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Concept: John Bowlby

167

BACKGROUND: This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother-infant residential intervention on PSE and infant behaviour. METHODS: 83 primiparous women with infants aged 0-12months admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts. RESULTS: Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and depressive symptom severity were found to predict low PSE. Major depression mediated the relation between attachment insecurity and PSE, but there were no links between PSE and infant behaviour. After the intervention, there was a significant improvement in PSE, with abusive parenting during childhood and depressive symptom severity being predictive of change. CONCLUSIONS: This study highlights the links between maternal psychopathology and maternal background factors such as childhood parenting experiences and attachment style in the development of postnatal PSE. Directions for future research are discussed.

Concepts: Psychology, Infant, Selective serotonin reuptake inhibitor, Abnormal psychology, Child abuse, Diagnostic and Statistical Manual of Mental Disorders, Attachment in adults, John Bowlby

166

This study investigated relationships between attachment insecurity, maladaptive cognitive schemas, and various types of psychopathological symptoms in a sample of clinically referred adolescents (N = 82). A mediation model was tested in which maladaptive schemas operated as mediators in the relations between indices of attachment quality and conduct, peer, and emotional problems. Results revealed partial support for the hypothesized mediation effect: the schema domain of disconnection/rejection acted as a mediator in the links between insecure attachment and peer problems and emotional problems. Further analysis of these effects revealed that different types of maladaptive schemas were involved in both types of psychopathology. Altogether, findings suggest that treatment of adolescent psychological problems may need to target the improvement of attachment relationships with peers and parents and the correction of underlying cognitive schemas.

Concepts: Psychology, Adolescence, Psychiatry, Attachment theory, Mediation, Peer group, Family therapy, John Bowlby

46

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static “trait” of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Concepts: Evaluation, Developmental psychology, Policy, Human development, Attachment theory, Family therapy, Attachment measures, John Bowlby

29

This cross-sectional, dyadic questionnaire study examined the contribution of romantic attachment and responsive caregiving to parenting style, investigating both gender and partner effects. One hundred and twenty-five couples with children aged 7 to 8 years completed measures of attachment styles, responsive caregiving toward partner, and parenting styles. Structural Equation Modeling was used to examine the intra- and interpersonal associations between romantic attachment, caregiving responsiveness, and parenting styles. Attachment avoidance and anxiety were both negatively associated with responsive caregiving to partner, which in turn was positively associated with authoritative (optimal) parenting styles and negatively associated with authoritarian and permissive (nonoptimal) parenting styles. Responsive caregiving mediated all links between attachment and parenting, with an additional direct association between attachment anxiety and nonoptimal parenting styles that was not explained by caregiving responsiveness. Findings are discussed with reference to attachment theory.

Concepts: Developmental psychology, Parenting, Love, Attachment theory, Attachment in adults, Attachment measures, Attachment parenting, John Bowlby

28

Over the past decade, there has been an explosion of interest in clinical applications of attachment theory. In the present article, we briefly describe John Bowlby’s model of therapeutic change, the therapeutic relationship, and the therapist’s role in emotional healing. We then review empirical evidence for three key propositions in Bowlby’s model. First, a client’s sense of security during therapy is crucial for facilitating therapeutic work. Second, a therapist’s own sense of security contributes to positive therapeutic outcomes. Third, attachment insecurities can be effectively reduced in therapy, and movement toward greater attachment security is central to achieving favorable therapeutic outcomes. In sum, research evidence confirms the importance of establishing what Bowlby called a safe haven and a secure base within a therapeutic relationship.

Concepts: Therapy, Attachment theory, Psychoanalysis, John Bowlby

27

In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, , , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding of psychotherapy practice.

Concepts: Attachment theory, Psychoanalysis, John Bowlby

27

The association between cortisol and adult attachment style, an important indicator of social relationships, has been relatively unexplored. Previous research has examined adult attachment and acute cortisol responses to stress in the laboratory, but less is known about cortisol levels in everyday life. The present study examined adult romantic attachment style and cortisol responses across the day. Salivary cortisol was collected at six time points during the course of the day in 1,807 healthy men and women from a subsample of the Whitehall II cohort. Significant associations were found between attachment on cortisol across the day and slope of cortisol decline. The lowest cortisol output was associated with fearful attachment, with preoccupied attachment having the highest levels and a flatter cortisol profile. The results tentatively support the proposition that attachment style may contribute to HPA dysregulation.

Concepts: Present, Time, Epidemiology, The Association, Interpersonal relationship, Attachment theory, Attachment in adults, John Bowlby

26

Background: Suicide among adolescents is an important public health problem. One risk factor for youth suicidal behavior that has been underexplored is insecure attachment. Aims: To investigate the association between attachment avoidance/anxiety and suicidal behavior in an adolescent sample. Method: This study examined attachment insecurity in 40 adolescents who had attempted suicide and 40 never-suicidal demographically matched youths. Adolescents completed self-report measures of attachment style, family alliance, and depressive symptoms. Results: Suicide attempters reported significantly higher attachment avoidance and anxiety. Attachment avoidance, but not anxiety, predicted suicide attempt status in a conditional logistic regression analysis that controlled for depressive symptoms and family alliance. Conclusion: Future research should determine the relative utility of attachment insecurity in prospectively predicting suicide attempts and investigate potential mediators and moderators of this association. Implications for clinicians working with suicidal youth with insecure attachment styles are discussed.

Concepts: Logistic regression, Schizophrenia, Bipolar disorder, Major depressive disorder, Attachment theory, Suicide, The Complete Manual of Suicide, John Bowlby

26

Schizophrenia is a complex psychiatric syndrome whose exact causes remain unclear. However, current scientific consensus has highlighted the importance of neurodevelopmental and neurocognitive processes in the development of schizophrenic symptoms. Research over the past three decades, motivated by the findings of the World Health Organization’s large-scale studies, has highlighted the importance of psychosocial adversities - including childhood abuse and neglect - in this disorder. In this paper, I propose a hypothesis based on John Bowlby’s framework of attachment theory, which I have termed the attachment-developmental-cognitive (ADC) hypothesis. The ADC hypothesis integrates recent developments related to (1) existing models of schizophrenia, (2) studies examining the effect of attachment on brain biology and cognitive development, and (3) various known facts about the course and outcome of this disorder. In doing so, it explains how disturbed childhood attachment leads to core psychological and neurochemical abnormalities which are implicated in the genesis of schizophrenia and also affect its outcome. The ADC hypothesis compasses and expands on earlier formulations, such as the “social defeat” and “traumagenic” models, and has important implications regarding the prevention and treatment of schizophrenia. Ways of testing and refining this hypothesis are outlined as avenues for future research. Though provisional, the ADC hypothesis is entirely consistent with both biological and psychosocial research into the origins of schizophrenia.

Concepts: Scientific method, Psychology, Attachment theory, Family therapy, John Bowlby, Mary Ainsworth, Attachment therapy, Maternal deprivation

26

This study sought to extend the confluence model of sexual assault perpetration by examining attachment insecurity and depression as additional predictors of sexual aggression. Male college students (N = 193) completed an online questionnaire assessing confluence model constructs in addition to attachment and history of depression. Overall, the model fit the data well, χ(2)(11, 193) = 19.43, p = ns; root mean square error of approximation = .063; comparative fit index = .94. Attachment and depression demonstrated both direct and indirect relationships with perpetration severity. The results contribute to elucidating the process by which certain men become susceptible to perpetrating sexual assault. Implications are discussed.

Concepts: Mean, Standard deviation, Das Model, Logic, Root mean square, Mean squared error, Root mean square deviation, John Bowlby