Trauma and anxious attachment influence the relationship between suggestibility and dissociation: a moderated-moderation analysis

Abstract

Introduction: Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterized by superior imagination. Methods: This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility. Results: In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model. Conclusions: These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.

Anomalous experiences are more prevalent among highly suggestible individuals who are also highly dissociative

“…These results are broadly consistent with the extant literature on predictors of hallucinationproneness including a reported greater history of stressful life events (Bailey et al, 2018), an insecure attachment style (Berry, Fleming, Wong, & Bucci, 2018;Pilton et al, 2016), an increased predisposition to dissociative states (Pilton et al, 2015), and a heightened responsiveness to suggestions for hallucinations (Alganami et al, 2017;van der Ven & Merckelbach, 2003;Young et al, 1987), all of which characterize high dissociative or HDHS individuals (Marcusson-Clavertz, Gušić, Bengtsson, Jacobsen, & Cardeña, 2017;Terhune et al, 2011;Wieder & Terhune, 2019).…”

“…Suggestions are communications for involuntary changes in behavior or perception (Kirsch, 1999), such as "you will hear a voice say your name" (suggestion for an auditory hallucination). Responsiveness to suggestion can be measured following a hypnotic induction (hypnotic suggestibility) or when no induction is administered (non-hypnotic suggestibility), although the two tend to correlate moderately (Braffman & Kirsch, 1999;Wieder & Terhune, 2019). Both hypnotic and non-hypnotic suggestibility appear to covary with hallucination-proneness (Alganami, Varese, Wagstaff, & Bentall, 2017), unusual sleep experiences (Fassler, Knox, & Lynn, 2006), and other spontaneous anomalous experiences (Pekala, Kumar, & Cummings, 1992), as well as germane traits such as selftranscendence (e.g., proneness to experience a loss of boundaries between the self and others, or the rest of the world; Cardeña & Terhune, 2014).…”

A critical review of standardized measures of hypnotic suggestibility

“…Figure 1 presents modern hypnotic suggestibility scales in chronological order. We have omitted general-purpose scales that tap broader phenomenological features of hypnosis (Field, 1965b;Pekala, 1991), are not specific to suggestion (Polito et al, 2013), and/or are measures of non-hypnotic suggestibility (Wieder & Terhune, 2019).…”

“…Further measurement advances include the development of scales that can be quickly administered in clinical and experimental contexts (Elkins, 2014;Lush et al, 2018;Pekala et al, 2010;Spiegel & Spiegel, 1978) or online (Palfi et al, 2019;Wieder & Terhune, 2019).…”

“…Many of our proposed changes require a shift from traditional pencil-and-paper measures to computer-based assessment of hypnotic suggestibility. Such a shift opens up novel opportunities for online administration of scales (Palfi et al, 2019;Wieder & Terhune, 2019), harnessing smartphone technology, and complementing behavioural assessment with physiological measures (e.g., pupillometry).…”