Understanding the effect of attachment styles in paranoid ideation: The mediator role of experiential avoidance

Abstract

Objectives: 1) to evaluate diff erent attachment styles depending on the attachment figure; 2) to explore the association between experiential avoidance and paranoid ideation frequency; 3) to test a mediation model in which the impact of adult attachment on frequency of paranoid ideation occurs through experiential avoidance. Method: We assessed adult-attachment, experiential avoidance and paranoid ideation frequency in a sample of 37 (30 male and 7 female) outpatients and inpatients with a psychosis-spectrum diagnosis. Results: The anxiety attachment pattern was significantly higher in all attachment figures. We found that attachment anxiety (mother) was associated with both experiential avoidance and paranoid ideation. An association between experiential avoidance and paranoid ideation frequency was also found. Results show that experiential avoidance mediated the relationship between attachment anxiety and paranoid ideation frequency. Conclusion: Our study highlights the importance of addressing therapeutically the mechanisms people with psychosis use to cope with the internal experience elicited by insecure attachment styles, specifically experiential avoidance, and suggests the adequacy of acceptance and mindfulness-based therapies in promoting recovery for psychotic patients.

The relationship between insecure attachment and paranoia in psychosis: A systematic literature review

“…The inclusion of participants with affective psychoses in this study could have introduced heterogeneity, and the sample size was small, limiting generalizability of findings. In another study, attachment was positively associated with paranoia ( r = .33) in an inpatient sample (Castilho et al ., ). Mediation analyses reported that experiential avoidance mediated the relationship between attachment anxiety and paranoia.…”

“…The two studies that used longitudinal designs were considered more methodologically robust in the assessment of this association and achieved a moderate rating (Berry et al ., ; Sitko et al ., ). Six studies (Castilho et al ., ; Dozier & Lee, ; Fett et al ., ; Korver‐Nieberg et al ., ; MacBeth et al ., ; Strand et al ., ) did not statistically control for relevant confounders (e.g., illness severity, comorbidity of hallucinations). Two studies were rated as strong (Sitko et al ., ; Wickham et al ., ) as these controlled for several relevant confounders.…”

“…Positive associations between attachment anxiety (or a ‘pre‐occupied’ attachment) and paranoia were reported in seven out of 11 studies that investigated attachment anxiety representations (Castilho et al ., ; Fett et al ., ; Korver‐Nieberg et al ., , ; Ponizovsky et al ., ; Strand et al ., ; Wickham et al ., ). Correlational effect sizes across studies tended to be moderate, ranging from r = .18 to r = .46.…”

“…One study (MacBeth et al ., ) used the Adult Attachment Interview (AAI; George, Kaplan, & Main, ) for categorical classifications of attachment (secure, dismissing, and pre‐occupied). One study (Castilho et al ., ) used Experiences in Close Relationships – Relationship Structure (ECR‐RS: Fraley, Heffernan, Vicary, & Brumbaugh, ) to assess attachment anxiety and avoidance.…”

“…In relation to withdrawals, one longitudinal study reported 80–100% of participants completing the study, earning a strong rating (Sitko et al ., ), with one study reporting that <60% of participants completed the study (Berry et al ., ; earning a weak rating). Analyses were rated as stronger in eight studies that clearly examined the relationship between attachment and paranoia, with the other four studies rated as moderate (Castilho et al ., ; Dozier & Lee, ; MacBeth et al ., ; Ponizovsky et al ., ).…”