The relation of dissociation and mind wandering to unresolved/disorganized attachment: an experience sampling study

Individuals with unresolved/disorganized representations of childhood trauma (U/d attachment) report more psychological distress than others, but little is known about their everyday mentation. In the present study adults with childhood trauma (N = 45) completed the Berkeley-Leiden Adult Attachment Questionnaire-Unresolved (BLAAQ-U) and the Adult Attachment Interview (AAI), and reported everyday mentation during 5 days of experience sampling. The BLAAQ-U and the AAI showed a medium association with each other, but only the former significantly predicted negative affect, dissociation, and low control/awareness of mentation. Contrary to our predictions, U/d attachment did not significantly predict mind wandering, but the BLAAQ-U predicted endorsements of a negative mind wandering style. U/d attachment, as assessed by both instruments, was associated with the Poor attentional control style and beliefs in anomalous mental phenomena. Experience sampling is a valuable way to investigate everyday experiences in individuals with U/d attachment.     

Stress buffering after physical activity engagement: An experience sampling study

Objectives

While encountering daily hassles is a normative experience, it poses a threat to individuals' daily affective well-being. However, physical activity engagement may help to reduce the current stress-related impact on affective well-being (i.e. stress buffering), which we investigate in this study. Furthermore, we examined the possible moderating role of people's global stress context (i.e. exposure to major life events and chronic stress) on this within-person stress-buffering effect.

Design

We approached these ideas using six-times-a-day experience sampling assessments over a period of 22 days.

Methods

Drawing on a broad national sample of 156 middle-aged adults from the EE-SOEP-IS study, we aimed to elucidate the naturally occurring within-person dynamics of current stress, physical activity engagement, and momentary affect within individuals' everyday lives. Major life events and chronic stress were measured as between-person variables.

Results

Multilevel analyses revealed significant within-person associations of current stress and physical activity engagement with momentary affect. Stress-related negative affect was lower when individuals engaged in physical activity, in accordance with the idea of a within-person stress-buffering effect of physical activity engagement. For individuals exposed to more severe major life events, the stress-buffering effect of physical activity engagement for negative affect was lower. Chronic stress did not moderate the within-person stress-buffering effect.

Conclusions

Overall, results add to the existing literature that links physical activity to increased stress resilience and emphasizes the need for taking the global between-person stress context into account.     

Autonomic correlates of attachment insecurity in a sample of women with eating disorders

The aim of this study was to develop a multiple-level-of-analysis model of preschool attachment security and to determine the processes (direct and indirect) whereby factors from different domains (e.g., stress and parenting) are related to attachment during this period. This study examined the direct and indirect effects of stress, family conflict, caregiver depression symptoms, and parenting on attachment security in a large (N = 796) and diverse sample of 4-year-olds. This study used the 3-Boxes Task to assess aspects of parenting critical to sensitivity in the preschool period, labeling this construct sensitivity/scaffolding. Parent-report questionnaires were used to assess stress, conflict, caregiver depressive symptoms, parent support/engagement, and parent hostility/coercion. Direct observation (3-Boxes Task) was used to assess sensitivity/scaffolding and attachment (Attachment Q-Sort) based on a 2½–3 hour home visit. Results of structural equation modeling indicated a good overall fit for the model. Among the parenting variables, sensitivity/scaffolding had the strongest effect on attachment. Depressive symptoms had both direct and indirect effects (mediated by parenting). The effects of stress and family conflict were mediated by caregiver depression symptoms and parenting. These data show that a developmentally appropriate measure of sensitivity plays a significant role in attachment security in preschoolers. Thus, strategies designed to enhance sensitivity/scaffolding may increase child resilience by enhancing attachment security.     

Exhaustion and endocrine functioning in clinical burnout: an in-depth study using the experience sampling method

The current study investigates the relationship between HPA-axis functioning and burnout symptoms by employing an electronic symptom diary. This diary method circumvents the retrospection bias induced by symptom questionnaires and allows to study relationships within-in addition to between-subjects. Forty two clinically burned-out participants completed the exhaustion subscale of the Maslach burnout inventory and kept an electronic diary for 2 weeks to assess momentary exhaustion and daily recovery through sleep. On 3 consecutive weekdays within the diary period, saliva was sampled to determine the cortisol awakening response (CAR), levels of dehydroepiandrosterone-sulphate (DHEAS) on the first 2 weekdays, and to conduct the dexamethasone suppression test (DST) on the third weekday. We found significant relationships between endocrine values and general momentary symptom severity as assessed with the diary, but not with the retrospective questionnaire-assessed burnout symptoms. Simultaneous assessments of endocrine values and burnout symptoms assessed with the diary after awakening rendered significant associations between persons, and a trend within persons. More severe burnout symptoms were consistently associated with a lower level and smaller increase of CAR, higher DHEAS levels, smaller cortisol/DHEAS ratios and a stronger suppression after DST. Burnout symptoms were significantly related to endocrine functioning in clinical burnout under the best possible conditions of symptom measurement. This adds support to the view that severity of burnout symptoms is associated with HPA-axis functioning.     

Physical activity,sleep and affective wellbeing on the following day: An experience sampling study

This study aims to investigate the temporal links between physical activity, sleep and affective wellbeing in young adults. In particular, the aim was to examine whether physical activity is associated with sleep indicators in subsequent nights and, in turn, whether sleep was associated with improved affective wellbeing the next morning. Relatedly, moderation by baseline levels of depressive symptoms, sleep quality, habitual physical activity and gender was analysed. One-hundred and forty-seven individuals (85.7% female) aged 18–25 years old participated in an experience sampling study over 14 consecutive days. Participants received seven prompts per day, and answered questions about their physical activity and affective states. Every morning, participants also reported their sleep. Physical activity throughout the day was not related to sleep during the following night or to affective wellbeing the next morning. An exception to that pattern was that physical activity before 14:00 hours was associated with longer subsequent sleep duration. Better subjective sleep quality predicted affective wellbeing the next morning. Associations of physical activity, sleep and affective wellbeing were not moderated by baseline depressive symptoms, sleep quality or habitual physical activity. However, investigation of gender as a moderator revealed that moderate physical activity was associated with better subsequent sleep quality for males, but not for females. Overall, we found that physical activity is associated with better subsequent sleep for males, but not for females. Also, our study provides further evidence that better sleep quality is associated with the next morning's affective wellbeing.     

Attachment mental states and inferred pathways of development in borderline personality disorder: a study using the Adult Attachment Interview

We report the outcome of an investigation on how specific attachment states of mind and corresponding risk factors related to different DSM Axis I comorbidities in subjects with BPD. Mental representations of attachment in four BPD sub-groups (BPD and Anxiety/Mood Disorders, BPD and Substance Use and Abuse Disorders, BPD and Alcohol Use and Abuse Disorders, and BPD and Eating Disorders) were assessed in 140 BPD subjects using the Adult Attachment Interview (AAI). In addition to the global attachment picture in which Insecure organized (Dismissing 51% and Enmeshed 35%) and Insecure disorganized categories (40%) were overrepresented, significant differences in attachment category were found between the four BPD sub-groups. Axis I comorbidities corresponded with attachment features on the internalizing/externalizing functioning dimension of the disorder. Furthermore, specific constellations of inferred developmental antecedents and attachment states of mind corresponded differentially with the BPD sub-groups. Implications for developmental research and clinical nosology are discussed.     

Developing a secure-enough base: teaching psychotherapists in training the relationship between attachment theory and clinical work

I present an account of a post–graduate training module I have developed for psychotherapy training students at The Centre for Attachment-based Psychoanalytic Psychotherapy entitled From Attachment Theory to Clinical Practice. I situate my interest in this work in my own life and my background in education. In describing the curriculum content, I focus in particular on an educational process that enables students to engage with the concepts from attachment theory which are both relevant to their own lives and their future work as psychotherapists. I show how the findings of the Adult Attachment Interview can be understood more deeply through a project the students are asked to present and evaluate. The article also includes some personal reflections on my experience of attachment research training from a clinician's perspective as a way to think about the divide between these two worlds. I conclude with a consideration of the strengths and limitations of attachment theory to understanding the effects of inequalities of power relations on the formation of intimate bonds.     

Longitudinal associations between attachment quality in infancy,C-reactive protein in early childhood,and BMI in middle childhood: preliminary evidence from a CPS-referred sample

ABSTRACT

In the current pilot study, we examined whether insecure or disorganized attachment was associated with elevated inflammation (i.e. C-reactive protein [CRP]) in children with histories of child protective services (CPS) involvement, and whether early childhood CRP predicted body mass index (BMI) in middle childhood. Participants included 45 CPS-referred children and 39 low-risk comparison children, for whom we assessed levels of CRP in early childhood (Mean age = 4.9 years). For the CPS-referred children, who were drawn from an ongoing longitudinal study, we had attachment classifications (assessed during infancy with the Strange Situation) and BMI data (assessed during early and middle childhood); these data were not available for the low-risk comparison group. CPS-referred children who had insecure or disorganized attachments during infancy had higher levels of CRP in early childhood than CPS-referred children who had secure attachments, who had similar levels of CRP to low-risk comparison children. Among CPS-referred children, early childhood CRP predicted age 8 BMI, controlling for BMI at age 4. Findings offer preliminary support for the association between attachment quality and inflammation in early childhood, which may have implications for later physical health.     

Continuity,discontinuity, and coherence in attachment from infancy to late adolescence: Sequelae of organization and disorganization

This longitudinal study examines continuity and discontinuity of attachment quality from infancy to late adolescence in a sample of 125 participants considered at birth to be at high-risk due to poverty. Strange Situations were conducted at 12 and 18 months; Adult Attachment Interviews were administered at age 19. Child and maternal characteristics and experiences and observational assessments of the families were explored as correlates of continuity and discontinuity in attachment. Contrary to findings of continuity from low-risk samples, analyses demonstrated no significant overall continuity in attachment security. Disorganized infants were significantly more likely than organized infants to be insecure or unresolved in late adolescence. Additionally, infant disorganization predicted unresolved abuse scores on the AAI for those participants who experienced childhood abuse. Significant correlates of continuity and change spanned a variety of age periods and included infant temperament, maternal life stress, family functioning at pre-adolescence, child maltreatment and features of the home environment. Findings are discussed as supporting the coherence of attachment over time.     

Continuity and discontinuity of attachment patterns: A short-term longitudinal pilot study using a sample of late-adopted children and their adoptive mothers

This study analysed the attachment patterns of 28 late-adopted children (placed when they were between four and seven years of age) and their adoptive mothers. The change in the children's internal working models (IWMs) within seven to eight months of their placement was evaluated. In addition, we wanted to observe the influence of a secure-autonomous maternal state of mind in facilitating the change in the children's IWMs and the possible associations between the maternal IWMs and the children's IWMs in the adoptive dyads. The separation-reunion procedure (SRP) was used for the late-adopted children in order to assess their attachment behavioural patterns, and the Manchester Child Attachment Story Task (MCAST) was used to evaluate their attachment narrative patterns. The adoptive mothers completed the Adult Attachment Interview (AAI) in order to classify their state of mind with regard to attachment. The results showed a significant change in the attachment behavioural patterns of late-adopted children, from insecure to secure (p = .002). Furthermore, the children who presented this change were predominantly placed with secure-autonomous adoptive mothers (p = .047), although the link between the adoptive mothers' representations of their attachment history and their adopted children's completed narratives was not significant. In conclusion, it seems possible to revise the attachment behaviour of late-adopted children but, for about one-third of children, the adverse history will persist at a narrative/representational level.     

Challenges for CNV interpretation in clinical molecular karyotyping: Lessons learned from a 1001 sample experience

Molecular karyotyping has moved from bench to bedside for the genetic screening of patients with mental retardation and/or congenital anomalies. The commercial availability of high-resolution microarray platforms has significantly facilitated this process. However, the notion that copy number variants are also abundantly present in the general population challenges the interpretation of the clinical significance of detected copy number variants (CNVs) in these patients. Moreover, the awareness of incomplete penetrance and variable expression, exemplified by the inheritance of causal CNVs from apparently unaffected parents, has further blurred the boundary between benign and pathogenic variation. We analyzed 1001 patients using a large insert clone array (298 patients) and an oligonucleotide-based (703 patients) platform. In this cohort we encountered several examples of causal imbalances that could have been easily interpreted as benign variants when relying on established paradigms. Based on our experience and the pitfalls we encountered, we suggest a decision tree that can be used as a guideline in clinical diagnostics. Using this workflow, we detected 106 clinically significant CNVs in 100 patients, giving a diagnostic yield of at least 10%. Of these imbalances, 58 occurred de novo, 22 were inherited and 26 of unknown inheritance. This underscores that inherited CNVs should not be automatically disregarded as benign variants. Among the clinically relevant CNVs were 11 single-gene aberrations, highlighting the power of high-resolution molecular karyotyping to identify causal genes.     

Mental representations of attachment in Eating Disorders: a pilot study using the Adult Attachment Interview

Mental representations of attachment in a sample of adults with Eating Disorders (ED) were assessed using the Adult Attachment Interview (AAI). Sixty subjects participated in the study: 30 non-clinical and 30 clinical. The results obtained showed a specific distribution of attachment patterns in the clinical sample: 10% Free/Autonomous (F), 47% Insecure-Dismissing (Ds), 17% Insecure-Entangled/Preoccupied (E) and about 26% disorganized (CC/U). The two samples differed in their attachment pattern distribution and were significantly different on some coding system scales. Further information was obtained by analyzing differences between the three ED subtypes considered (i.e. Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder) and by investigating the differential role of the two parental figures in the definition of attachment representations. Results showed potential benefits in using the AAI coding system scales in addition to the main classifications in order to understand better the developmental issues involved in these disorders. Implications for developmental research and clinical nosology are discussed.     

Community participation in a low-income neighborhood: The salience of sociodemographic characteristics,perceptions and experience of violence,and neighborhood attachment

While community participation may serve as a vehicle to improve health and socioeconomic outcomes for residents in poor communities, little research exists on the individual factors that influence community participation, particularly in contexts where violence is exceptionally high. This study examined the relationship between sociodemographic characteristics, perceptions, and experiences of violence, neighborhood attachment, and community participation in a low-income, under-resourced neighborhood in Johannesburg South Africa. The study used baseline data from 300 randomly selected households and multiple linear regression to assess the relationship between individual factors and community participation. The results suggest a high level of community participation, with religious organizational membership the most common. Being female, employed, and fear of violent crime were positively associated with community participation. Future research should include mixed methods and transdisciplinary research approaches for building our understandings of social justice and transformation-oriented community participation.     

The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well-being of the supervisee has yet to be fully examined. In this cross-sectional observational study, the Experiences in Close Relationships-Revised (ECR-RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC-13) were analysed for 346 (81.8% female) health professionals. Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (β = −.31) but positively predicted sense of coherence (β = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence. The results underline the importance of the supervisory relationship for the well-being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.     

Improving sensitivity of cervical cytology by removal of cervical secretions before sampling: a prospective study in Mexico

Sensitivity of cervical cytology is suboptimal, especially in developing countries such as Mexico, despite available guidelines aimed at improving this. When obtaining cervical samples, whether the samples are taken from the transformation zone and whether abnormal cells are missing must be considered. Cervical secretions (CS) are always present in variable proportions, and when cleaning the cervix, better samples may be obtained. In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods. Methods: Of 500 patients who underwent cytology and colposcopy, 271 (54.2%) required a second opinion due to a diagnosis of cervical intraepithelial neoplasia (CIN). CS was removed and compared with the clean, second sample (SS) using in both liquid-based cytology. The quality of samples according to the Bethesda System, the presence of CIN, and inflammatory reactions were recorded. The sensitivity and specificity were calculated using biopsy as the gold standard. Results: The SS resulted in a higher proportion of adequate samples being obtained (97.6% vs. 44.8%), and in increased sensitivity (88.2% vs. 58.8%). CIN was detected in the SS 26% more often than in the CS (34 vs. 27 samples), whereas inflammatory reactions were noted more often in the CS (91.4% vs. 74%). Conclusion: Cervical sampling including CS results in lower sensitivity and CIN detection rates, and in more inflammatory reactions. By excluding CS from cervical samples, the sensitivity could be improved and the false negative rate could be reduced.     

An investigation into the relationship between attachment,gender and recovery from psychosis in a stable community‐based sample

The current study sought to investigate how men and women who experience psychosis represent early bonding experiences, current attachment style and the recovery style adopted. Seventy‐three participants (18 women and 55 men) with a diagnosis of psychosis completed the Parental Bonding Instrument, the Attachment Style Questionnaire and the Recovery Style Questionnaire. Differences were observed between men and women in relation to the nature of insecure attachment styles demonstrated. Significant associations were found between perceptions of parents as uncaring and insecurity in adult attachment style. A greater number of significant associations were found between recollections of early bonding and attachment styles amongst women than men. Men and women did not differ significantly in terms of the recovery style adopted, nor were significant differences found in relation to perceptions of early bonding experiences. Methodological and theoretical issues were considered and directions for future research were suggested. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Individuals with psychosis are more likely to have lower levels of parental care than the general population.
• This lower parental care is likely to be associated with insecure adult attachment relationships but not recovery style.