Enduring Bonds: Duration and Contact in Close Relationships in Late Life

BACKGROUND AND OBJECTIVES

Older adults maintain ties to long-duration social partners, some with whom have regular contact and some with whom have little contact. We asked whether these ties with little contact still offer a sense of connection and security, and buffer the effects of interpersonal stress in daily life. Helping older adults foster these ties may improve their mental health.

RESEARCH DESIGN AND METHODS

Participants (n = 313) aged 65+ completed a baseline interview reporting duration and contact frequency of their closest ties. Then, participants completed ecological momentary assessments every 3 hr for 5-6 days, reporting their social encounters and mood.

RESULTS

We classified ties according to duration (10+ years = long vs shorter duration) and frequency of contact (at least once a month = active vs dormant). Throughout the day, participants were more likely to have stressful encounters with long-duration active ties. Encounters with active ties were associated with more positive mood (regardless of duration) and encounters with long-duration dormant ties with more negative mood. Having more active ties buffered effects of interpersonal stress on mood, but more long-duration dormant ties exacerbated these effects.

DISCUSSION AND IMPLICATIONS

Supporting social integration theory, ties with frequent contact were associated with positive mood. Surprisingly, long-duration ties with infrequent contact exacerbated effects of interpersonal stress on mood. Older adults who lack contact with long-duration social partners may be more sensitive to interpersonal stress. Future interventions might focus on phone or electronic media to increase contact with long-duration social partners.

Attachment Theory and Sexual Offending: Making the Connection

PURPOSE OF REVIEW

The purpose of this review is to discuss how attachment theory can be applied to explain sexual violence. Specifically, it discusses how the development of certain risk factors contributes to these behaviors and how attachment-based models can be used to address this issue through prevention and therapeutic interventions.

RECENT FINDINGS

Recent research demonstrates that individuals who commit sexual offenses have higher rates of insecure attachment styles and that these styles are associated with a number of criminogenic risk factors associated with sexual offending. Such risk factors include cognitive processing difficulties, affect dysregulation, and challenges in interpersonal relationships, among others. Fortunately, treatment interventions have been shown to foster more secure attachment styles and reduce these risk factors. Attachment theory is a viable theory to both understand and intervene with those who have committed sexual violence to reduce the risk factors associated with sexual violence.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships

BACKGROUND

Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives.

METHODS

Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis.

RESULTS

Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation.

CONCLUSIONS

We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

The Attachment Mapping Protocol (AMP): An Assessment and Treatment Tool for General Psychotherapy, Systemic Family Therapy and Multifaith Spiritual Care

This paper introduces the Attachment Mapping Protocol (AMP), which is an assessment and treatment tool for use in individual psychotherapy, systemic family therapy and multifaith spiritual care, using a bio-psycho-social-spiritual model of care. Attachment theory has a long and significant history in psychology, with an evolving relationship within the above clinical domains. A central aim of this paper will be to recognize and affirm the extension of attachment theory beyond the traditional parameters of nascent parental, guardianship bonds and individual, developmental psychology, to reveal a much broader spectrum of valid attachment considerations for mental health and spiritual well-being. A case study will be applied to the interviewing instrument to demonstrate its utility for broadening assessment beyond attachment figures to include surrogate attachments of other persons, places and things. A model of spiritual discernment derived from the Spiritual Exercises of Ignatius of Loyola will undergird this larger worldview of attachment considerations.

An exploration of the role played by attachment factors in the formation of social media addiction from a cognition-affect-conation perspective

More and more users are overusing social media and the situation is getting worse, yet there is still a lack of research on social media addiction. Based on attachment theory and the Cognition-Affect-Conation (CAC) framework, this study combines the perception of intrinsic motivation and the technical features of social media as extrinsic motivators and explores the formative factors in social media addiction. The results show that social media addiction is determined by an individual's emotional and functional attachment to the platform, and that attachment is in turn influenced by intrinsic motivation (perceived enjoyment and perceived relatedness) and extrinsic motivation (functional support and information quality). The SEM-PLS technique was used to analyze the data collected from a questionnaire survey of 562 WeChat users. The results showed that social media addiction is determined by an individual's emotional and functional attachment to the platform. This attachment is, in turn, influenced by intrinsic motivation (perceived enjoyment and perceived relatedness) and extrinsic motivation (functional support and informational quality). The study first explains the latent antecedents of social media addiction. Second, it examines user attachment, particularly the role of emotional and functional attachment, and explores the platform technology system, which plays a key role in the development of addiction. Third, it extends attachment theory to the study of social media addiction.

Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments

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.

Attachment orientation and depression: A moderated mediation model of self-silencing and gender differences

BACKGROUND

While the effect of insecure attachment on depression is well established, findings pertaining to the relationship between specific attachment dimensions (anxious and avoidant) and depression are inconsistent. The role of interpersonal factors underlying this effect has been little explored. 'Silencing the Self', a socio-cognitive construct may provide important insights as a mediating pathway from insecure attachment to depression and help resolve the inconsistencies.

AIMS

The present study explored the mediating effect of self-silencing and the role of gender as a moderator in the relation between insecure attachment orientation (i.e. avoidant and anxious) and depressive symptoms.

METHOD

Data was collected via an online survey, from 121 adults who were in a relationship. The participants were asked to complete three self-report questionnaires, assessing attachment orientation, silencing the self and depressive symptoms. Moderated mediation analysis was performed using conditional process analysis.

RESULTS

The results indicated that the effect of both insecure attachment dimensions on depressive symptoms was mediated by silencing the self. In addition, gender moderated the association between insecure attachment and self-silencing.

CONCLUSIONS

This study adds to the literature on mediating pathways between insecure attachment and depression, and provides a new perspective for therapeutic interventions in the context of depression. It indicates that professionals should focus on current social context and relational schemas of individuals with an insecure attachment, especially women, while treating cases of depression in clinical settings.

A "transmission gap" between research and practice? A Q-methodology study of perceptions of the application of attachment theory among clinicians working with children and among attachment researchers

Clinical practitioners are frequently encouraged, through literature, training, and policy, to learn, understand, refer to and use their knowledge of attachment theory and research when working to meet the needs of children and families. However, there has been very little empirical study of how practitioners understand and perceive the relevance of attachment concepts and methods. Q-methodology was used to examine the perceptions of attachment knowledge and its applications for practice among 30 UK clinicians working with children and an international group of 31 attachment researchers. Factor analysis revealed three perspectives, described as: i) pragmatic, developmental, and uncertain, ii) academic, and iii) autodidactic and therapeutic. Participants agreed on core tenants of theory, their aspirations for clinical practice and the inaccessibility of current assessment measures for practitioners. Yet they diverged on their understandings of attachment insecurity, disorganisation, and the implications of both for various aspects of child development.

The predictive significance of fluctuations in early maternal sensitivity for secure base script knowledge and relationship effectiveness in adulthood

Attachment theory suggests that both the quality and consistency of early sensitive care should shape an individual's attachment working models and relationship outcomes across the lifespan. To date, most research has focused on the quality of early sensitive caregiving, finding that receiving higher quality care predicts more secure working models and better long-term relationship outcomes than receiving lower quality care. However, it remains unclear whether or how the consistency of early sensitive care impacts attachment working models and adult relationship functioning. In this research, we utilized data from the Minnesota Longitudinal Study of Risk and Adaptation to examine to what extent the quality (i.e., mean levels) and consistency (i.e., within-person fluctuations) in behaviorally coded maternal sensitive care assessed 7 times from 3 months to 13 years prospectively predicts secure base script knowledge and relationship effectiveness (i.e., interpersonal competence in close relationships) in adulthood. We found that larger fluctuations and lower mean levels of early maternal sensitivity jointly predict lower relationship effectiveness in adulthood via lower secure base script knowledge. These findings reveal that nonlinear models of early caregiving experiences more completely account for relationship outcomes across the lifespan, beyond what traditional linear models have documented. Implications for attachment theory and longitudinal methods are discussed.

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Corporate Users' Attachment to Social Networking Sites: Examining the Role of Social Capital and Perceived Benefits

The debate on the pros and cons of employee attachment to social networking sites (SNS) has led to social media policy paralysis in many organizations, and often a prohibition on employee use of SNS. This paper examines corporate users' attachment to SNS. An analysis of 316 survey responses showed that corporate users' socialization in large public SNS was steeped in perceived work-related benefits, which in turn nourished their SNS attachment. Social use outperformed informational use in generating perceived work-related benefits from SNS. Weak ties in large heterogeneous networks resulted in strategic and operational benefits, whereas the effects of strong bonding in homogenous networks were limited to operational benefits. The paper contributes to research on SNS use by corporate users and the debate on the effect of SNS use for work. The findings will benefit SNS strategists of organizations and policymakers to exploit the benefit potential of public SNS.

Longitudinal study of the cascading effects of racial discrimination on parenting and adjustment among African American youth

Attachment theory posits that parenting plays akey role in children's attachment and subsequent development. Given the normativity of racial discrimination on everyday life experiences of African American families, there is a need to integrate historical and socio-environmental processes in studies to understand how minoritized parents raise secure and stable children. Results from the current study revealed direct associations between mothers' reports of discrimination and heightened depression and anxiety. Maternal discriminatory experiences were indirectly associated with more negative parenting and compromised parent-child relationship quality, through mothers' psychological functioning. Elevated emotional and behavioral management problems among youth were directly associated with exposure to racial discrimination. Exposure to discrimination during middle childhood facilitated adapted or learned strategies to manage similar situations as youth transitioned into adolescence, with reduced patterns of depressive symptomology. No significant gender effects emerged. Implications for theoretical advancement and future research are provided.

Understanding developmental psychopathology in Type 1 diabetes through attachment, mentalisation and diabetes distress

This article examines the combined roles of attachment mentalisation and diabetes distress in the psychological development of young people with Type 1 diabetes (T1D). We use these ideas to unify the evidence for psychological variables affecting young people and their families and suggest how diabetes distress and mentalisation might be part of the pathways for development of psychiatric diagnoses.Attachment theory's central hypothesis is that a secure relationship with a care-giver in the early life of a child is essential to normal emotional and relational development, whilst diabetes distress is a well recognised phenomena of burden experienced by both child and parent in relation to the condition.We extend the ideas of attachment, into the psychological adaptation processes for young people at the time of diagnosis of T1D with emphasis on the function of the parent/caregiver in mentalising the experience of the child. We also connect our current understanding of diabetes distress to the associated increased risk for disorders of eating and personality in T1D.Using principles learnt in other areas of psychotherapeutic practice we end by suggesting interventions that could impact mental health and diabetes outcomes using the mentalisation model.

An Attachment Perspective on Favorite Media Figures

Anxiously attached individuals tend to report stronger parasocial relationships with their favorite media figures than people with other attachment orientations. Researchers have suggested that these individuals may be inclined to see their favorite media figures as safe and secure attachment figures. The purpose of the current study was to evaluate this possibility by assessing the qualities of people’s favorite media figures, particularly within a television context. A sample of 200 online participants filled out an attachment measure, reported their favorite television figure, and rated several aspects of the television figure’s personality. It was expected that anxiously attached individuals would be drawn to figures that are high in warmth, emotional stability, and sensitivity. Instead, results showed that these individuals preferred figures with greater anxious and insecure characteristics. These results suggest that anxiously attached individuals may not see their favorite media figures as safe and secure attachment figures as previously theorized. Exploratory analyses failed to show significant effects for the second attachment dimension, attachment avoidance, or for the interaction between anxiety and avoidance.

Containing the Anxieties of Children, Parents and Families from a Distance During the Coronavirus Pandemic

The coronavirus pandemic and the move to teletherapy has created uncertainty among both clinicians and patients. As therapists who work with children, we have heard from parents who are desperate for support and advice about how to respond to their children’s behavioral changes, as well as those who feel too overwhelmed to continue their children’s sessions at the moment and want to take a break from treatment. We have had to rethink the frame in concrete ways, reimagine how to play, and renegotiate parameters around confidentiality. At a time when fear and uncertainty make mentalizing difficult, the hallmarks of a mentalizing approach—curiosity and flexibility—are most critical. This paper will describe how the Mentalization-Based Treatment for Children (MBT-C) model offers a framework for an integrative approach that can inform treatment via teletherapy, so that clinicians can continue supporting young people and their families through this period. We will begin by describing how the mentalizing stance, particularly an awareness of our own mentalizing capacities in the moment, has become more important than ever. Ways in which clinicians maintain their mentalizing in the face of the mentalizing breakdowns will be also discussed. Finally, we illustrate with clinical vignettes how the developmental levels of mentalizing—attention control, emotion regulation, and explicit mentalizing—can inform the structure, techniques and interventions in teletherapy with children and parents.

The psychobiological consequences of child separation at the border: lessons from research on attachment and emotion regulation

In the spring of 2018, the Attorney General of the United States issued a memorandum declaring a "zero tolerance policy" under which all adults entering the United States illegally would be criminally prosecuted, and, if traveling with minor children, forcibly separated from their children. Although the government was ordered to reunite the children with their parents it is still unclear how many children have been or remain separated. Given the high risk of permanent harm to a vulnerable population, and the fact that this risk may continue into the near future, we present a review of what nearly eight decades of scholarly research has taught us about the damaging impact of deprivation and separation from parents. The article briefly reviews the origins of attachment theory as well as empirical studies that examine the psychobiological impact on children who experienced parental deprivation or separation. The paper concludes with recommendations, for future research.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION

Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9.

METHODS

A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development.

RESULTS

The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills.

CONCLUSIONS

Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Understanding the use of attachment theory applied to the patient-provider relationship in cancer care: Recommendations for future research and clinical practice

Patient attachment styles may inform how patients react differently to the stress of being diagnosed with cancer, as well as how patients may desire to interact and be supported by their provider. The objectives of this study were two-fold: 1) to conduct a systematic scoping review to clarify how attachment theory is utilized and applied within the current body of research on the patient-provider relationship within cancer care, and 2) add to the existing body of literature by introducing an integrated model of patient attachment styles and patient-provider relationships for use in clinical and scholarly work. A systematic search of multiple databases including PubMed, Google Scholar, PsychInfo, and WorldCat was conducted using variations and combinations of keywords related to patient-provider relationship, attachment style, and cancer. The nine studies included in the review were published from 2011 to 2019. The majority of studies had participant samples with multiple cancer diagnoses (n = 5) and examined attachment as an independent or predictor variable (n = 6). Results suggest that a secure attachment was predictive of a better working alliance, more perceived support, less general distress, higher levels of trust and satisfaction with healthcare providers when compared to patients with an insecure attachment style. Data from the current review suggest that using an attachment theory framework can improve the understanding of the patient-provider relationship. We propose a conceptual model that aligns patient attachment style and patient-provider relationship types to be utilized in clinical practice in future research to tailor patient-centered cancer care.

Mapping evidence from systematic reviews regarding adult attachment and mental health difficulties: a scoping review

OBJECTIVE

The aim of this scoping review was to map evidence gathered through systematic reviews regarding adult attachment and mental health difficulties. This review highlights established, emerging, and inconsistent findings, suggesting areas for future research, and implications for theory and practice.

METHODS

A systematic search for meta-analyses and systematic reviews measuring adult attachment and concerning mental health difficulties was conducted. In total, 17 studies met the selection criteria.

RESULTS

Findings were presented according to four identified themes, (1) measurement of attachment; (2) measurement of mental health difficulty; (3) intrapersonal processes related to attachment and mental health difficulties; and (4) interpersonal processes related to attachment and mental health difficulties.

CONCLUSIONS

This review highlights the connection between attachment style and mental health difficulties, and suggests that relationships can facilitate both mental health and illheath. However, the mechanisms through which insecure attachment confers risk for mental health difficulties require further research.

Attachment Styles and Employee Performance: The Mediating Role of Burnout

Researchers are becoming increasingly interested in how early experiences within the family are relevant to an individual's behavior at work. Drawing on Bowlby's attachment theory, the present study addresses this topic by examining the relationship between attachment in adulthood and job performance, and the mediating role of burnout in that relationship. We used data from two samples (201 Dutch employees and 178 Romanian working students) and structural equation modeling to test this mediation model and its possible invariance across both samples. The results showed that in both samples, attachment-related anxiety was positively related to burnout, which was in turn negatively related to job performance. Attachment-related avoidance was not significantly associated with burnout or performance. These results were similar in both samples, thus increasing their validity. The results suggest that childhood and early socialization experiences play a role in shaping the employee's behavior and well-being at work. The study is one of the few examining attachment styles in relation to burnout and performance.

Attachment, Mothering and Mental Illness: Mother-Infant Therapy in an Institutional Context

This paper is an ethnographic exploration of how attachment theory underpins therapeutic practices in an Australian institutional context where mothers of infants have been diagnosed and are undergoing treatment for mental illness. We argue that attachment theory in this particular context rests on a series of principles or assumptions: that attachment theory is universally applicable; that attachment is dyadic and gendered; that there is an attachment template formed which can be transferred across generations and shapes future social interactions; that there is understood to be a mental health risk to the infant when attachment is characterised as problematic; and that this risk can be mitigated through the therapeutic practices advocated by the institution. Through an in-depth case study, this paper demonstrates how these assumptions cohere in practice and are used to assess mothering as deficient, to choose therapeutic options, to shape women's behaviour, and to formulate decisions about child placement.

Brain activity underlying negative self- and other-perception in adolescents: The role of attachment-derived self-representations

One of teenagers’ key developmental tasks is to engage in new and meaningful relationships with peers and adults outside the family context. Attachment-derived expectations about the self and others in terms of internal attachment working models have the potential to shape such social reorientation processes critically and thereby influence adolescents’ social-emotional development and social integration. Because the neural underpinnings of this developmental task remain largely unknown, we sought to investigate them by functional magnetic resonance imaging. We asked n = 44 adolescents (ages 12.01–18.84 years) to evaluate positive and negative adjectives regarding either themselves or a close other during an adapted version of the well-established self-other trait-evaluation task. As measures of attachment, we obtained scores reflecting participants’ positive versus negative attachment-derived self- and other-models by means of the Relationship Questionnaire. We controlled for possible confounding factors by also obtaining scores reflecting internalizing/externalizing problems, schizotypy, and borderline symptomatology. Our results revealed that participants with a more negative attachment-derived self-model showed increased brain activity during positive and negative adjective evaluation regarding the self, but decreased brain activity during negative adjective evaluation regarding a close other, in bilateral amygdala/parahippocampus, bilateral anterior temporal pole/anterior superior temporal gyrus, and left dorsolateral prefrontal cortex. These findings suggest that a low positivity of the self-concept characteristic for the attachment anxiety dimension may influence neural information processing, but in opposite directions when it comes to self- versus (close) other-representations. We discuss our results in the framework of attachment theory and regarding their implications especially for adolescent social-emotional development and social integration.

Could we remedy the 'crisis of care' by incorporating mandatory group psychotherapy in nurse education?

This paper suggests a tentative proposal for nurse education that may go some way to remedying the 'crisis of care' described by Judge Francis and others. Any viable strategy to improve caring attitudes in nursing students must involve activities across the curriculum that foster self-awareness and empathy. It is suggested that the best way to do this is for all undergraduate nursing students to participate in regular, supervised group psychotherapy sessions as a mandated requirement for registration. This strategy would be helpful in at least two main ways. First, it would be enormously beneficial in terms of promoting emotional intelligence - a necessary requirement for providing ethical, person-centred care. Second, it would also serve as an excellent form of student support, which would likely improve student retention rates. This is because individuals with strong group support systems are less likely to become mentally or physically ill and are, therefore, more resilient. Finally, some possible objections to this proposal are considered.

Attachment Orientations, Respiratory Sinus Arrhythmia, and Stress Are Important for Understanding the Link Between Childhood Socioeconomic Status and Adult Self-Reported Health

BACKGROUND

Low childhood socioeconomic status (SES) is reliably associated with poor adult health. Social environments early in life and physiological stress responses are theorized to underlie this link; however, the role of attachment orientations is relatively unknown.

PURPOSE

In this study, we examined whether attachment orientations (i.e., attachment anxiety and attachment avoidance) and self-reported stress were mediators of the association between childhood SES and self-reported health in adulthood. Furthermore, we examined whether parasympathetic nervous system functioning was a moderator of associations between attachment orientations and self-reported stress.

METHODS

Participants (N = 213) provided self-reports of childhood SES, attachment orientations, general stress, and self-rated health. Respiratory sinus arrhythmia (RSA) was measured at rest, as well as during an acute social stressor.

RESULTS

Low childhood SES was associated with poor self-reported health via the serial pathway from attachment anxiety to general stress. Moreover, attachment avoidance was associated with self-reported health via general stress, but only among those with high stress-induced RSA. Findings were independent of participant age, sex, race, body mass index, baseline RSA, and adult SES.

CONCLUSIONS

Attachment theory is useful for understanding why those from low SES backgrounds are at greater risk of negative health outcomes in adulthood. Findings extend our knowledge of how interpersonal relationships in childhood can shape emotional and physical health outcomes in adulthood.

Memories of paternal relations are associated with coping and defense mechanisms in breast cancer patients: an observational study

BACKGROUND

Breast cancer diagnosis and treatment represent stressful events that demand emotional adjustment, thus recruiting coping strategies and defense mechanisms. As parental relations were shown to influence emotion regulation patterns and adaptive processes in adulthood, the present study investigated whether they are specifically associated to coping and defense mechanisms in patients with breast cancer.

METHODS

One hundred and ten women hospitalized for breast cancer surgery were administered questionnaires assessing coping with cancer, defense mechanisms, and memories of parental bonding in childhood.

RESULTS

High levels of paternal overprotection were associated with less mature defenses, withdrawal and fantasy and less adaptive coping mechanisms, such as hopelessness/helplessness. Low levels of paternal care were associated with a greater use of repression. No association was found between maternal care, overprotection, coping and defense mechanisms. Immature defenses correlated positively with less adaptive coping styles, while mature defenses were positively associated to a fighting spirit and to fatalism, and inversely related to less adaptive coping styles.

CONCLUSIONS

These data suggest that paternal relations in childhood are associated with emotional, cognitive, and behavioral regulation in adjusting to cancer immediately after surgery. Early experiences of bonding may constitute a relevant index for adaptation to cancer, indicating which patients are at risk and should be considered for psychological interventions.

The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis

Background

A systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives.

Method

An electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies.

Results

From 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences.

Conclusions

Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.

Attachment anxiety is associated with a fear of becoming fat, which is mediated by binge eating

Background

Previous work demonstrated that individuals with higher levels of attachment anxiety are prone to increased binge eating (Alexander & Siegel, 2013). Given that our society rejects obese individuals and individuals with higher levels of attachment anxiety tend to be highly sensitive to rejection (Downey & Feldman, 1996), it follows that those with increased attachment anxiety may be especially fearful of becoming fat.

Methods

Undergraduate psychology students (n = 148) completed surveys measuring attachment, binge eating, and fear of becoming fat.

Results

The data demonstrate that attachment anxiety is positively associated with a fear of becoming fat (β = .30, p < .001) and binge eating mediates this relationship. In other words, binge eating underlies the fear of becoming fat.

Discussion

These findings contribute to a more refined understanding of binge eating which may create pathways for professionals to develop targeted interventions.

Attachment in medical care: A review of the interpersonal model in chronic disease management

Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

Change trajectories of aggressive behavior among children in long-term residential care

This study examined change trajectories of aggressive behaviors among children in long-term residential care in Israel and identified various child-, family-, and placement-related predictors of the change trajectories. Records of 799 children (average age at the beginning of the four years=10.4, 33.1% female) in their first four consecutive years in care were analyzed using the TRF aggressive behavior subscale (Achenbach, 1991) to measure the outcome variable. Children's and parents' characteristics and placement-related factors were used to explain variance in change trajectories. Latent Class Growth Analyses identified four aggressive behavior trajectories: 'stable-low' levels of aggressiveness over time (45% of the children), 'stable-high' levels (13%), 'improvement' (20%), and 'deterioration' (22%). Predictors of less resilient trajectories (i.e., stable-high or increasing aggressiveness) included mothers' difficulties and disabilities, children's attendance of special education classes, more intensive type of care, and non-immigrant status. The Attachment Theory, Life Course Perspective theories, and the General Strain Theory are used to interpret some of the findings of the study. Identifying the factors that predispose children to certain patterns of change may help direct resources to children at risk of having high or increasing levels of aggression while in residential care.

Attachment figures when death is approaching: a study applying attachment theory to adult patients' and family members' experiences during palliative home care

PURPOSE

Attachment theory is currently receiving much attention in relation to how adults cope with severe illness. The study aims were using the experiences of patients and family members to explore attachment figures (a central concept within the theory) during palliative home care.

METHODS

Twelve patients and 14 family members were interviewed during ongoing palliative home care. The interviews were analysed using qualitative content analysis.

RESULTS

Four types of attachment figures were identified: (i) family and friends, (ii) health care practitioners, (iii) pets and (iv) God. Both non-physical and physical contact with the attachment figures facilitated a sense of security. In addition, the patient/family members and their attachment figures were described by some as a "we", and when one part of the "we" felt insecure, this made the other also feel insecure. The patients' unstable and progressing illnesses constituted a threat to the patients' and family members' sense of security. The availability of the attachment figures made them feel secure, and they could then divert their attention from the patients' illnesses to other things in everyday life, e.g. socialising with family and friends. Some family members also had to cope with the loss of their own attachment figure, when the patient, who had previously been a source of security for them, was no longer able to offer protection and comfort due to the progression of the illness.

CONCLUSION

Important aspects of attachment figures in the end-of-life context were identified, and their clinical implications will be discussed.

Does insecure attachment mediate the relationship between trauma and voice-hearing in psychosis?

This study extends existing research and theoretical developments by exploring the potential mediating role of insecure attachment within the relationship between trauma and voice-hearing. Fifty-five voice hearers with a psychosis-related diagnosis completed comprehensive assessments of childhood trauma, adult attachment, voice-related severity and distress, beliefs about voices and relationships with voices. Anxious attachment was significantly associated with the voice-hearing dimensions examined. More sophisticated analysis showed that anxious attachment mediated the relationship between childhood sexual and emotional abuse and voice-related severity and distress, voice-malevolence, voice-omnipotence, voice-resistance and hearer-dependence. Anxious attachment also mediated the relationship between childhood physical neglect and voice-related severity and distress and hearer-dependence. Furthermore, consistent with previous research, the relationship between anxious attachment and voice-related distress was mediated by voice-malevolence, voice-omnipotence and voice-resistance. We propose a model whereby anxious attachment mediates the well-established relationship between trauma and voice-hearing. In turn, negative beliefs about voices may mediate the association between anxious attachment and voice-related distress. Findings presented here highlight the need to assess and formulate the impact of attachment patterns upon the voice-hearing experience in psychosis and the potential to alleviate voice-related distress by fostering secure attachments to therapists or significant others.

Cancer patients' experiences with nature: Normalizing dichotomous realities

AIMS

To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge.

METHODS

Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi-structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis.

RESULTS

Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook.

CONCLUSIONS

New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting.

[Impact of attachment behavior on chronic and somatoform pain]

In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.

An attachment research perspective on ADHD

Since the beginning of clinical attachment research in the mid-1980s the number of research projects in this area has been continuously increasing. The research questions so far can be allocated to numerous medical disciplines such as psychosomatic medicine, adult psychiatry or child and adolescent psychiatry. Recently, children with ADHD and their families have also become subjects of this branch of research. Their specific behavioral characteristics from early childhood on constitute unique challenges on the parent-child interaction. If these interactions develop in a suboptimal way, children may develop an insecure or even a disorganized attachment quality. The latter represents a risk factor for a clinically significant psychopathological development.

This article initially presents basic principles of attachment theory and discusses the relevance of the cardinal symptoms of ADHD for clinical attachment research. Subsequently, it outlines and discusses the main results of existing research regarding attachment and ADHD. It concludes with a perspective on research questions that need to be addressed in the future with regard to a transgenerational model that highlights the importance of parental attachment representations to the development of children’s attachment quality.

How adolescents experience and cope with pain in daily life: a qualitative study on ways to cope and the use of over-the-counter analgesics

OBJECTIVE

The aim of this study was to describe how different adolescents experience and manage pain in their daily life, with a focus on their use of over-the-counter analgesics. More specifically, the aim was to explore different patterns among the adolescents in pain descriptions, in the management of pain, in relationships with others, and in their daily life.

DESIGN

Qualitative semistructured interviews on experiences with pain, pain management and involvement of family and friends during pain. Pain and stress management strategies and attachment theory will be in focus for interpretations.

PARTICIPANTS AND SETTING

25 participants aged 15-16-years from six different junior high schools, both genders, with and without immigrant background were interviewed at their local schools in Norway.

RESULTS

We identified 4 groups of adolescents with similarities in attitudes and management strategies to pain: 'pain is manageable', 'pain is communicable', 'pain is inevitable' and 'pain is all over'. The participants within each group differed in how they engaged their parents in pain; how they perceived, communicated and managed pain; and how they involved emotions and used over-the-counter analgesics.

CONCLUSIONS

The adolescents' different involvement with the family during pain related to their pain perception and management. Knowledge of the different ways of approaching pain is important when supporting adolescents and may be a subject for further research on the use of over-the-counter analgesics in the family.

Enriching practice of dialectic behaviour therapy with the dynamic maturational model of attachment and adaptation

The major challenge for a clinician is integration of the wisdom available in the wide range of therapeutic paradigms available. I have found the principles guiding dialectic behaviour therapy (DBT; see Miller, Rathus, & Linehan, 2007, for applying DBT to adolescents) extremely useful in my practice running a general adolescent unit; similarly, the understanding of the different information processing and learning principles associated with each of the Type A and C attachment strategies, as understood in dynamic maturational model (DMM), has guided me through the dark corners of treatment. Specifically, how does DMM inform practice of DBT? As a 'DBTer' might say, 'Where is the wisdom in both points of view?' Nevertheless, DMM is not primarily about treatment. It concerns how different ways of adapting to developmental contingencies bias perceptual propensities, and hence the information available for reflective brain function. Recognition of these twists to knowing what is going on can then be used to inform a variety of therapeutic approaches. The purpose of this article is to look for the signposts in DBT and DMM which together help navigate the comprehensive approach necessary in complicated therapy. In the process, hopefully some more general principles for addressing discomfited adolescents arise for informing future practice. Although many steer shy of using personality disorder diagnoses for adolescents, clinicians are nevertheless addressing, directly or indirectly, the personality development of all adolescents in treatment, regardless of their classical axis I diagnoses, including both those with developing emotional instability and a group of avoidant over-controlled adolescents, which in Norway is growing in prominence.

The Causal Factors Associated with the Loving Care of the Mothers of Children with Multiple Disabilities

BACKGROUND

Families with disabled children need more psycho-social considerations. Motherhood care of the children with multiple disabilities is difficult. Due to its importance, the aim of this study was to investigate the causal factors affecting loving care of mothers of children with multiple disabilities.

METHODS

The study used a cross-sectional method in which 75 mothers of exceptional children with multiple disabilities (physical and mental) in elementary schools in Shiraz, Iran. The data were collected through questionnaires which, besides demographical factors, evaluated the relationship between mothers' loving care of children with multiple disabilities and four other variables including purpose in life, life satisfaction, religious attitude, and sense of coherence. Mann-Whitney U was used for comparison between mothers' loving care and other variables.

RESULTS

Results revealed that demographic variables did not have a significant relationship with loving care. In the case of social variables, there was a significant relationship between mothers' loving care and purpose in life (P<0.001), religious attitude (P<0.001), and life satisfaction (P=0.01).

CONCLUSION

Motherhood care of disabled children is a unique phenomenon which is due to attachment of mother-child situation. Nevertheless, these mothers are vulnerable and marginalized people who need more attention and social supports provided by related governmental institutions and also NGOs actors.

Wait Up!: Attachment and Sovereign Power

Sociologists and feminist scholars have, over many decades, characterised attachment as a social construction that functions to support political and gender conservatism. We accept that attachment theory has seen use to these ends and consider recent deployments of attachment theory as justification for a minimal State within conservative political discourse in the UK since 2009. However, we contest that attachment is reducible to its discursive construction. We consider Judith Butler's depiction of the infant attached to an abusive caregiver as a foundation and parallel to the position of the adult citizen subjected to punitive cultural norms and political institutions. We develop and qualify Butler's account, drawing on the insights offered by the work of Lauren Berlant. We also return to Foucault's Psychiatric Power lectures, in which familial relations are situated as an island of sovereign power within the sea of modern disciplinary institutions. These reflections help advance analysis of three important issues: the social and political implications of attachment research; the relationship between disciplinary and sovereign power in the affective dynamic of subjection; and the political and ethical status of professional activity within the psy disciplines.

Attachment and time preference : Relations between early stress and sexual behavior in a sample of American university women

This paper investigates hypotheses drawn from two sources: (1) Belsky, Steinberg, and Draper's (1991) attachment theory model of the development of reproductive strategies, and (2) recent life history models and comparative data suggesting that environmental risk and uncertainty may be potent determinants of the optimal tradeoff between current and future reproduction. A retrospective, self-report study of 136 American university women aged 19-25 showed that current recollections of early stress (environmental risk and uncertainty) were related to individual differences in adult time preference and adult sexual behavior, and that individual differences in time preference were related to adult attachment organization and sexual behavior. These results are consistent with the hypothesis that perceptions of early stress index environmental risk and uncertainty and mediate the attachment process and the development of reproductive strategies. On this view individual differences in time preference are considered to be part of the attachment theoretical construct of an internal working model, which itself is conceived as an evolved algorithm for the contingent development of alternative reproductive strategies.

Early stress predicts age at menarche and first birth, adult attachment, and expected lifespan

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. Attachment theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular.

Adult attachment style as a risk factor for maternal postnatal depression: a systematic review

Background

Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The extra community care cost for women with PND living in the UK was found to be £35.7 million per year.

Method

We carried out a systematic search to the literature to investigate the associations between attachment style and PND, using meta-narrative analysis methods, reporting statistical data and life narratives. The following databases were searched: PsycInfo, PsycExtra Web of Science, The Cochrane Library and Pubmed. We focused on research papers that examined adult attachment styles and PND, and published between 1991 and 2013. We included any papers showing relationship between maternal adult attachment and PND. Out of 353 papers, 20 met the study inclusion criteria, representing a total of 2306 participants. Data from these 20 studies was extracted by means of a data extraction table.

Results

We found that attachment and PND share a common aetiology and that ‘insecure adult attachment style’ is an additional risk factor for PND. Of the insecure adult attachment styles, anxious styles were found to be associated with PND symptoms more frequently than avoidant or dismissing styles of attachment.

Conclusion

More comprehensive longitudinal research would be crucial to examine possible cause-effect associations between adult attachment style (as an intergenerational construct and risk factor) and PND (as an important maternal mental health), with new screening and interventions being essential for alleviating the suffering and consequences of PND. If more is understood about the risk profile of a new or prospective mother, more can be done to prevent the illness trajectory (PND); as well as making existing screening measures and treatment options more widely available.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-014-0056-x) contains supplementary material, which is available to authorized users.

Systemic therapy and attachment narratives: Attachment Narrative Therapy

This article outlines an integration of attachment theory with narrative theory and systemic theory and practice: Attachment Narrative Therapy (ANT). This integration offers a more powerful explanatory formulation of the development and maintenance of human distress in relationships, families and communities, and gives direction to psychotherapeutic intervention.

Attachment anxiety is related to Epstein-Barr virus latency

Attachment theory provides a framework for understanding individual differences in chronic interpersonal stress. Attachment anxiety, a type of relationship insecurity characterized by worry about rejection and abandonment, is a chronic interpersonal stressor. Stress impacts cellular immunity, including herpesvirus reactivation. We investigated whether attachment anxiety was related to the expression of a latent herpesvirus, Epstein-Barr virus (EBV), when individuals were being tested for breast or colon cancer and approximately 1 year later. Participants (N=183) completed a standard attachment questionnaire and provided blood to assess EBV viral capsid antigen (VCA) IgG antibody titers. Individuals with more attachment anxiety had higher EBV VCA IgG antibody titers than those with less attachment anxiety. The strength of the association between attachment anxiety and antibody titers was the same at both assessments. This study is the first to show an association between latent herpesvirus reactivation and attachment anxiety. Because elevated herpesvirus antibody titers reflect poorer cellular immune system control over the latent virus, these data suggest that high attachment anxiety is associated with cellular immune dysregulation.

Are parents really attached to their adopted children?

BACKGROUND

Psychological studies found that adopted children suffer from lack of attachment relationships in life. It is important for new parents to understand the underlying concepts before they begin to comprehend behavior issues arising out of different turbulent situations in an adopted child's life. Attachment theory facilitates in comprehending the frame of mind of these children, when they come from emotionally turbulent backgrounds and how some, if not all behavior issues can be attempted to be resolved to recognize children better and to create a nurturing relationship between adopted child and new parents.

FINDINGS

Focus group method was deployed to collect the data via un-restricted non-probability sampling approach; data was quantified for evaluating the hypotheses via t-test of equality of means. Cross cultural findings suggested that parents-adopted children relationship in terms of secure attachment is revealed more in non-working parents, female parents, children of 11-14 years and female children across stated nations while, the ambivalent, avoidant and disorganized attachments are found more in practice if parents are working & male parents and if foster children are male at large & of 15-18 years.

CONCLUSION

It is concluded that the task of creating an enriched attachment relationship with an adopted child depends more on parents, normally non working parents and female parents while quality time and care is given somehow the other to young and female kids by either of the parents for establishing quality attachment. Quality time being bestowed to kids translates the category and intensity of parents- children associations.

[Interpersonal psychotherapy from research to practice]

THEORETICAL BACKGROUND

Interpersonal therapy (IPT) is a brief, structured psychotherapy initially intended to treat adult depression that was developed in the 1970s and manualized in 1984 by G. Klerman and his team. Two main theories served as a basis for its design: Bowlby's attachment theory and communication theory. Klerman theorized that tensions and problems in interpersonal relationships (i.e. disputes) cause psychological distress in vulnerable individuals that may lead to a major depressive episode. Clinical and epidemiological studies have shown that an insecure attachment style is strongly associated with lifetime depression. Severe depressive episodes have been correlated with avoidant attachment in women.

THERAPY STRUCTURE AND TECHNIQUES

IPT is based on the hypothesis that recent or ongoing disturbances in interpersonal relationships either trigger or follow the onset of mood disorder. In practice, IPT assists patients in analysing their interpersonal relationship modes, correlating their relational states with their mood and in learning to use better communication. Resolving difficulties in interpersonal relationships through the use of better communication skills promotes the improvement of depressive symptoms. Klerman identified four interpersonal areas that seem to be highly correlated with depressive episodes: grief (a close and important personal relation who has died), interpersonal disputes (conflicts with significant people such as a spouse or another close family member), role transition (significant life changes such as retirement, parenthood or chronic and invalidating illness) and interpersonal deficits (patients who have limited social contacts and few interpersonal relations). Classically, IPT is planned around 12-16 weekly sessions. During the initial sessions, the therapist will explore all existing interpersonal relations and any significant dysfunctions, both recent and ongoing. Following this interview, the area the patient considers as driving the current depressive episode will be designated as the focus of therapy. Evaluation of depressive symptoms by a quantitative measure (i.e. Visual Analogue Scale) and qualitative measures (activity, pleasure, quality of life) reoccurs at each session. During the intermediate sessions, therapy uses current situations and events in the designated area that particularly affect the patient's mood. Coping, communication and decision-making skills are gradually improved through a number of techniques. These include non-directive and directive exploration, clarification, encouragement of affect, and communication analysis. The therapeutic relationship is empathetic and encouraging of all progress the patient makes. The final phases close the therapy and help the patient to plan future actions and improvements.

CLINICAL TRIALS OF IPT AND DEVELOPMENTS

Several controlled clinical trials in adult populations have demonstrated the efficacy of IPT in treating Major Depressive Disorder (initial and recurrent episodes). It has been recommended as an appropriate treatment option in several guidelines. It can be provided in individual, couple or group formats. There remains an ongoing discussion of the efficacy of monthly maintenance sessions in recurrent depression. Since its conception, clinical trials have explored its use in specific populations such as adolescents and the elderly. IPT has also been the object of trial in other disorders such as post-partum depression, bipolar disorder, social phobia and eating disorders.

CONCLUSION

This article reviews the basic principles and objectives of this therapeutic model. Theoretical concepts and results from research are also discussed. The approach is briefly described and the various therapeutic phases are discussed. Clinical trials have shown that IPT is effective in treating major depressive disorder in a wide variety of populations. Further trials are necessary to determine its efficacy in other psychiatric disorders.

Sleep tight: exploring the relationship between sleep and attachment style across the life span

Based on early life experiences in which developmental, genetic, and environmental components interact, humans learn to trust themselves and others and connect emotionally in consistent ways that are broadly defined as "attachment styles." These relatively stable patterns of interpersonal interaction are associated with either vulnerability to various health risks or resilience. Similarly, the mechanisms involved in sleep regulation undergo developmental changes that overlap temporally with attachment formation and remain sensitive to a series of biological, environmental and psychological influences. Interestingly, while sleep has been conceptualized as a fundamental attachment behavior given its dyadic context, few studies have explored its relationship with attachment style in various ages. We present the first systematic review of the published literature examining the relationship between attachment style and sleep in humans across the life span. While levels of evidence and methods of assessment vary significantly, the results suggest a possible life-long relationship between individual attachment style and sleep. These findings are particularly useful in understanding relatively ingrained psychological mechanisms that can affect and be affected by sleep. Clinical and research implications are discussed.

Child maltreatment and adult health in a national sample: heterogeneous relational contexts, divergent effects?

OBJECTIVE

This study considers the long-term health consequences of child maltreatment. Distinct from previous research, we examine the effects of maltreatment in the context of more general parental evaluations.

METHOD

Analyses used retrospective and current data from the Midlife Development in the United States (MIDUS) study.

RESULTS

A considerable proportion of middle- and older-age adults who experienced frequent maltreatment nevertheless evaluated the relationship with their offending parent as "excellent", "very good", or "good" (e.g., 47% for physical and emotional maltreatment by mothers). Maltreated respondents generally evaluated their maltreating parents less favorably than non-maltreating parents, but there was considerable variation in these recollected relationships. Adults who experienced child maltreatment reported a greater number of chronic medical conditions and physical symptoms and lower self-rated health, but effects were smaller when they had positive relationships with their parents than when one or more of the relationships was perceived as negative.

CONCLUSIONS

These findings highlight a common and seemingly paradoxical pattern among MIDUS participants: the co-presence of harsh parental behavior and positive recollections of parental relationships during childhood. Moreover, these surprising patterns of retrospective interpretation predict very different experiences of adult health - health problems are most pronounced among maltreatment in cases where the respondent had a generally negative relationship with one or more of his or her parents.

Perceived hunger mediates the relationship between attachment anxiety and emotional eating

Eating is an inherently emotional activity and the attachment system is an emotion regulation system. Individuals with attachment insecurity have less interoceptive awareness and difficulty regulating emotion. Insecurely attached individuals may eat emotionally because they misinterpret internal hunger cues, (i.e. think they are hungry when they are experiencing some other internal, attachment-related state). The current study found a positive association between attachment anxiety and emotional eating. This relationship was mediated by perceived hunger.

[Not Available]

Theoretical issues and research emphasis within the field of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.