COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum

BACKGROUND

The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase.

METHODS

Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4.

RESULTS

Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12).

DISCUSSION

The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.

The Perks of Pet Ownership? The Effects of Pet Ownership on Well-Being During the COVID-19 Pandemic

Pet ownership has often been lauded as a protective factor for well-being, particularly during the COVID-19 pandemic. We expanded this question to consider how pet (i.e., species, number) and owner (i.e., pet relationship quality, personality, attachment orientations) characteristics affected the association between pet ownership and well-being in a pre-registered mixed method analysis of 767 people assessed three times in May 2020. In our qualitative analyses, pet owners listed both benefits and costs of pet ownership during the COVID-19 pandemic. In our quantitative analyses, we found that pet ownership was not reliably associated with well-being. Furthermore, this association largely did not depend on the number of pets owned, the species of pet(s) owned, the quality of the human-pet relationship, or the owner's psychological characteristics. Our findings are consistent with a large body of research showing null associations of pet ownership on well-being (quantitatively) but positive reports of pet ownership (qualitatively).

"Picking up the pieces": Patients' retrospective reflections of rupture resolution episodes during treatment

Objective: Although theorists and researchers have stressed the importance of rupture resolution episodes for successful treatment process and outcome, little is known about patients' retrospective reflections about rupture resolution. Aim: The overarching goal of the present study was to use a mixed-method approach to examine patients' retrospective reflections on the frequency, types, and consequences of rupture resolution episodes and the association between rupture resolution episodes and patients' attachment orientation and treatment outcome. Method: Thirty-eight patients diagnosed with major depressive disorder (MDD) were interviewed, on average three years after termination, about their experiences of ruptures in short-term dynamic psychotherapy. Results: Thirty patients reported having experienced at least one rupture, with patients who showed less improvement in depressive symptoms more likely to report having had a rupture. Ruptures were judged as having been successfully resolved for 13 of these patients; suggesting that patients with a high level of attachment anxiety were less likely to be judged as having had a successful resolution. Patients whose ruptures were successfully resolved with the therapist's help reported better treatment process and outcome than patients whose ruptures were not successfully resolved. Conclusion: Results highlight the importance of hearing patients' perspectives on ruptures, rupture resolution, and treatment outcome.

The Study of Security Priming on Avoidant Attentional Biases: Combining Microsaccadic Eye-Movement Measurement With a Dot-Probe Task

Microsaccades are small fixational eye movements that have shown to index covert attentional shifts. The present experiment combined microsaccades with performance measures from a dot-probe task to study influences of attachment security priming on the attentional biases of individuals high in attachment avoidance. Security priming is an experimental manipulation aimed at boosting felt security. Using a randomized, mixed design, we measured differences in attentional vigilance toward angry and neutral faces as a function of priming (neutral vs. secure) and attachment avoidance. Individuals high in avoidance habitually tend to withdraw from, or otherwise dismiss, emotionally salient stimuli. Here, we operationalized attentional withdrawal based on both task performance in the dot-probe task and microsaccadic movements. In addition, unlike previous studies where priming salience for the individual participant has been unclear, we used a standardized narrative method for attachment script assessment, securing an indication of how strongly each participant was primed. Dot-probe data significantly captured the link between avoidance and attentional disengagement, though from all facial stimuli (angry and neutral). Although microsaccadic movements did not capture avoidant attentional disengagement, they positively correlated to dot-probe data suggesting measurement convergence. Avoidance was associated with weaker security priming and no overall effect of priming on attention was found, indicating a need for further exploration of suitable priming methods to bypass avoidant deactivation. Our results provide a first indication that, as an implicit looking measure, microsaccadic movements can potentially reveal where early attention is directed at the exact moment of stimulus presentation.

Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes

We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).

The role of the working alliance in psychological treatment of substance use disorder outpatients

Objective: The main objective of this study was to explore the relationship between alliance and treatment outcome of substance use disorder (SUD) outpatients in routine care. Attachment, type of substance use, and treatment orientation were analyzed as potential moderators of this relationship.Method: Ninety-nine SUD outpatients rated their psychological distress before every session. Patients and therapists rated the alliance after every session. At treatment start and end, the patient completed the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test (DUDIT), and the Experiences in Close Relationships (ECR-S). Data were analyzed using multilevel growth curve modeling and Dynamic Structural Equation Modeling (DSEM).Results: The associations between alliance and outcome on psychological distress and substance use were, on average, weak. Within-patient associations between patient-rated alliance and outcome were moderated by self-rated attachment. Type of abuse moderated associations between therapist-rated alliance and psychological distress. No moderating effect was found for treatment orientation.Conclusions: Patients' attachment style and type of abuse may have influenced the association between alliance and problem reduction. A larger sample size is needed to confirm these findings.

The moderation of attachment in the association between depressive symptoms and self-harm among a clinical sample

BACKGROUND

Self-harm is a severe health problem worldwide and in particular in clinical settings. The association of depression and self-harm has been extensively studied alongside various variables that have been examined as moderating this association. However, no previous study has examined the moderating role of attachment in this association.

AIM

We explored the role of attachment orientation in moderating the association between depressive symptoms and self-harm among a sample of patients in a community mental health clinic.

METHOD

This study was a de-identified archival study of patients' medical charts, and used a convenience sample of 199 patients, which completed self-report measures following the initial intake appointment as part of clinic procedures.

RESULTS

Findings showed that both attachment anxiety and avoidance moderated the association between depressive symptoms and self-harm, such that depressive symptoms were positively associated with self-harm only when attachment anxiety scores were high, and attachment avoidance scores were high or average.

CONCLUSIONS

Attachment anxiety and avoidance should be assessed in the initial intake of patients as it has a contribution to understanding self-harm vulnerability among new patients. Future studies should explore this moderation longitudinally so causality could be inferred.

What's interpersonal in interpersonal perception? The role of target's attachment in the accuracy of perception

OBJECTIVE

We examined the influence of attachment orientation on the accuracy of perception of negative affect in close relationships. We hypothesized that tracking accuracy of perceiving negative affect (a) would be lower among perceivers and targets with higher attachment avoidance and (b) would be lowest when both the target and perceiver were high on attachment avoidance. Tracking accuracy would be (c) higher among perceivers and targets with higher attachment anxiety and (d) highest when both the target and perceiver were high on attachment anxiety.

METHOD

We collected data from 92 couples who reported their negative affect and perception of their partner's negative affect in interactions with each other on 20 days.

RESULTS

Results supported the hypotheses for attachment avoidance and tracking accuracy. Tracking accuracy of perceived negative affect was low when the target was high on attachment avoidance; accuracy was lowest when both the target and the perceiver were high on attachment avoidance.

CONCLUSIONS

Lower "readability" of high avoidantly attached targets' emotions may inhibit intimacy and sensitive responding, which thereby may contribute to poor relationship outcomes.

Attachment and alliance in the treatment of depressed, sexually abused women

BACKGROUND

Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women's difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse.

METHOD

Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual.

RESULTS

Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group.

CONCLUSION

Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve the treatments for depressed women with a history of childhood sexual abuse.