Activating the attachment system modulates neural responses to threat in refugees with PTSD

Abstract

Social attachment systems are disrupted for refugees through trauma and forced displacement. This study tested how the attachment system mitigates neural responses to threat in refugees with PTSD. Refugees with PTSD (N=28) and refugee trauma-exposed controls (N=22) viewed threat-related stimuli primed by attachment cues during fMRI. We examined group differences and the moderating effects of avoidant or anxious attachment style, and grief related to separation from family, on brain activity and connectivity patterns. Separation grief was associated with increased amygdala but decreased ventromedial prefrontal (VMPFC) cortical activity to the attachment prime, and decreased VMPFC and hippocampal activity to attachment primed threat in the PTSD (vs TEC) group. Avoidant attachment style was connected with increased dorsal frontoparietal attention regional activity to attachment prime cues in the PTSD group. Anxious attachment style was associated with reduced left amygdala connectivity with left medial prefrontal regions to attachment primed threat in the PTSD group. Separation grief appears to reduce attachment buffering of threat reactivity in refugees with PTSD, while avoidant and anxious attachment style modulated attentional and prefrontal regulatory mechanisms in PTSD respectively. Considering social attachments in refugees could be important to post-trauma recovery, based within changes in key emotion regulation brain systems.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

“…A study on trauma-focused treatment demonstrated a concurrent improvement of PTSD symptoms and attachment avoidance and anxiety, pointing towards a correlation between attachment and stress-related symptoms (Rimane et al, 2022). Also, the result aligns with existing cross-sectional research linking insecure attachment, particularly attachment anxiety, to PTSD (e.g., Liddell et al, 2021), and PGD symptoms (Russ et al, 2022) in bereaved adults. However, due to the cross-sectional character of these studies and the present study, it remains unclear in how far the loss event has a possible impact on attachment styles themselves (e.g., increasing insecurity) and how the relation between attachment styles and PGD and PTSD symptoms develops over time.…”

“…Previous research has consistently linked attachment anxiety with symptoms of PGD, although results were less consistent for attachment avoidance and limited by the lack of longitudinal studies (Russ et al, 2022). For PTSD symptoms, research has also identified associations with insecure attachment in ASRs (e.g., Liddell et al, 2021;Morina et al, 2016). In a LCA in bereaved adults with PGD and comorbid depression diagnoses, attachment styles differentiated between classes, with high anxious attachment predicting the PGD/depression class and avoidant attachment predicting the depression class (Maccallum & Bryant, 2018).…”

Posttraumatic stress disorder in a war-affected area of Northeast Ethiopia: a cross-sectional study

“…This could be because family separation affects how well people recover psychologically from trauma when there is constant, forced separation from important attachment figures. In addition, this sense of loss may reduce the ability of the attachment system to function correctly, which could change how the brain regulates itself in the presence of perceived threats and stress, making people less able to handle daily pressures [ 48 ].This is supported by a study of the post-war conflict-affected population in Southern Sudan [ 33 ].Participants who had experienced stressful life events were more likely to have PTSD than those who had not. Stressful life events, such as problems with work, relationships, or finances, can exacerbate PTSD [ 49 ].…”

Posttraumatic Stress Disorder in Refugees

“…This experience may lead to attachment system fragmentation, which can be problematic because secure attachments are important for mental health and represent a key emotion regulation strategy to buffer the effects of adversity. Indeed, priming awareness of attachment figures shows reduced buffering of neural responses to threats in refugees with PTSD or subsyndromal PTSD when experiencing grief connected to separation from family (Liddell et al 2021c). The attachment systems of refugees can be further compromised by the experience of interpersonal losses incurred through frequent bereavement resulting from war and other severe trauma.…”