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

Abstract

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.

Does disorganised attachment lead to auditory hallucinations via dissociation? An experimental study with an analogue sample

“…State paranoia reduced from pre‐ to post‐imagery in the secure imagery condition as predicted, though no change was seen in the disorganised condition. This is consistent with previous research showing that secure attachment priming reduces paranoia (Sood et al, 2021, 2022; Sood & Newman‐Taylor, 2020). In the current study, the effect was found in a sample highly predisposed to AHs who had not been selected for elevated levels of paranoia, indicating that the effect of attachment security priming on paranoia is replicable and robust.…”

“…Alternatively, the increase in dissociation might be due to secure images provoking distress in people with trauma histories (akin to fear of compassion; Gilbert et al, 2011). However, this has not been seen in previous priming studies which have recruited participants with high non-clinical paranoia, in which secure attachment priming is consistently associated with increased felt security (Newman-Taylor et al, 2021;Sood et al, 2021Sood et al, , 2022. The current study is the first to examine secure attachment priming in people vulnerable to voice-hearing, and future priming studies should control for past trauma (and linked beliefs).…”

“…They then rated vividness of the image on a 10-point scale from 1 (not at all) to 10 (very much), and finally estimated the percentage of time they had held the image in mind over the testing period (0-100%). The manipulation checks were used to compare pooled data between groups, and not to make inclusion/exclusion decisions for individual participants, as per our pre-registration and following other priming studies in analogue psychosis groups (e.g., Newman-Taylor et al, 2021;Sood et al, 2021Sood et al, , 2022.…”

A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation

“…This pragmatic study has been the first to explore the feasibility of conducting a trial comparing the effects of attachment security priming within an IAPT setting. The lack of any differences between the arms with regard to symptom reduction runs contrary to evidence using clinical (Carnelley et al, 2018;McGuire et al, 2018) and community (Sood et al, 2021) samples, where repeatedly priming attachment security has been found to improve symptoms. There are three key differences that might account for the disparity.…”

Temporal pathways from attachment insecurity to paranoia in a heterogeneous clinical sample: An experience sampling study

“…The findings from this study emphasize the possibility to target intervention on state attachment insecurity, which could lead to improved emotional experience and reduced paranoia. By identifying attachment‐related experience and needs together with contextual factors related to state attachment insecurity fluctuation, it would be possible to focus on the key problem areas and develop specific ER strategies and reorganize maladaptive interpersonal patterns and beliefs (Mallinckrodt et al, 2009; Newman‐Taylor et al, 2021; Sood et al, 2022b).…”