High Prevalence of Insecure Attachment in Patients with Primary Hypertension

Attachment-Related Differences in Emotion Regulation in Adults: A Systematic Review on Attachment Representations

In recent years, there has been an increase in the prevalence of mental disorders connected with affective dysregulation and insecure attachment. Therefore, it is even more important to understand the interplay between an individual's attachment representation and patterns of emotion regulation. To our knowledge, this is the first systematic review to examine this association. PsycInfo, PsyArticles, and PubMed were searched for studies that examined attachment-related differences in emotion regulation in adults. To examine the unconscious attachment representation, only studies using the Adult Attachment Interview or the Adult Attachment Projective Picture System were included. Thirty-seven peer-reviewed studies (with a total of 2006 subjects) matched the PICO criteria. Emotion regulation was measured via four objective approaches: autonomic nervous system, brain activity, biochemistry, or nonverbal behavior. Across all measurements, results reveal a significant correlation between attachment representation and emotion regulation. Secure attachment correlates consistently with balanced emotion regulation, whereas it is impaired in insecure and dysfunctional in unresolved attachment. Specifically, unresolved individuals display counterintuitive responses and fail to use attachment as a resource. Insecure-dismissing attachment is associated with an emotionally deactivating strategy, while on a physiological, biochemical, and nonverbal level, emotional stress is still present. There is still a lack of studies examining preoccupied individuals. In addition to interpreting the results, we also discuss the risk of bias, implications for psychotherapy and coaching, and an outlook for future research.

Adolescent Relational Roots of Adult Blood Pressure: A Fourteen-Year Prospective Study

Intensity in adolescent romantic relationships was examined as a long-term predictor of higher adult blood pressure in a community sample followed from age 17 to 31. Romantic intensity in adolescence--measured via quantity of time spent alone with a partner and duration of the relationship--was predicted by parents' psychologically controlling behavior, and was in turn found to predict higher resting adult systolic and diastolic blood pressure even after accounting for relevant covariates. The prediction to adult blood pressure was partially mediated via conflict in non-romantic adult friendships and intensity in adult romantic relationships. Even after accounting for these mediators, however, a direct path from adolescent romantic intensity to higher adult blood pressure remained. Neither family income in adolescence nor trait measures of personality assessed in adulthood accounted for these findings. Results are interpreted both as providing further support for the view that adolescent social relationship qualities have substantial long-term implications for adult health, as well as suggesting a potential physiological mechanism by which adolescent relationships may be linked to adult health outcomes.

Physiological Indicators of Acute and Chronic Stress in Securely and Insecurely Attached Dogs Undergoing a Strange Situation Procedure (SSP): Preliminary Results

Simple Summary

The attachment bond that dogs form towards their owners shares similar features with the bond children form towards their caregivers. Insecurely attached children struggle to find support from their caregivers and therefore to regulate their own emotional response in times of distress. We aimed to investigate whether the quality of dog attachment to the owner may affect their physiological response to stress. We selected ten insecure and ten secure dogs from a sample of individuals who underwent a Strange Situation Procedure (SSP) to assess their attachment pattern towards the owner. The SSP is specifically designed to progressively generate stress. We collected saliva samples before and after the test to measure cortisol concentrations, as an indicator of acute stress, as well as a hair sample to assess chronic stress. We also measured blood pressure, heart rate, respiratory rate and rectal temperature after the completion of the test. The results showed that salivary cortisol concentrations were higher in insecure dogs, particularly after the test. Heart rate also tended to be higher in insecure dogs. No difference in hair cortisol levels were found between secure and insecure dogs. Dogs’ physiological response to acute stress may be affected by the quality of the attachment to the owners.

Abstract

The quality of the attachment bond towards the caregiver may affect the dog’s physiological responses to stressful stimuli. This study aimed to measure chronic and acute physiological parameters of stress in ten securely and ten insecurely attached dogs. The twenty experimental subjects were selected from a sample of dogs that participated with their owners in the Strange Situation Procedure. Saliva samples were collected before (T0) and after (T1) the test. Blood pressure, heart rate, respiratory rate, and rectal temperature were measured after the test, only. At this time, a hair sample was also collected. RM ANOVA was used to analyse cortisol concentrations between secure and insecure dogs at T0 and T1. Mann–Whitney U test or T test were used for other physiological parameters. Insecure dogs had significant higher salivary cortisol concentrations than secure dogs at T1 (p = 0.024), but only a non-significant trend towards higher cortisol concentrations at T0 (p = 0.099). Post-test heart rate also tended to be higher in insecure compared to secure dogs (p = 0.077). No significant differences in hair cortisol concentration were found. The quality of attachment may affect the dog’s physiological response to acute stress, at least when related to separation from the caregiver. The effect of attachment on chronic stress requires further investigation.

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

Recent research suggests an impact of psychological distress on postoperative outcomes in orthopedic and neurosurgery. It is widely unknown whether patients' mood might affect the postoperative outcome and complication rate in colorectal surgery. Over a period of 22 months, a monocentric, observational study among patients undergoing elective colorectal surgery without the creation of an ostomy was conducted. Patients were asked to fill in a standardized multi-dimensional mood questionnaire (MDMQ) preoperatively as well as on the third, sixth, and ninth postoperative days to assess mood, wakefulness, and arousal. The results of 80 patients (51% male, mean age 59 years) were analyzed. Almost half of the patients (58%) developed postoperative complications according to the Clavien-Dindo classification (Grade I 14%, Grade II 30%, Grade III 9%, Grade IV 3%). Patients' mood increased continually from the preoperative day to the ninth postoperative day. Patients' wakefulness decreased initially (pre- to third postoperative day) and increased again in the further course. Patients' arousal decreased pre- to postoperatively. Neither preoperative mood, nor arousal or wakefulness of patients showed a clear association with the development of postoperative complications. In conclusion, preoperative psychological distress measured by MDMQ did not affect the postoperative complication rate of patients undergoing elective colorectal surgery.

[Attachment-Related Affect Regulation of Mothers in a Psychiatric Parent-Child Ward - A Case Study]

Attachment researchers propose that the term affect regulation is associated with attachment-related defensive processes resulting from attachment experiences with primary caregivers. They serve to regulate attachment-related inner states. The Adult Attachment Projective Picture System (AAP) is a reliable and valid tool to classify attachment patterns and it allows to assess these attachment-related defensive processes. It provides information about the defensive processes that help clinicians to understand complex symptoms and interaction patterns in the parent-child relationship that can be integrated into psychiatric treatment. The present case study deals with a mother of a child with a feeding disorder. We will illustrate how information on attachment-related affect regulation can successfully be integrated into psychotherapeutic intervention in a psychiatric parent-child ward.

The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study

Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p < 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.

Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants

During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.

Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients

OBJECTIVE

Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.

METHODS

Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.

RESULTS

Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios.

CONCLUSION

Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.

[Attachment Based Short Intervention During Inpatient Treatment of Adolescents]

Attachment Based Short Intervention During Inpatient Treatment of Adolescents In clinical attachment research the established and economic Adult Attachment Projective Picture System (AAP) has been increasingly used in the past few years to assess the attachment representations in adults and recent studies demonstrated sufficient validity for assessing attachment representations in adolescents. Apart from coding attachment classifications, the AAP provides useful and clinically valid information concerning attachment related defences, aspects of capacity to act and synchrony in relationships and emotion regulation strategies with respect to attachment related traumatic experiences. These valuable aspects with respect to individual resources led to the conceptualization to implement the AAP in the therapeutic setting as a feedback tool. In this pilot case we report on an adolescent patient in an inpatient setting. The therapist received an individualized feedback on the patients' AAP to focus on specific attachment related themes used as a short intervention respective an add-on treatment. This paper presents the first results of this new approach by demonstrating the potential therapeutic effects and process of therapy.