Insecure attachment and support-seeking during COVID-19: a sequential mixed methods investigation.

The COVID-19 pandemic led many couples to stay at home together with minimal contact with others. As social distancing measures reduced contact with outside households, many partners could seek support only from one another. In two studies using a sequential mixed methods design, we investigated support-seeking behaviors in romantic relationships during COVID-19. In the qualitative study, semi-structured interviews (n = 48) showed differences in how and why partners seek support with an initial consideration of the role of attachment. We identified the following themes: direct support-seeking, indirect support-seeking, (in)dependence, and gender dynamics. In the quantitative study (n = 588), high COVID-19 worry, high attachment anxiety, and low attachment avoidance were associated with more support-seeking. Interestingly, we also found that when COVID-19 worry was high, individuals high in attachment avoidance were more likely to report seeking support. The paper provides a unique insight into the impact of COVID-19 on support-seeking behaviors in romantic relationships.

Toward a causal link between attachment styles and mental health during the COVID-19 pandemic.

BACKGROUND: Recent research has shown that insecure attachment, especially attachment anxiety, is associated with poor mental health outcomes, especially during the COVID-19 pandemic. Other research suggests that insecure attachment may be linked to nonadherence to social distancing behaviours during the pandemic. AIMS: The present study aims to examine the causal links between attachment styles (secure, anxious, avoidant), mental health outcomes (depression, anxiety, loneliness) and adherence to social distancing behaviours during the first several months of the UK lockdown (between April and August 2020). MATERIALS & METHODS: We used a nationally representative UK sample (cross-sectional n = 1325; longitudinal n = 950). The data were analysed using state-of-the-art causal discovery and targeted learning algorithms to identify causal processes. RESULTS: The results showed that insecure attachment styles were causally linked to poorer mental health outcomes, mediated by loneliness. Only attachment avoidance was causally linked to nonadherence to social distancing guidelines. DISCUSSION: Future interventions to improve mental health outcomes should focus on mitigating feelings of loneliness. Limitations include no access to pre-pandemic data and the use of categorical attachment measure. CONCLUSION: Insecure attachment is a risk factor for poorer mental health outcomes.

Insecure Attachment Orientation in Adults and Children and Negative Attribution Bias: A Meta-Analysis.

This is the first meta-analysis to synthesize the literature on insecure attachment and negative attribution bias (NAB) from both developmental and social/personality attachment traditions. This meta-analysis is important because extant studies report inconsistent associations, making it difficult to draw conclusions about the nature of these associations. Based on 41 samples (N = 8,727) from 32 articles, we specify and compare the effect sizes of these associations across studies. Results confirmed positive associations between NAB and anxious and avoidant attachment dimensions and an insecure composite, with a medium effect size. Correlations were moderated by age group, type of attachment measurement, and cultural background. Our findings advance knowledge and build on attachment and attribution theories, reconcile mixed findings, and inform the development of NAB interventions. Important gaps in the literature are revealed that will inspire future research.

Do emotion regulation strategies mediate the attachment-paranoia association? An experimental study of repeated attachment imagery priming and stress buffering.

OBJECTIVES: Paranoia describes unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but limited research examines mechanisms of change and no studies examine how secure imagery may be implemented most effectively in clinical practice. In this study, we tested: (a) the causal impact of secure, anxious, and avoidant attachment imagery on paranoia and anxiety, (b) whether emotion regulation strategies mediate these relationships, and (c) whether secure imagery buffers against social stress. DESIGN: We utilized a longitudinal, experimental design. METHOD: A general population sample with high non-clinical paranoia (N = 265) completed measures of paranoia, anxiety, and emotion regulation strategies. Participants were randomly allocated to secure, anxious, or avoidant conditions and repeated an imagery prime for four days prior to a social stress task. RESULTS: Relative to anxious and avoidant imagery, secure imagery decreased state paranoia and anxiety. These associations were not mediated by state emotion regulation strategies, and secure imagery did not buffer against stress. Exploratory analyses on trait variables revealed that: (a) hyperactivating strategies mediated the association between attachment anxiety and paranoia, and (b) suppression mediated the association between attachment avoidance and paranoia. CONCLUSIONS: Secure attachment imagery reduces state paranoia and anxiety and could be incorporated into psychotherapies to attenuate clinical paranoia. Measurement of state emotion regulation was problematic. Attachment imagery does not buffer stress; further research is required to test whether secure imagery facilitates recovery from stress. Attachment style is likely to account for trait paranoia via attachment-congruent emotion regulation strategies. Research is now needed to determine if these strategies can be targeted to alleviate paranoia in clinical populations.

Successful negotiation of goal conflict between romantic partners predicts better goal outcomes during COVID-19: A mixed methods study.

When romantic partners' personal goals conflict, this can negatively affect personal goal outcomes, such as progress. In a concurrent mixed methods study, we investigated whether goal conflict and negation of goal conflict were associated with goal outcomes (progress, confidence, motivation) and what strategies partners used during the COVID-19 pandemic to negotiate goal conflict. Survey participants (n = 200) completed a daily diary for a week and weekly longitudinal reports for a month and interview participants (n = 48) attended a semi-structured interview. Results showed that higher goal conflict was associated with lower goal outcomes, and successful negotiation of goal conflict was associated with better goal outcomes. Qualitative analyses identified three goal conflict negotiation strategies (compromise, integration, concession). Conversations focused on both practical and emotional needs and included respectful communication and space from conflict (timeout or avoidance). The mixed methods results suggest that goal conflict was low during the pandemic and participants were often able to negotiate goal conflict resulting in better goal outcomes.

Adapting to change: How has COVID-19 affected people's work and personal goals?

COVID-19 has had a devastating impact on the global economy and affected millions of people's work and personal lives across the world. The purpose of the present study was to better understand how individuals' work and personal goals have been affected by the pandemic and how they have adapted to these changes. We conducted qualitative semi-structured interviews (n = 48) and surveyed participants (n = 200) weekly for 5 weeks. Both methods revealed similar themes regarding the adaptation and pursuit of goals (social support, handling unpredictable situations, logistics, solving problems creatively, goal postponement, and no changes). Survey responses also showed that most individuals experienced their goals as more difficult (79%; 13% easier; 9% no change) and found that many had had to adapt or postpone their work and personal goals, often due to logistical difficulties. Businesses and governments should do more to help individuals adapt their goals to the new circumstances.

How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms.

BACKGROUND: The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis. METHOD: We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment-paranoia association. RESULTS: We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self- and other-beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment-secure people with psychosis are more likely to seek help and engage with services than attachment-insecure people. CONCLUSIONS: Attachment styles impact help-seeking behaviours in people with psychosis and are likely to influence paranoia via self- and other-beliefs, cognition fusion, and emotion regulation - these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia. PRACTITIONER POINTS: Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment-secure are more likely to seek help and engage with services than those who are attachment-insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help-seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.

Attachment anxiety predicts worse mental health outcomes during COVID-19: Evidence from two studies.

COVID-19 has resulted in a mental health crisis across the globe. Understanding factors that may have increased individuals' risk of poor mental health outcomes is imperative. Individual differences in attachment styles have been shown to predict poorer mental health outcomes and insecure individuals struggle to cope with stressful situations. Therefore, we extended past research by examining whether higher attachment insecurity (anxiety and avoidance) predicted worse mental health over time during the COVID-19 pandemic. Study 1 examined mood and mood fluctuations daily over a week in the beginning of lockdown and depression and anxiety weekly over a five-week period (n = 200). Study 2 examined depression and anxiety before and during the pandemic (n = 100 couples). As predicted, individuals higher (vs. lower) in attachment anxiety, but not avoidance, reported greater depression and anxiety during the pandemic in both studies. Individuals lower in attachment anxiety experienced an improvement in mental health over time in Study 1 suggesting that more secure individuals may recover more quickly from the initial change in circumstances. Attachment styles did not significantly predict mood or mood fluctuations. Attachment anxiety is likely to be a risk factor for poor mental health outcomes during COVID-19.

The Impact of Repeated Attachment Priming on Paranoia, Mood and Help-Seeking Intentions in an Analogue Sample.

Attachment security priming effects therapeutic change in people with depression and anxiety. Preliminary studies indicate that visualising secure attachment memories also reduces paranoia in non-clinical and clinical groups, probably due to a decrease in cognitive fusion. Benefits to clinical populations depend on the sustainability of these effects and the impact on help-seeking behaviours. The combination of paranoia and an insecure-avoidant attachment style is likely to be a particular barrier to help seeking. We used a longitudinal experimental design to test the impact of repeated attachment priming on paranoia, mood and help-seeking intentions and whether cognitive fusion mediates these effects. Seventy-nine people with high levels of non-clinical paranoia, aged 18-50 years (M = 20.53, SD = 4.57), were randomly assigned to a secure or insecure-avoidant priming condition. Participants rehearsed the visualisation prime on four consecutive days and were assessed on standardised measures of paranoia, positive and negative affect, help-seeking intentions and cognitive fusion. A series of mixed-model analyses of variance showed that security priming decreases paranoia, negative affect and cognitive fusion and increases positive affect and help seeking, compared to insecure-avoidant priming. Examining the impact of primed attachment (rather than measured attachment style) allows us to draw conclusions about the causal processes involved; mediation analyses showed indirect effects of the primes on paranoia and negative affect through cognitive fusion. With a growing understanding of (1) the impact of security priming on paranoia, affect and help-seeking behaviours, (2) causal mechanisms and (3) sustainability of effects, security priming may be developed into a viable intervention for clinical populations.

Partner support and goal outcomes during COVID-19: A mixed methods study.

During the COVID-19 pandemic, people have been stuck indoors with their partners for months. Having a supportive partner is likely to be especially important during this time when access to outside sources of support is limited. The present mixed-methods study aimed to investigate how partner support is associated with goal outcomes during COVID-19. The survey participants (n = 200) completed a daily diary for a week and five weekly longitudinal reports, and 48 participants attended a semi-structured interview. The quantitative results showed that higher relational catalyst support (i.e., support for growth opportunities) predicted better goal outcomes; qualitative analyses revealed partners use direct and indirect forms of emotional and instrumental support toward goal pursuit. This is important because most studies to date have not differentiated between direct and indirect forms of support. Overall, the findings suggest that having a supportive partner is important for not only surviving, but also thriving through the pandemic.

The effect of attachment security priming and oxytocin on physiological responses to trauma films and subsequent intrusions.

To further understand protective mechanisms to prevent post-traumatic stress disorder or assist recovery from psychological trauma, this study investigated whether pharmacological and psychological activation of a secure attachment representation elicits higher felt-security and a related response pattern of reduced physiological arousal and increased parasympathetic activation; and whether it protects individuals from developing intrusions and experiencing distress in the week following exposure to a trauma film. Using a double-blind, experimental mixed factorial design, 101 volunteers received either oxytocin or placebo and either secure attachment or neutral priming before watching a trauma film. We measured felt security as an indicator of the strength of activation of a secure attachment representation, skin conductance and heart rate as indicators of physiological arousal, and high frequency heart rate variability as an indicator of parasympathetic activation during the priming and the film. Participants then completed a seven-day intrusion diary. Secure attachment priming, but not oxytocin administration or the combination of both, was associated with reduced physiological arousal and increased parasympathetic activity during priming. Although secure attachment priming was not related to the absolute number of intrusions or to less perceived distress or physiological arousal during the trauma film, it was associated with lower intrusion-related distress in the 7-days post-testing. Our findings extend previous research that suggests the importance of interventions that address intrusion-related distress for recovery from trauma, and suggest a promising role for secure attachment priming in trauma-focused psychological therapies. We contribute to the growing literature that finds that higher subjective distress during a trauma is associated with higher intrusion-related distress. We discuss theoretical implications and possible mechanisms through which secure attachment priming may exert potential beneficial effects.

Attachment styles, negotiation of goal conflict, and perceived partner support during COVID-19.

Due to the pandemic, people have been stuck indoors with their partners for months. Instead of being able to rely on multiple sources of support, many couples have to rely on each other more. We investigated whether goal conflict, successful negotiation of the conflict, and individual differences in attachment styles were associated with perceived partner support to understand factors that may enable or hinder goal pursuit during the pandemic. Participants (n = 200) completed a daily diary for a week and weekly longitudinal reports for five weeks. Results showed that higher goal conflict predicted perception of less relational catalyst (RC) support and more anti-RC support from partner, whereas more successful negotiation of goal conflict predicted higher RC support and lower anti-RC support. Attachment avoidance was directly associated with less support whereas attachment anxiety moderated the relationship between goal conflict and support. Implications for partner support during the pandemic are discussed.

The Effectiveness of Attachment Security Priming in Improving Positive Affect and Reducing Negative Affect: A Systematic Review.

: Attachment security priming has been extensively used in relationship research to explore the contents of mental models of attachment and examine the benefits derived from enhancing security. This systematic review explores the effectiveness of attachment security priming in improving positive affect and reducing negative affect in adults and children. The review searched four electronic databases for peer-reviewed journal articles. Thirty empirical studies met our inclusion criteria, including 28 adult and 2 child and adolescent samples. The findings show that attachment security priming improved positive affect and reduced negative affect relative to control primes. Supraliminal and subliminal primes were equally effective in enhancing security in one-shot prime studies (we only reviewed repeated priming studies using supraliminal primes so could not compare prime types in these). Global attachment style moderated the primed style in approximately half of the studies. Importantly, repeated priming studies showed a cumulative positive effect of security priming over time. We conclude that repeated priming study designs may be the most effective. More research is needed that explores the use of attachment security priming as a possible intervention to improve emotional wellbeing, in particular for adolescents and children.

Attachment and prejudice.

There is a paucity of research that examines prejudice from an attachment theory perspective. Herein we make theoretical links between attachment patterns and levels of prejudice. Perceptions of outgroup threat, which activate the attachment system, are thought to lead to fear and prejudice for those high in attachment anxiety, and to distancing and prejudice for those high in attachment avoidance. We review the literature that examines the associations between attachment patterns and prejudice; evidence from attachment priming studies suggests a causal role of attachment security in reducing prejudice. We identify several mediators of these links: empathy, negative emotions, trust, social dominance orientation, romanticism, and contact quality. Future research should manipulate potential mediators and use psychophysiological assessments of threat.

Priming attachment security improves attitudes towards a range of therapies.

We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non-relational and distanced-relational therapies for those with a fearful-avoidant attachment orientation. For relational and distanced-relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help-seeking behaviour. Priming security may promote open-minded decision-making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.

Effects of repeated attachment security priming in outpatients with primary depressive disorders.

BACKGROUND: The aim of this study was to assess the potential effectiveness of secure attachment priming in outpatients with depressive disorders. METHODS: Forty-eight participants engaged in secure attachment priming or neutral priming in the laboratory (Time 1), after which they received three daily consecutive primes via text message (Times 2-4), aimed at maintaining the effects from Time 1. A follow-up one day later (Time 5) was also included. Dependent measures were assessed at Times 1, 4 and 5. RESULTS: Participants in the secure attachment priming condition experienced higher felt-security than the control group at all time-points, indicating that the felt-security benefit was maintained through repeated priming. Secure priming had a greater impact on reducing symptoms of anxiety and depression in comparison to the control prime, though the differences were only significant at Time 4. LIMITATIONS: The moderate sample size limited our statistical power. CONCLUSIONS: This study was the first experiment using repeated secure attachment priming within a clinical sample. Our findings have potential clinical implications; security priming could be used alongside other treatments to improve outcome. Recommendations for further research are discussed.

Attachment Security and Self-compassion Priming Increase the Likelihood that First-time Engagers in Mindfulness Meditation Will Continue with Mindfulness Training.

Mindfulness practice has many mental and physical health benefits but can be perceived as 'difficult' by some individuals. This perception can discourage compliance with mindfulness meditation training programs. The present research examined whether the activation of thoughts and feelings related to attachment security and self-compassion (through semantic priming) prior to a mindfulness meditation session might influence willingness to engage in future mindfulness training. We expected both of these primes to positively influence participants' willingness to continue with mindfulness training. We primed 117 meditation-naïve individuals (84 female; mean age of 22.3 years, SD = 4.83) with either a self-compassion, attachment security, or a neutral control prime prior to an introductory mindfulness exercise and measured their post-session willingness to engage in further training. Both experimental primes resulted in higher willingness to engage in further mindfulness training relative to the control condition. The self-compassion prime did so indirectly by increasing state mindfulness, while the attachment security prime had a direct effect. This study supports theoretical links between self-compassion and mindfulness and reveals a causal role for these factors in promoting willingness to engage in mindfulness training. Our findings have implications for improving compliance with mindfulness intervention programs.

Attachment and prejudice: The mediating role of empathy.

In two studies, we examined the novel hypothesis that empathy is a mechanism through which the relationship between attachment patterns and prejudice can be explained. Study 1 examined primed attachment security (vs. neutral prime), empathy, and prejudice towards immigrants. Study 2 examined primed attachment patterns (secure, avoidant, anxious), empathy subscales (perspective taking, empathic concern, personal distress), and prejudice towards Muslims. Across both studies, empathy mediated the relationship between primed attachment security and low prejudice levels. The findings suggest that enhancing felt security and empathic skills in individuals high in attachment-avoidance may lead to reduced prejudice.

The associations between adult attachment, posttraumatic symptoms, and posttraumatic growth.

BACKGROUND AND OBJECTIVES: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. DESIGN: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. METHODS: The sample comprised 393 university staff and students (RangeAge= 18-49, 85% females) who completed online measures. RESULTS: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. CONCLUSIONS: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.

Core belief content examined in a large sample of patients using online cognitive behaviour therapy.

BACKGROUND: Computerised cognitive behavioural therapy provides a unique opportunity to collect and analyse data regarding the idiosyncratic content of people's core beliefs about the self, others and the world. METHODS: 'Beating the Blues' users recorded a core belief derived through the downward arrow technique. Core beliefs from 1813 mental health patients were coded into 10 categories. RESULTS: The most common were global self-evaluation, attachment, and competence. Women were more likely, and men were less likely (than chance), to provide an attachment-related core belief; and men were more likely, and women less likely, to provide a self-competence-related core belief. This may be linked to gender differences in sources of self-esteem. Those who were suffering from anxiety were more likely to provide power- and control-themed core beliefs and less likely to provide attachment core beliefs than chance. Finally, those who had thoughts of suicide in the preceding week reported less competence themed core beliefs and more global self-evaluation (e.g., 'I am useless') core beliefs than chance. LIMITATIONS: Concurrent symptom level was not available. The sample was not nationally representative, and featured programme completers only. CONCLUSIONS: Men and women may focus on different core beliefs in the context of CBT. Those suffering anxiety may need a therapeutic focus on power and control. A complete rejection of the self (not just within one domain, such as competence) may be linked to thoughts of suicide. Future research should examine how individual differences and symptom severity influence core beliefs.