Role of adult attachment style in psychosis : a research portfolio
Bryers, Christine Mairi
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Background: Attachment theory represents a developmental framework which proposes that early relationships with primary caregivers have an enduring effect on interpersonal relationships, affect regulation and psychological functioning throughout the lifespan. It has been suggested that this occurs via the influence of internal representations regarding the self, others and relationships, which form the basis of an attachment style in adulthood. Attachment has been conceptualised as a constructive theoretical basis from which to consider psychological mechanisms underlying the emotional distress, interpersonal problems and difficulties in affect regulation commonly associated with psychosis. Aims: A systematic literature review was conducted investigating the current research findings regarding adult attachment style in psychosis and clinical correlates of this. An empirical study used a cross sectional design to investigate the role of adult attachment style in emotional recovery in psychosis. It was hypothesised that attachment insecurity would be associated with higher levels of depression and symptom related distress. Interpersonal problems and emotion regulation were also investigated and it was predicted that these variables would mediate the relationship between attachment insecurity and increased emotional distress. Method: Individuals with psychosis (n=70) completed self report measures of adult attachment style, interpersonal problems and emotion regulation. Clinician rated measures of depression and symptom related distress were also completed. Results: The literature review revealed that adult attachment style is of relevance in psychosis as consistent findings of greater attachment insecurity in psychosis compared with non clinical populations have been reported. Adult attachment insecurity has been associated with a number of clinical outcomes in exploratory research. The empirical study found support for hypothesised associations between attachment insecurity and greater emotional distress. Predicted relationships were also supported between attachment insecurity and higher rates of interpersonal problems and more use of expressive suppression as an emotion regulation strategy. Interpersonal problems significantly mediated the relationship between attachment insecurity and emotional distress. The hypothesised mediating role of emotion regulation was not supported. Conclusions: Findings of the empirical study suggest that insecurity in adult attachment style is an important variable in understanding emotional distress in individuals with psychosis and that difficulties in interpersonal functioning, as a mediating factor in this relationship, may represent a useful focus in clinical work.