University of Groningen Adult attachment and psychosocial functioning Pielage, Suzanne Brenda IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2006 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Pielage, S. B. (2006). Adult attachment and psychosocial functioning. s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 03-04-2019
6 Insecure attachment as a risk factor for psychopathology: The role of stressful events Abstract Attachment theory predicts that attachment styles learned in previous relational experiences affect the way people cope with stressful events and, consequently, their mental health. The present study tested two mediational models of the relationships between stressful events, attachment style and psychopathology in a sample of 51 student couples. No evidence was found for a mediating role of attachment style in the relationship between stressful events and psychopathology, i.e. attachment style did not influence the effects of stressful events on mental health. Rather, the results indicated that stressful events mediated the association between fearful attachment and psychopathology. It seems as though fearfully attached individuals are more prone to perceive and interpret events as stressful which in turn seems to increase their vulnerability to experience psychological symptoms. Findings are discussed in the context of theory and research on adult attachment. Pielage, S.B., Gerlsma, J., & Schaap, C.P.D.R. (2000). Clinical Psychology and Psychotherapy, 7, 296-302.
Introduction Attachment theory (Bowlby 1969, 1973, 1980) suggests that early relational experiences have tremendous significance for later development. Daily interactions with parents and peers contribute to the formation of internal working models of attachment of the world and significant persons in it, including the self. Once developed, working models of attachment are expected to play an important role in shaping how people behave in their relationships, how they construe their social world and guide behavior in new situations. Moreover, working models of attachment are presumed to affect mental health. As will be outlined below, in the literature on the link between attachment and psychopathology, two approaches can be discerned (see also Mikulincer, Birnbaum, Woddis & Nachmias, 2000). One approach starts from the central tenet of attachment theory that stress is a necessary prerequisite for activation of the attachment system. Specifically, attachment theory states that the attachment system is most strongly activated during times of stress (Bowlby, 1969, 1988). When life experiences induce an individual to feel frightened, fatigued or sick, a need for closeness, comfort and support from attachment figures will surface. Security in attachment stems from early experiences with affectionate parents that promote attachment behavior by being responsive, available, and comforting when a threat or stressor presents itself (Bowlby, 1988a; Bretherton, 1985). These positive experiences help to create a basic trust in the world and the self, making it possible to foster a positive attitude in life and buffer the psychological distress resulting from life adversities. In contrast, insecure attachment can be seen as a risk factor leading to poor coping and maladjustment. The early attachment experiences of insecure persons are characterized by rejecting or inconsistent parenting which may hamper the development of inner resources necessary for successful coping with life-stressors (Bartholomew & Horowitz, 1991; Collins & Read, 1990; Mikulincer & Florian, 1998). Hence, this approach assumes that stressful events activate the attachment system and that attachment mediates the effects of the experienced stress on mental health. The model that conceptualizes attachment as a mediator between stressful events and mental health is depicted in Figure 6.1: Secure attachment is thought to buffer the harmful effects of stressful circumstances on mental health, whereas insecure attachment can be seen as a risk 104
factor that increases vulnerability to the development of psychological complaints as a consequence of stressful events. Attachment style (Mediator) Stressfull events (independent variable) Psychological symptoms (dependent variable) Figure 6.1. Mediational model where attachment style mediates the relation between stressful events and psychological symptoms. On the other hand, individual differences in the accessibility of working models are presumed to influence the amount of stress a person experiences (e.g. Collins & Read, 1994; Simpson & Rholes, 1994). Working models of attachment are expected to bias cognitive response patterns such as attention, memory encoding and retrieval, inference and explanation processes (see Collins & Read, 1994). As Bowlby originally suggested: Every situation we meet with in life is constructed in terms of the representational models we have of the world about us and of ourselves. Information reaching us through our sense organs is selected and interpreted in terms of those models, its significance for us and for those we care for, is evaluated in terms of them, and plans of action conceived and executed with those models in mind. On how we interpret and evaluate each situation, moreover, turns also how we feel (Bowlby, 1980, p.229). Insecure attachment is characterized by a lack of trust of self and others. It would be reasonable to assume that their sense of unworthiness, intense fear of rejection and their longing for social contact can cause an attentional bias in insecure persons that keeps them highly alert for signs of disapproval by others. They are likely to interpret and evaluate events in ways that confirm their fears; information that is inconsistent with their negative expectations is likely to be disregarded (Bartholomew & Horowitz, 1991; Collins & Read, 1994; Simpson & Rholes, 1994). According to this model (as depicted in Figure 6.2), the amount of general life stress experienced by each attachment group is not necessarily similar and events are not inherently 105
stressful. Rather, the subjective appraisal of these events plays a crucial role in the way people experience and respond to stress (e.g. Lazarus & Folkman, 1984). Stressfull events (Mediator) Attachment style (independent variable) Psychological symptoms (dependent variable) Figure 6.2. Mediational model where stressful events mediate the relation between attachment style and psychological symptoms. The relationship between attachment style and responses to stress has been documented by a number of studies (e.g. Carpenter & Kirkpatrick, 1996; Kemp & Niemeyer, 1999; Simpson, Rholes & Nelligan, 1992; Mikulincer, Florian & Weller, 1993) as has the relationship between attachment style and mental health. Insecure attachment has been found to be associated with depression (Carnelley, Pietromonaco & Jaffe, 1994; Hammen, Burge, Daley, Davila, Paley & Rudolph, 1995; Murphy & Bates, 1997), anxiety (Hazan & Shaver, 1990; Mikulincer et al., 1993; Shaver & Brennan, 1992) and low self-esteem (Bartholomew & Horowitz, 1991; Collins & Read, 1990; Hazan & Shaver, 1990), offering empirical support for the hypothesis that insecure attachment constitutes a risk-factor for psychopathology. Generally, these studies did not address the interrelationships between all three variables, i.e. attachment style, amount of stressful events and mental health. The present study extends the work on adult attachment by analyzing the way in which stressful events and attachment style each contribute to mental health. In our attempt to address this issue, we examined whether attachment style is a mediator between stressful events and psychological symptoms (Figure 6.1) or alternatively, whether the experience of stress mediates between attachment style and psychological symptoms (Figure 6.2). 106
Method Subjects and procedure Fifty-one student couples, together for at least three months, were asked to participate in an experiment about autobiographical memory and close relationships. They were recruited on campus at the University of Groningen. Mean age was 22.76 years (SD = 3.54) and the mean duration of the relationship was 2.14 years (SD = 1.62, range.8 to 6.5 years). The level of education in the sample was high with a mean of 4.70 (SD =.71) on a five point scale that ranged from 1 (primary school only) to 5 (university education). Couples were requested to come to the department of clinical psychology where they individually responded to a series of questionnaires that inquired about their attachment style, recently experienced stressful events, current relationship functioning and mental health. The couples were then brought together and were unobtrusively videotaped while interacting. Measures The Relationship Questionnaire (RQ; Bartholomew and Horowitz, 1991) consists of four short paragraphs characterizing the four attachment styles; i.e. Secure (with positive models of both self and others), Preoccupied (with a negative self-model and a positive other-model), Dismissing (with a positive self-model and a negative other model), and Fearful (with negative models of both self and others). For example, the prototypical description of the Fearful attachment pattern reads as follows: I am uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I worry that I will be hurt if I allow myself to become too close to others. Respondents were instructed to rate on 7-point scales the extent to which each description corresponds to their general relationship style. A Dutch version of the Survey of Recent Life Experiences (SRLE; De Jong, Timmerman & Emmelkamp, 1996; Kohn & McDonald, 1992) was used to measure the degree of general life stress. The SRLE consists of six scales (social and cultural difficulties, work, time pressure, finances, social acceptability and social victimization) which measure various kinds of daily stressors that people may have encountered over the last month. Respondents rate on a four-point scale the extent to which these stressors have been a part of their life over the last month. Examples of items are: too 107
many things to do at once ; being let down or disappointed by friends and financial burdens. The SRLE is considered to be relatively free of contamination with psychological distress (see: De Jong et al., 1996; Kohn & McDonald, 1992;). Reliability in terms of internal consistency was good (Cronbach s alpha =.87). Psychological symptoms were measured by the Revised version of the Symptom Checklist (SCL-90-R; Derogatis & Clearly, 1977), a multi-dimensional self-report inventory of current psychiatric symptoms. The Dutch version of the SCL-90-R (Arrindell & Ettema, 1986) consists of the subscales agoraphobia, anxiety, depression, somatic complaints, insufficiency of thinking and acting, interpersonal sensitivity and mistrust, hostility and sleeping problems. In addition to these eight symptomatic scales a total score termed psychoneuroticism, summarizes the degree of distress on all 90 items. Respondents rate on a five-point scale the extent to which they have experienced symptoms the past week. In this study only the total score psychoneuroticism was used in the analyses (Cronbach s alpha =.96). Results Prior to conducting the analyses, a check was performed in order to establish the influence of gender on the analyses. A Manova with gender as the independent and the four attachment styles, recently experienced stressful events and level of psychological symptoms as dependent variables proved non-significant [F(6,98) = 1.20; p = n.s.]. Therefore gender was dropped from further analyses. As a second preliminary analysis, Pearson correlation coefficients were computed among all measures in the study. Table 6.1 summarizes the correlations between the four attachment styles, recently experienced stress and psychological symptoms. 108
Table 6.1. Correlations between the attachment style, recent stressful events and psychological symptoms Variable 1 2 3 4 5 6 1. Secure - -.13 -.23* -.34** -.22* -.21* 2. Dismissing - -.03.03.06 -.07 3. Preoccupied -.04.23*.16 4. Fearful -.40**.30** 5. Stressful events -.65** 6. Psychological symptoms - * Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed). Note: Due to missing data N varies from 99 to 100 Secure attachment was negatively related to all three of the insecure attachment styles (r = -.13, -.23, -.34 for dismissing, preoccupied and fearful attachment respectively). However the three insecure styles were not related to each other (r. 04), indicating relative independence of the insecure attachment styles as predicted by the Bartholomew and Horowitz (1991) model of attachment. Attachment style was significantly related to stressful events: Fearful and preoccupied attachment were positively related to the amount of stressful events experienced (r =.40 and r =.23 respectively) whereas secure attachment showed a negative correlation (r = -.22). The correlation for the dismissing category was not significant. Attachment style was also significantly related to psychological symptoms. Secure attachment showed a negative correlation (r = -.21) whereas fearful attachment had a positive relationship with psychological symptoms (r =.30). The correlation for the dismissing and preoccupied styles (r = -.07 and.16 respectively) was not significant. Finally, the amount of recently experienced stressful events and psychological symptoms were very strongly related to each other (r =.65) To test whether attachment style mediates the effect of stressful events on psychopathology, or alternatively whether stressful events mediate the effect of attachment style on psychopathology, a series of regression analyses was conducted. Attachment style can be considered a mediator when it meets the following conditions: (1) the relationship between stressful events and psychological symptoms must be significant; (2) there is a significant relation between attachment and psychological symptoms and (3) when attachment is added to the equation, the 109
previously significant relation between stressful events and psychological symptoms should attenuate, with the strongest demonstration of mediation occurring when the relation between stress and psychological symptoms becomes zero. Stressful events function as a mediator when (1) the relation between attachment style and psychological symptoms is significant; (2) the relation between stressful events and psychological symptoms is significant; and (3) the significant relation between attachment styles and psychological symptoms is attenuated e.g. reduced to non-significance when stressful events are entered into the equation (Baron & Kenny, 1986). Table 6.2. Regression and summary statistics for each model with psychological symptoms as dependent variable. Psychological symptoms MR adj. R 2 F Sign. F β Regression equation 1:.65.41 70.69.001 Stressful events.65* Regression equation 2:.36.09 3.42.012 Secure -.10 Dismissing -.08 Preoccupied.12 Fearful.27* Regression equation 3:.66.41 14.39.001 Stressful events.63* Secure -.07 Dismissing.12 Preoccupied -.00 Fearful.03 * Correlation is significant at the 0.05 level (2-tailed), ** Correlation is significant at the 0.01 level (2-tailed). Table 6.2 shows the results of the regression analyses: Regression equation 1, the effect of stressful events on psychological symptoms, was significant [F(1,99) = 70.69; p<.001]. The influence of attachment style on psychological symptoms, depicted by regression equation 2, was also significant [F(4,98) = 3.42; p<.05]. Regression equation 3 where stressful events and the four attachment styles were simultaneously entered in the analyses was also significant [F(5,98) =14.39; p<.001]. However, there 110
was no indication of attachment being a mediator between stressful events and psychological symptomatology: The relation between stressful events and psychological symptoms was hardly reduced when attachment was added to the model. On the contrary, when all variables are simultaneously entered in the regression, the unique effects of attachment on psychological symptoms disappear. This makes the amount of stressful events recently experienced a perfect mediator between fearful attachment and psychological symptomatology. Discussion Attachment theory predicts that attachment styles learned in previous relational experiences affect the way people cope with stressful events and, consequently, their mental health. While a number of empirical studies have demonstrated the predicted associations between attachment styles and stressful events on the one hand, and between attachment styles and psychological symptoms on the other hand, empirical data on the interplay of all three variables is sparse. The present study was designed to examine these interrelationships, in an effort to explore the mechanism underlying the link between attachment styles and psychopathology. Overall, the results of our study replicate previous findings in the sense that secure attachment was negatively related to both the amount of stressful events recently experienced and the amount of psychological symptoms; the insecure attachment styles showed positive associations with stressful events and psychological symptoms. As to the mechanism underlying the link between attachment style and psychopathology two models were tested. The first model conceptualized attachment style as a mediator between stressful events and psychopathology, based on the theoretical premise that stressful events activate the attachment system which, dependent on one's previous experiences, i.e. one s attachment style, may lead to adaptive or maladaptive ways of coping with the stressors (e.g., Collins & Read, 1994; Mikulincer & Florian, 1998; Simpson & Rholes, 1994). We found no empirical evidence for attachment style as such a mediator in this study. Rather, our results seemed to corroborate the second model, which highlights insecure attachment as a susceptibility to appraise events as stressful. According to this model, many events are not inherently stressful. Rather, the subjective appraisal of events plays a crucial role in 111
the way people express, experience, and respond to stress (e.g. Lazarus & Folkman, 1984). Insecure attachment is considered to bias the interpretation and evaluation of events in such a way as to confirm existing negative beliefs and expectations about the helpfulness and supportiveness of others and one's own resourcefulness (e.g., Bartholomew & Horowitz, 1991; Collins & Read, 1994; Simpson & Rholes, 1994). Our results suggest that fearful individuals chronic sense of insecurity and distress, as reflected in their negative view of both self and others, makes them more prone to perceive and interpret events as stressful which, in turn, seems to increase their vulnerability to experience psychological symptoms. Several methodological features of the present study limit the generalizability of our results and call for future research and replication efforts. For one thing, we used a concurrent design, in which the amount of recently experienced stressful events, attachment style, and current level of psychological symptoms were assessed simultaneously; hence, the causal direction of the associations found remains unclear. Although attachment theory favours the interpretation that insecure attachment styles constitute a vulnerability factor for the development of psychological symptoms, in the absence of longitudinal data the reverse is equally likely: the experience of a relatively high amount of psychological symptoms might well lead individuals to endorse an attachment vignette that describes interpersonal experiences in terms of fear and distress. Another limitation of this study concerns the use of student couples, who are relatively young and healthy, and have been together for only a short time. Therefore, replication in other groups and preferably in clinical populations is necessary to investigate the ways in which stressful events and insecure attachment style contribute to the development of psychopathology. A point that deserves attention concerns the way attachment was conceptualized in this study. Previous studies (Kemp & Niemeyer, 1999; Mikulincer & Florian, 1998) have tended to favour a grouping-approach to attachment, thereby classifying individuals into one of the four (or three) attachment patterns. An ongoing debate (see for example Bartholomew & Shaver, 1998; Griffin & Bartholomew, 1994; Crowell & Treboux, 1995) concerning the measurement of adult attachment remains, but recently Fraley & Waller (1998) have pleaded in favour of a dimensional view of 112
attachment. This study differs from earlier research by using a dimensional approach to attachment, which may have contributed to the unexpected findings. In conclusion, a lot more is to be learned about the developmental pathways (Bowlby, 1988) that can lead individuals to maladjustment and psychological distress. The findings presented in this study underscore the fact that variables that are expected to influence each other should be simultaneously analyzed. In this way their interdependency can be taken into account and more elaborate models based on attachment theory can be constructed. Future studies might wish to focus on the mediational role stressful events may play when considering the relations between attachment and psychopathology. 113
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