Exploration of the role of attachment in the relationship between trauma and distress in psychosis
Clark, Lucy Victoria
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Background: Attachment literature indicates attachment status is related to trauma with associations between early trauma and insecure attachment. Links between psychosis and trauma have been established within the literature; however the precise nature of this relationship is still not fully understood. A systematic review was carried out to assess the state of the evidence pertaining to psychosis and attachment. Associations between insecure attachment and psychotic symptoms were identified. Other psychological correlates such as perceived parental care, attachment to services and interpersonal problems were found to relate to insecure attachment status. However due to the early stage of this area of research, small clinical sample sizes and heterogeneity of correlates investigated, firm conclusions cannot currently be drawn. Aim: The aim of this study was to investigate the relationship between trauma, attachment, reflective functioning (RF) and distress for people with psychosis with a view to further understanding these links and the clinical implications. Method: Participants with a diagnosis of psychosis were recruited and measures were completed with the principle investigator pertaining to trauma, attachment and distress in psychosis. Results: The majority of the sample reported insecure attachment and low RF and there were high levels of general, and more specifically, interpersonal trauma within the sample. Results indicated that early interpersonal trauma was associated with higher levels of emotional distress. Exploratory mediation analyses implicated anxious attachment in mediating the relationship between interpersonal trauma and distress. Discussion: The results indicate the need to consider early trauma histories and specifically interpersonal trauma and attachment in the context of emotional distress for people experiencing psychosis. Incorporating trauma and attachment based therapeutic approaches for people with psychosis is as relevant as it is for other trauma populations, where these approaches may be more routinely drawn on for formulation and treatment. Limitations of the methodological approach are considered along with suggestions for future research.