Anxious attachment may be a vulnerability factor for developing embitterment

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1 351 Psychology and Psychotherapy: Theory, Research and Practice (2012), 85, C 2011 The British Psychological Society The British Psychological Society Brief report Anxious attachment may be a vulnerability factor for developing embitterment David Blom 1,2,Henriët van Middendorp 2 and Rinie Geenen 1,2 1 Department of Clinical and Health Psychology, Utrecht University, The Netherlands 2 Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands By predisposing to ego-defensive strategies in social situations, a negative attachment history may promote embitterment. The present study identified attachment anxiety more than attachment avoidance as a possible vulnerability factor for the development and maintenance of embitterment. This factor should be considered in theories and in interventions of embitterment. Practitioner Points Interventions directed at embitterment should take anxious attachment into account. Embittered individuals with high levels of attachment anxiety should be provided a secure therapeutic environment in which defensive tendencies are no longer needed. Embitterment, the persistent feelings of being let down, insulted, or being a loser, and of being revengeful but helpless (Linden, 2003), has been suggested to be an egodefensive mechanism against invalidation by others (Alexander, 1960; Znoj, 2009). As a negative attachment history predisposes to the use of ego-defensive strategies in social situations (Mikulincer, Shaver, Cassidy, & Berant, 2008), it may be a vulnerability factor for developing embitterment. Four attachment styles have been defined by their position on the dimensions anxiousness and avoidance (Bartholomew & Horowitz, 1991): secure (low anxious low avoidant), preoccupied (high anxious low avoidant), dismissive (low anxious high avoidant), and fearful (high anxious high avoidant). The anxious (hyperactivating) strategies aim to avoid a lack of support from others through amplifying distress and devaluating the self as a needy individual. The avoidant (deactivating) strategies aim to avoid dependency on others through dismissing distress, aggrandizing the Correspondence should be addressed to David Blom, PO Box 80140, 3508 TC Utrecht, The Netherlands ( d.blom1@uu.nl). DOI: /j x

2 352 David Blom et al. Table 1. Characteristics of the research participants (N = 159) Gender: female, n (%) 75 (47) Age (years), mean (SD) 33.4 (16.7) Marital status, n (%) Single 58 (37) Married/partnered 94 (59) Divorced 5 (3) Widowed 1 (1) Education level, n (%) Primary 2 (1) Secondary 86 (54) Tertiary 65 (41) Employment status, n (%) Student 79 (50) Employed 60 (38) Retired 16 (10) Workmen s compensation act/benefit 5 (3) Housekeeping 5 (3) Unemployed 4 (3) Embitterment, mean (SD) Total embitterment 1.00 (.68) Emotional embitterment.90 (.87) Performance-related embitterment 1.21 (.88) Pessimism/hopelessness.86 (.74) Misantropy.98 (.80) Attachment, mean (SD) Fearful 2.44 (.84) Preoccupied 2.52 (.73) Dismissive 3.27 (.71) Secure 3.90 (.58) self, and devaluating others (Mikulincer et al., 2008). In agreement with the anxious (hyperactivating) attachment strategy, embittered people typically try to persuade oneself and others of how badly they have been treated through displaying high distress, ruminating on past interpersonal injuries, and displaying oneself as a helpless victim (Linden, 2003; Sensky, 2010). In accordance with the avoidant (deactivating) strategy, embittered people tend to devaluate others (Wurmser, 2009; Znoj, 2009), but dismissing distress is atypical for embitterment. In order to clarify whether negative attachment experiences might be a vulnerability factor for embitterment, our aim was to examine the association between attachment styles and embitterment. We hypothesized that especially the anxious attachment styles fearful and preoccupied would be associated with embitterment. Methods Participants Questionnaires were presented during mid-week train rides at varying trajectories and timepoints. They were completed by 159 Dutch-speaking participants (Table 1).

3 Anxious attachment and embitterment 353 Instruments The 24-item Attachment Styles Questionnaire (ASQ, Van Oudenhoven, Hofstra, & Bakker, 2003) measured fearful attachment (e.g., I would like to be open to others, but I feel I can t trust other people ), preoccupied attachment (e.g., I m afraid of being abandoned ), dismissive attachment (e.g., I like to be self-sufficient ), and secure attachment (e.g., I feel at ease in close emotional relationships ). Statements were rated on a five-point Likert scale (1 = does not apply, 5= fully applies). The scales have theoretically sound associations with other psychological variables (Van Oudenhoven et al., 2003). In the present study, Cronbach s coefficients were good:.80,.80,.73, and.78 for fearful, pre-occupied, dismissive, and secure attachment. Embitterment was measured with the Dutch version of the Bern Embitterment Inventory (BEI-NL; Van Middendorp, Geenen, & Znoj, 2008). Participants rated their agreement with 18 evaluative statements on a five-point Likert scale (1 = does not apply, 5 = fully applies). The broadband domain total embitterment includes four subordinate domains: emotional embitterment (e.g., It fills me with bitterness to think of my unfulfilled wishes ), performance-related embitterment (e.g., In the end my achievements are not really appreciated ), pessimism/hopelessness (e.g., I have a rather pessimistic stance towards life ), and misanthropy (e.g., Sometimes I feel hatred towards mankind or a part of it ). Preliminary validity of the BEI-NL has been established (Blom, Van Middendorp, & Geenen, 2010). In the present study, Cronbach s coefficients were adequate to good:.90,.85,.78,.68, and.66 for total embitterment, emotional embitterment, performance-related embitterment, pessimism/hopelessness, and misanthropy. Statistical analysis Associations were examined using Spearman s rank correlations and linear regression analyses. Some scales of the BEI-NL had a skewed score distribution. Score distributions of residuals in regression analyses were sufficiently normal. Results Table 2 shows the results. The two anxious attachment styles, fearful and preoccupied, showed moderate (.30 < <.50) correlations with most embitterment scores, dismissive attachment did not correlate significantly with any embitterment scale, and secure attachment showed significant small, negative correlations ( >.10) with two embitterment scales. A lower age and education were significantly associated with embitterment. In multiple regression analyses, the broadband domain total embitterment was significantly associated with the two anxious attachment styles: fearful attachment and, most clearly, preoccupied attachment. The subordinate embitterment domains mostly followed this pattern, but misanthropy was associated with fearful and secure attachment and emotional embitterment only with preoccupied attachment. Discussion Preoccupied attachment (high anxious low avoidant) and fearful attachment (high anxious high avoidant) were most clearly associated with embitterment, which complies

4 354 David Blom et al. Table 2. Association between the embitterment scores and attachment styles: Spearman correlations ( ) and -values of linear regression analyses while adjusting for age and education level Embitterment score Correlation Linear regression Attachment style p B SEB P Total embitterment Fearful attachment Preoccupied attachment Dismissive attachment Secure attachment Emotional embitterment Fearful attachment Preoccupied attachment Dismissive attachment Secure attachment Performance-related embitterment Fearful attachment Preoccupied attachment Dismissive attachment Secure attachment Pessimism/hopelessness Fearful attachment Preoccupied attachment Dismissive attachment Secure attachment Misanthropy Fearful attachment Preoccupied attachment Dismissive attachment Secure attachment p.05, p.01, p.001. with the notion that especially anxious attachment may be a vulnerability factor for developing embitterment. Only fearful attachment was associated with misanthropy, suggesting that both anxious and avoidant attachment underlie this other-devaluating aspect of embitterment. Our findings open the door for theoretical considerations about the yet scarcely investigated construct embitterment by illuminating emotion regulation and appraisal processes underlying this invalidating condition. For example, the tendency of anxious individuals to mentally link negative experiences tightly together, so that one negative thought or memory triggers a flood of others, is core to embitterment (Shaver & Mikulincer, 2002; Znoj, 2009). Future research should integrate longitudinal and experimental approaches to identify prospective associations between anxious attachment styles and embitterment and the critically involved environmental and internal factors. The lack of association between the dismissive attachment style and embitterment complies with the notion that avoidant people keep their attachment system deactivated by dismissing affects (Cassidy & Berlin, 1994; Mikulincer & Shaver, 2003) and suggests

5 Anxious attachment and embitterment 355 that dismissive attachment is neither a vulnerability factor nor a protective factor for the development of embitterment. With respect to therapeutic implications, embittered individuals with high levels of attachment anxiety could be provided a consistent and reliable therapeutic frame (secure base) in which defensive tendencies are no longer needed, experiences can be safely explored and (re)interpreted, insight into the consequences of embitterment can be developed, and affect tolerance and self-worth can be enhanced (Bowlby, 1988; McCann & Pearlman, 1990). Eventually, experimental clinical trials should verify which treatment works for embittered patients with high anxious attachment. The strength of the present study is that it identified attachment anxiety as a possible vulnerability factor for the development and maintenance of embitterment. This implies that interventions directed at preventing or treating embitterment should take this factor into account. References Alexander, J. (1960). The psychology of bitterness. The International Journal of Psycho-Analysis, 41, Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, doi: / Blom, D., Van Middendorp, H., and Geenen. R. (2010). Embitterment, a notorious yet noteworthy emotion. The Bern Embitterment Inventory Dutch Version. Manuscript submitted for publication. Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London England: Routledge. Cassidy, J., & Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65, doi: / Linden, M. (2003). Posttraumatic embitterment disorder. Psychotherapy and Psychosomatics, 72, doi: / McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: activation, psychodynamics, and interpersonal processes. In Mark P. Zanna (Ed.), Advances in experimental social psychology (pp ). New York NY: Academic Press. doi: /S (03) Mikulincer, M., Shaver, P. R., Cassidy, J., & Berant, E. (2008). Attachment-related defensive processes. In J. H. Obegi, & E. Berant (Eds.), Clinical applications of adult attachment (pp ). New York, NY: Guilford Press. Sensky, T. (2010). Chronic embitterment and organisational justice. Psychotherapy and Psychosomatics, 79, doi: / Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment & Human Development, 4, doi: / Van Middendorp, H., Geenen, R., & Znoj, H. (2008). Bernse Verbitterings Inventaris. Bern Switzerland: Verlag Hans Huber, Hogrefe AG. Van Oudenhoven, J. P. L. M., Hofstra, J., & Bakker, W. (2003). Ontwikkeling en evaluatie van de Hechtingsstijlvragenlijst (HSL). Nederlands Tijdschrift voor de Psychologie, 58, Wurmser, L. (2009). The Superego as Herald of Resentment. Psychoanalytic Inquiry, 29, doi: / Znoj, H. (2009). Manual Berner Verbitterungs-Inventar. Göttingen Germany: Hogreve. Received 23 July 2010; revised version received 11 April 2011

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