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Evans HE, Sansom-Daly UM, Bryant RA. Attachment as a mechanism influencing end-of-life communication: An analogue investigation. PLoS One 2024; 19:e0303652. [PMID: 39083512 PMCID: PMC11290637 DOI: 10.1371/journal.pone.0303652] [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: 04/11/2023] [Accepted: 04/29/2024] [Indexed: 08/02/2024] Open
Abstract
Talking about dying when faced with end-of-life may be important for achieving optimal outcomes for young people and their families. Given the lack of research on young people's communication around end-of-life and death, this analogue study examined the role of attachment theory in conversations about dying. Experiment 1 assessed attachment security of 80 healthy young adults and randomised them to receive either an induction that raised awareness of one's attachment figures or a neutral induction, and then primed them with an imagined scenario where they were diagnosed with an incurable illness. Participants then completed a self-report measure of their willingness to discuss end-of-life topics with family, friends, or a psychologist. The experimental attachment induction did not increase willingness to talk about end-of-life concepts. Experiment 2 extended this design and asked participants to describe these conversations and assessed the content of their imagined end-of-life conversations. Experiment 2 replicated the finding that enhancing individuals' awareness of key attachment figures did not increase participants' willingness to engage in end-of-life conversations. However, heightened attachment awareness led participants to talk more about their relationship with the person they were hypothetically talking with. Across both experiments, avoidant attachment tendencies reduced the likelihood that participants receiving the attachment prime would want to engage in end-of-life conversation. Overall, it seems there are important differences between individuals on willingness to talk about death, and this may be influenced by one's attachment style. These results raise implications for the importance of attachment in the therapeutic relationship for healthcare professionals working with young people with life-limiting illnesses, such as cancer. Further research may shed light on how an individually tailored approach, taking into account attachment security, achieves the best outcomes for individuals who require end-of-life conversations.
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Affiliation(s)
- Holly E Evans
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, University of New South Wales (UNSW) Sydney, Randwick, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Ursula M Sansom-Daly
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, University of New South Wales (UNSW) Sydney, Randwick, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
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Bryant RA. Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments. Clin Psychol Rev 2023; 99:102228. [PMID: 36493729 DOI: 10.1016/j.cpr.2022.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.
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Espinosa L, Bonsall MB, Becker N, Holmes EA, Olsson A. Pavlovian threat conditioning can generate intrusive memories that persist over time. Behav Res Ther 2022; 157:104161. [DOI: 10.1016/j.brat.2022.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
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Abstract
Post-traumatic Stress Disorder is a chronic condition that occurs following a traumatic experience. Information processing models of PTSD focus on integrating situationally triggered sensory-emotional memories with consciously accessible autobiographical memories. Review of the nature of implicit memory supports the view that sensory-emotional memories are implicit in nature. Dissociation was also found to be associated with the development and severity of PTSD, as well as deficits in autobiographical memory. Moreover, disorganized attachment (DA) was associated with greater degrees of dissociation and PTSD, and like the defining neural activation in PTSD, was found to be associated with basal ganglia activity. In addition, subcortical neuroception of safety promotes a neurophysiological substrate supportive of social engagement and inhibition of fear-based responses. Furthermore, activation of representations of co-created imagined scenes of safety and secure attachment are associated with increases in this neurophysiological substrate. Repeated priming of secure attachment imagery was associated with modification of internal working models of DA along with reductions in dissociation and recovery from complex PTSD. In conclusion, it is posited that adequate recovery from extensive trauma experiences requires more than conscious elaboration of traumatic autobiographical memories and that the application of implicit nonconscious memory modification strategies will facilitate more optimal recovery.
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Doolan EL, Bryant RA. Modifying insecure attachment style with cognitive bias modification. J Behav Ther Exp Psychiatry 2021; 73:101664. [PMID: 34087690 DOI: 10.1016/j.jbtep.2021.101664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Attachment theory suggests that internal working models developed from early experiences with attachment figures biases cognitive appraisals a person makes of themselves and others. The current paper investigates whether attachment-related interpretative biases can be altered using Cognitive Bias Modification (CBM-I). METHODS Eighty anxiously attached participants were randomly assigned to receive either secure or insecure CBM-I training. To measure training effects on attachment-related interpretation bias, participants read scenarios involving attachment figures whereby the availability of the attachment figure was undetermined, followed by test sentences that assigned an attachment-secure or -insecure interpretation to the situations. Participants rated the similarity of these sentences to the previously read ambiguous situations. RESULTS Participants who received secure CBM-I training ascribed higher similarity ratings to secure sentence interpretations of ambiguous scenarios compared to insecure sentence interpretations. Attachment anxiety increased after CBM-I training for those who received insecure training, but did not differ for those who received secure training. LIMITATIONS This study was limited to healthy participants and did not include clinical participants. These findings need to be replicated by assessing the effects of CBM-I over an extended period. CONCLUSIONS CBM-I training may provide a viable means of modulating attachment anxiety. If validated with more potent strategies for secure attachment training, this approach could have significant implications for the treatment of affective disorders characterized by insecure attachments.
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Toumbelekis M, Liddell BJ, Bryant RA. Secure attachment primes reduce fear consolidation. Depress Anxiety 2021; 38:1078-1086. [PMID: 33949748 DOI: 10.1002/da.23166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies have found that attachment security primes can inhibit fear acquisition. This current study aimed to examine whether a brief imaginal prime of one's attachment figure could impact on fear consolidation. METHODS A total of 75 participants underwent fear conditioning on Day 1 and fear recall was tested on Day 2. Immediately following conditioning, half the participants were instructed to imagine an attachment figure while the other half imagined a nonattachment positive situation. Fear-potentiated startle and subjective expectancy of shock ratings were used as the measures of fear learning across trials. RESULTS The attachment group showed significantly lower levels of fear recall on Day 2 at both physiological and subjective levels. Furthermore, this effect was moderated by attachment anxiety, such that it was greatest for individuals who were securely attached. CONCLUSIONS These findings suggest that attachment relationships are protective during the consolidation of fear memories, and may have implications for how social attachments may impact how anxiety disorders can develop.
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Affiliation(s)
- Metaxia Toumbelekis
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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An Experimental Investigation of the Impact of Blame Appraisals and Moral Injury Beliefs on Psychological Outcomes. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10264-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karl A, Carnelley KB, Arikan G, Baldwin DS, Heinrichs M, Stopa L. The effect of attachment security priming and oxytocin on physiological responses to trauma films and subsequent intrusions. Behav Res Ther 2021; 141:103845. [PMID: 33780748 DOI: 10.1016/j.brat.2021.103845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
To further understand protective mechanisms to prevent post-traumatic stress disorder or assist recovery from psychological trauma, this study investigated whether pharmacological and psychological activation of a secure attachment representation elicits higher felt-security and a related response pattern of reduced physiological arousal and increased parasympathetic activation; and whether it protects individuals from developing intrusions and experiencing distress in the week following exposure to a trauma film. Using a double-blind, experimental mixed factorial design, 101 volunteers received either oxytocin or placebo and either secure attachment or neutral priming before watching a trauma film. We measured felt security as an indicator of the strength of activation of a secure attachment representation, skin conductance and heart rate as indicators of physiological arousal, and high frequency heart rate variability as an indicator of parasympathetic activation during the priming and the film. Participants then completed a seven-day intrusion diary. Secure attachment priming, but not oxytocin administration or the combination of both, was associated with reduced physiological arousal and increased parasympathetic activity during priming. Although secure attachment priming was not related to the absolute number of intrusions or to less perceived distress or physiological arousal during the trauma film, it was associated with lower intrusion-related distress in the 7-days post-testing. Our findings extend previous research that suggests the importance of interventions that address intrusion-related distress for recovery from trauma, and suggest a promising role for secure attachment priming in trauma-focused psychological therapies. We contribute to the growing literature that finds that higher subjective distress during a trauma is associated with higher intrusion-related distress. We discuss theoretical implications and possible mechanisms through which secure attachment priming may exert potential beneficial effects.
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Affiliation(s)
- Anke Karl
- Psychology, University of Exeter, Exeter, UK.
| | | | - Gizem Arikan
- Department of Psychology, Ozyegin University, Istanbul, Turkey
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, UK; Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Lusia Stopa
- School of Psychology, University of Southampton, Southampton, UK
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Hoffman J, Nickerson A. The Impact of Moral-Based Appraisals on Psychological Outcomes in Response to Analogue Trauma: An Experimental Paradigm of Moral Injury. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Intergenerational attachment orientations: Gender differences and environmental contribution. PLoS One 2020; 15:e0233906. [PMID: 32687501 PMCID: PMC7371162 DOI: 10.1371/journal.pone.0233906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/14/2020] [Indexed: 12/04/2022] Open
Abstract
After more than four decades of research and almost 100 attachment studies, the mechanisms of intergenerational transmission of attachment still remain unclear. To better understand the mechanisms moderating the associations of attachment orientations from one generation to the next, this empirical study examined the roles of 1) shared and non-shared environmental factors that characterize critical events in adulthood such as career choice, income and child care; 2) gender differences in attachment between parents (Generation 1, G1) and their adult offspring (Generation 2, G2) and their possible interactions. A sample of 321 families with G2 adults aged 18 and over and two G1 parents up to the age of 81 took part in this study. Both generations completed the Experiences in Close Relationships attachment measure as well as a comprehensive detailed measure of current core characteristics in adulthood (e.g. employment status, income, whether they had children) and demographic variables (gender, age). The findings suggest that the associations between the attachment orientations of G1 and the attachment orientations of G2 were moderated by G2’s income, their G1 paternal income and employment status, whether G2 had children (G3) of their own, and their family status after controlling for the age of G2, and the age of both paternal and maternal G1. When the associations for both paternal and maternal G1attachment orientation with both their male and female G2 was analyzed separately, this accounted for 35% of the variance of males’ G2 attachment orientation. The discussion focuses on the contribution of these findings to attachment theory and draws clinical conclusions.
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Sim S, Shin JE, Sohn YW. Effects of Non-verbal Priming on Attachment-Style Activation. Front Psychol 2019; 10:684. [PMID: 31024376 PMCID: PMC6459896 DOI: 10.3389/fpsyg.2019.00684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 11/16/2022] Open
Abstract
Using an affective priming procedure, two experiments examined the effects of non-verbal cues on activating attachment styles. In Study 1, the secure attachment group, which was primed non-verbally, showed higher levels of self-esteem, interpersonal competence, and positive affect than the insecure attachment group, which was also primed non-verbally. In contrast, no significant difference was found between the two attachment groups that were primed verbally. In Study 2, using a different priming method and adding a neutral group, similar interactions between priming modality (non-verbal or verbal cues) and attachment styles were found: the differences in self-esteem, interpersonal competence, and positive affect between the secure attachment group, neutral group, and insecure attachment group were greater when primed non-verbally than when primed verbally. Finally, the limitations of the research and recommendations for follow-up study are discussed.
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Affiliation(s)
- Suhyung Sim
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Ji-eun Shin
- Department of Psychology, Chonnam National University, Gwangju, South Korea
| | - Young Woo Sohn
- Department of Psychology, Yonsei University, Seoul, South Korea
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Liddell BJ, Courtney BS. Attachment buffers the physiological impact of social exclusion. PLoS One 2018; 13:e0203287. [PMID: 30183772 PMCID: PMC6124764 DOI: 10.1371/journal.pone.0203287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/19/2018] [Indexed: 11/24/2022] Open
Abstract
Attachment systems facilitate coping with stress, with previous studies demonstrating attachment figures diminishing subjective, behavioral and neural responses to social pain. Yet little is known about the physiological mechanisms governing this benefit in the context of social exclusion. This study investigated the impact of attachment (vs non-attachment) priming on affective and cardiovascular responses to social exclusion induced by the computerized “Cyberball” ball-tossing game, and the moderating influence of individual differences in attachment style, rejection sensitivity and self-construal. No significant change in high frequency heart rate variability (HF-HRV)–an index of parasympathetic activity and cardiovagal balance–was observed across the time course in the attachment priming condition, whereas the non-attachment condition showed significant fluctuation in HF-HRV–increasing during Cyberball and decreasing relative to baseline during recovery. Moreover, the benefit afforded by attachment priming on was enhanced amongst participants with lower rejection sensitivity and higher collectivistic self-construal, and those with higher anxious attachment style in the non-attachment prime group showed a trend towards increased HF-HRV during the Cyberball. Results are consistent with Social Baseline Theory, which argues that social proximity–particularly from attachment figures–protects against the metabolic costs associated with strong reactions to stress, including the preservation of cardiovagal homeostasis in this instance. Social attachments may provide an important mechanism to increase adaptive responding to the distressing experience of social exclusion.
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