Experiences in Close Relationships-Revised [ECR-RD8]), primary affective traits (Brief Affective Neuroscience Personality Scales [BANPS-GL]) and psychopathological symptoms (ICD-10-Symptom-Rating Questionnaire [ISR]) was estimated via the EBICglasso algorithm. Node centrality, predictability and bridge centrality were analyzed. To evaluate the stability of the network and evaluate the significance of differences, we employed bootstrap techniques.

RESULTS

The network was found to be stable, allowing reliable interpretations. We observed SADNESS, as well as depressive, PTSD and anxiety symptoms as the most influential nodes within the investigated network. Attachment AV and SADNESS were observed as nodes with the highest bridge centrality.

CONCLUSIONS

The results provide a data-driven in-depth look into the complex dynamics between psychopathological symptoms, attachment security and basic affective traits. Results underscore the critical interconnections between affect, attachment, and psychopathology, advocating for a psychodynamically informed systems approach in psychological research that considers the affective dimensions underlying human mental health.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms.Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic  - and flight-related variables were investigated in exploratory analyses.Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership.Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor.Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment  - and migration-related variables distinguishing between these profiles offer starting points for interventions.

The relationship between attachment, primary emotions and positive/negative spirituality: a path analysis

Objective

The present study investigates what may influence individuals to experience their religiosity/spirituality as either subjectively positive [religious or spiritual (r/s) wellbeing] or as negative (r/s struggles). Drawing on existing literature attachment insecurity and the seven primary emotions as outlined by Jaak Panksepp in Affective Neuroscience are identified as likely influences.

Methods

The final sample consisted of 340 participants (age: M = 36, SD = 14.2; 68.5% = female), among which 65% self-identified as religious/spiritual. A path analysis was conducted to test a proposed mediation model in which the expected effects of primary emotions (B-ANPS) on r/s wellbeing (MI-RSWB) and r/s struggles (RSSS) were mediated through attachment insecurity (ECR-RD8).

Results

The data indicated that attachment insecurity fully mediated the relationships between the primary emotions SADNESS and LUST with r/s struggles. Furthermore, the primary emotions FEAR and ANGER displayed small direct effects on both r/s struggles and r/s wellbeing. Overall, the model, which demonstrated excellent model fit, was able to explain 30% of the variance of r/s struggles, 24% of attachment insecurity and 5% of r/s wellbeing.

Conclusions

The findings suggest that primary emotions such as SADNESS and LUST substantially explain r/s struggles and that these relationships seem to be mediated through attachment. Moreover, r/s struggles seem to be qualitatively distinct from r/s wellbeing. Finally, a moderate link between LUST and attachment suggests that sexuality plays a significant role in (adult) attachment processes.

Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

Originalbeiträge (Originals). Primäremotionen und Bindung bei psychischer Störung

Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness. This study illuminates the mediation relationship of these psychodynamic constructs in relation to psychiatric disorders.

METHODS

921 subjects (69.9 % female) were examined, who completed the questionnaires Brief Affective Neuroscience Personality Scales including a LUST Scale, Experiences in Close Relationships - Revised 8, and ICD-10 Symptom Rating online. A path analysis was conducted to evaluate the mediation effects of attachment anxiety.

RESULTS

A disease-specific pattern of direct associations between primary emotions, attachment anxiety, and psychological impairment emerged (all p < .01). Attachment exerted mediating effects primarily for SADNESS (p < .01), and to a lesser extent for LUST and CARE (p > .01).The model provided variance resolution ranging from7%(eating disorders) to 47%(depression).

CONCLUSION

The results demonstrate the relevance of affective explanations regarding the development of psychological symptoms, as well as therapeutic implications.

Attachment styles and healthcare utilization: exploring the role of the patient-doctor relationship

BACKGROUND

With the purpose of improving healthcare, past research has examined the link between healthcare utilization and attachment. It is suggested that an individual's attachment style influences both the quality of their patient-physician relationship and healthcare utilization patterns. Nevertheless, most studies concentrate on the individual aspect, overlooking the dyadic dimension; specifically, the investigation of how insecure attachment relates to health behavior within patient-physician relationships. This gap leaves the role of the patient-doctor relationship in this process unclear. Therefore, to elucidate this complex interplay, we hypothesized that the correlation between attachment and healthcare utilization is mediated by the quality of the patient-physician-relationship.

METHOD

Participant selection was based on electoral districts, a random-route procedure, and the Kish selection grid. The participants were visited by a trained interviewer who collected psychometric and sociodemographic information. Participants answered the Experiences in Close Relationships-Revised questionnaire (ECR-RD8) and the Patient-Doctor Relationship Questionnaire (PDRQ-9). Additionally, participants were asked about their healthcare utilization. The final sample consisted of N = 2.275 participants.

RESULTS

In average the participants reported consulting their primary health care practitioner M(SD) = 4.44 (4.76) times in the past 12 months. Generally, the participants rated the quality of the relationship with their primary health care practitioner close to "totally appropriate" (M = 4.12 ± .69). The degree of insecure attachment manifested towards the lower extremity of the scale. The total effect of the mediation analyses was significant. Regardless, the indirect effect indicated a trend result with minimal effect sizes.

CONCLUSION

The findings of the current study bridged the gap between attachment styles and healthcare utilization. Nonetheless, our results suggested insufficient support for the mediating role of the primary care physician in the relationship between attachment style and healthcare utilization. Considering the characteristics of the sample, this outcome may not apply in a clinical context. However, further research is needed to shed light in the revealed trends and indicate implications.

The 10-Item Short Form of the German Experiences in Close Relationships Scale (ECR-G-10)-Model Fit, Reliability, and Validity

The aim of the present work was the development and validation of a short form of the Experiences in Close Relationship Scale (ECR) in German. Three studies were conducted. In study 1, the best items for the short form were selected from the item pool of the original version based on ant colony optimization (ACO), a recently developed probabilistic approach. Data from three samples collected at a university, an online portal, and a psychosomatic clinic with a total of 1470 participants were analyzed. A 10-item solution resulted, measuring avoidance and anxiety with five items each. This solution showed a good model fit and acceptable reliability in all three samples. The two new short scales were independent of each other. In study 2, the 10-item solution was validated by correlating the new short scales with external criteria. Data from previous studies that included student, community, and clinical samples were reanalyzed. Both short scales showed expected correlations with measures of romantic relationships, personality, psychopathology, and childhood trauma, indicating convergent and discriminant validity. The significant correlations were moderate to strong. In study 3, the selected ten items alone and several content-related scales were presented online to 277 participants, most of them students. The good results in terms of model fit, reliability, and validity observed in studies 1 and 2 could be replicated here. The new short form, called ECR-G-10, allows the measurement of attachment avoidance and anxiety in an economic way in research and clinical practice.

Attachment insecurity and breadcrumbing engagement in young adults: a cross-sectional, cross-country study in India and Spain

BACKGROUND

Breadcrumbing, defined as the act of sending out flirtatious, but non-committal text messages to lure a sexual/romantic partner without expending much effort, has gained attention in popular culture and the media due to its relevance to contemporary dating dynamics. However, there is lack of evidence of the association between attachment insecurity and breadcrumbing This study aims to uncover the potential relationship between breadcrumbing engagement and attachment insecurity among Indian and Spanish young adults.

METHODS

Data were collected through an anonymous online survey answered by 334 adults in India and by 348 adults in Spain aged between 18 and 40 years old. A linear regression model in both countries was run to examine breadcrumbing engagement and its relationship with the set of sociodemographic variables included in the study (participants' age and sex, sexual orientation, relationship status and educational level) and the two dimensions of attachment insecurity (anxious and avoidant).

RESULTS

The results showed that insecure attachment, both anxious and avoidant, were associated with engaging in breadcrumbing in both the countries. However, there was a stronger association between anxious attachment and breadcrumbing in India compared to Spain, where the association was stronger between avoidant attachment and breadcrumbing.

CONCLUSIONS

Findings from this study offer insight into an under-studied practice in the context of interpersonal relationships (i.e., breadcrumbing behaviour) and show the importance of attachment theoretical framework to hypothesize and analyse expectations regarding strategies to negotiate intimate relationships and the breadcrumbing experience particularly.

Mentalizing partially mediates the association between attachment insecurity and global stress in preservice teachers

Objective

Considering the fact that the teaching profession is a highly stressful occupation and that teachers' ineffective coping strategies contribute to higher levels of stress, the objective of the present study was to investigate whether insecure attachment is related to global stress experiences in preservice student teachers. Furthermore, it was examined whether this link is mediated by the preservice teachers' mentalizing-the capacity to perceive and consider one's own and others' behavior based on intentional mental states.

Methods

Data of this cross-sectional study came from 202 preservice student teachers using self-report instruments (attachment: Expectation in Close Relationships; mentalizing: Reflective Functioning Questionnaire; stress: Trier Inventory of Chronic Stress). The hypotheses were tested using structural equation modelling.

Results

Anxious attachment was positively related to stress and impairments in mentalizing. In addition, the link between attachment-related anxiety and stress was partially mediated by mentalizing. Avoidant attachment was not associated with stress or mentalizing.

Discussion

Results indicate that anxious attachment is associated with higher perceived stress in preservice student teachers. Consequently, attachment-related anxiety may be a risk factor which, in turn, may foster perceptions of higher global stress experiences.

Conclusion

Additional research needs to focus on exploring the link between attachment insecurity and global stress experiences among preservice student teachers. An examination of preservice student teachers' own attachment experiences proves to be useful, for example in the context of mentalization-based supervision or reflective practice.

[Measurement Invariance and Validity of the Short Form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12)]

The short form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12) measures three partner-related attachment scales: fear of rejection, readiness for self-disclosure and conscious need for care. In addition to factor structure and reliability, the present study examined measurement invariance and validity using a non-clinical and a clinical sample of college students (N=208). Besides the BFPE12, the following Questionnaires were assessed: Short Form of Experiences in Close Relationships - Revised (ECR-RD8), Outcome Questionnaire (OQ-30), revised Beck Depression Inventory (BDI-II), Social Phobia Inventory (SPIN), and Test Anxiety Inventory (TAI-G). The factor structure is tested using confirmatory factor analysis (CFA), the internal consistency of the scales is quantified using McDonald's ω, the measurement invariance is investigated with two-group structural equation models, and the validity is examined using correlation and regression analyses. In both samples, the factor structure was confirmed (CFI>0.93; TLI>0.93; RMSEA<0.08; SRMR<0.08) and the reliability of all three scales was acceptable (ω>.7) - with the exception of need for care in the non-clinical group. We found configurational, metric and scalar measurement invariance regarding to the assignment in the clinical and non-clinical sample. In terms of convergent validity, fear of rejection and conscious need for care were associated with attachment-related anxiety (r=0.771 and r=0.539, p<0.001) and low readiness for self-disclosure was correlated with attachment-related avoidance (measured with ECR-RD8, r=- 0.704, p<0.001). Overall, the present study supports the factor structure, measurement invariance, reliability, and validity of the BPEQ12 in clinical and non-clinical samples.

Periodontal maintenance: individual patient responses and discontinuations

Aim

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

Methods

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

Results

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

Conclusion

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

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

Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning

OBJECTIVE

Although the relationship between insecure attachment patterns and eating disorder (ED) psychopathology has repeatedly been demonstrated, the underlying mechanisms of this association are not fully understood. Therefore, the current study aimed to examine personality functioning, defined as an impairment in self and interpersonal functioning, as a mediator between attachment insecurity and ED psychopathology.

METHODS

In a representative population-based sample (N = 2508; age range 14-92 years) ED symptomatology, personality functioning, and attachment insecurity (anxiety and avoidance) were assessed. Besides descriptive uni-/bivariate analysis, path analysis was used to test a mediation model while controlling for the effects of age, gender, mental distress, and BMI.

RESULTS

ED symptomatology was associated with lower levels of personality functioning (r = 0.22) and higher levels of attachment anxiety (r = 0.14) but did not correlate with attachment avoidance (r = 0.02). Path analysis revealed that personality functioning fully mediated the effect of attachment anxiety on ED symptomatology: The indirect effect via personality functioning (β = 0.04, p < .001) accounted for 77% of the total effect. Fit indices were excellent. Sensitivity analyses revealed that the main results were mainly applicable to women and the middle age group.

CONCLUSION

The present findings contribute to the growing body of research using dimensional conceptualizations of personality functioning, suggesting that it provides an informative, overarching framework for understanding and treating ED psychopathology. Findings indicate that underlying individual differences, e.g., with respect to insecure attachment configurations, have relevant implications for symptom manifestations. Potential clinical implications and avenues for future research are discussed.

Reflective functioning and Alexithymia as mediators between attachment and psychopathology symptoms: cross-sectional evidence in a community sample

This study sought to examine the role of Reflective Functioning and Alexithymia as mediators in the association between Attachment and Psychopathology. Questionnaires were administered to 1099 adults aged between 18 and 30 years. Results showed relations between Attachment Anxiety, Reflective Functioning, Alexithymia and Psychopathology. Moreover, Alexithymia was a mediator between Attachment, Reflective Functioning and Psychopathology.Current results provided evidence of the role of both Reflective Functioning and Alexithymia in the relationship between Attachment and Psychopathology. Implications are discussed.

Study Protocol for an Ecological Momentary Assessment Study: TempRes "Temporal Variability of Risk and Resilience Factors for Suicidal Ideation"

Suicide prevention is an important public mental health issue that can be significantly brought forward by recent advances in psychological research methods and assessment. The project "TempRes" aims to harness the power of Ecological Momentary Assessment (EMA) to investigate the transdiagnostic risk and resilience factors associated with suicidal ideation drawn from the most recent research in suicide prevention and personality assessment. Participants will comprise the general population (planned: N = 100) and a risk group (patients currently in psychosomatic or psychiatric treatment) (planned: N = 50). After a comprehensive baseline assessment, they will complete up to ten short assessments per day over the course of 10 days at roughly equidistant intervals. In detail, the project examines the interplay of biography (previous suicidal behavior, experiences of childhood maltreatment), individual differences (level of personality functioning), and time-varying factors (entrapment, loneliness, mood) with respect to the emergence and fluctuation of suicidal ideation. There are two main research foci: First, the project will provide an operationalization and empirical verification of a core assumption of the integrated motivational-volitional model of suicide (IMV model). It will test whether the interaction of the time-varying predictors entrapment with loneliness (as a motivational moderator) explains reports of suicidal ideation over time. Second, it will be the first to examine personality functioning (a transdiagnostic, psychodynamically grounded conceptualization of vulnerability to psychological crises over the life span) as a time-invariant predictor of suicidal ideation assessed within an intensive longitudinal study design. The main analyses will be built on linear mixed models. The overarching aim of the project is to gain a better understanding of the psychological dynamics underlying suicidal ideation in different populations by bringing together concepts from different theoretical traditions. This will inform prevention efforts geared toward the general public as well as intervention in clinical populations.

Erstellung und Validierung einer Kurzversion des Fragebogens zur Erfassung aversiver und protektiver Kindheitserfahrung (APK-18)

Zusammenfassung. Die Erfassung von Kindheitserfahrungen stellt einen wichtigen Baustein für Verständnis und Behandlung psychischer Belastungen im Erwachsenenalter dar. Dabei kommt der Erfassung protektiver Kindheitserfahrungen neben etablierten aversiven Erlebnissen eine wachsende Bedeutung zu. Ziel der vorliegenden Studie ist die Erstellung einer validen, reliablen und zeitökonomischen Kurzform des Fragebogens zur Erfassung aversiver und protektiver Kindheitserfahrungen (APK). Mithilfe des Ant-Colony Optimization (ACO) Algorithmus wurden an einer klinisch-psychotherapeutischen Stichprobe ( n = 701) aus den 59 Items der Langversion ein Set von 18 Items identifiziert und an einer nicht-klinischen Stichprobe ( n = 643) validiert. Die Kurzversion (APK-18) zeigte gute Reliabilität und Validität und unterschied anhand latenter Mittelwertunterschiede zuverlässig zwischen klinischen und nicht-klinischen Teilnehmenden. Einschränkungen bezüglich der Reliabilität ergaben sich bei 2 der insgesamt 8 Sub-Skalen, „Sonstige traumatische Ereignisse“ und „Trennungserfahrungen“. Mit der Kurzversion APK–18 liegt ein ökonomisches und valides Messinstrument vor, welches in klinische Routineerhebungen integriert werden kann.