“Non-affective” psychotic disorders are in fact associated with a high rate of emotional disorders. A number of attachment-based models of impairments in emotion regulation and mentalization in psychosis have been put forward. The present thesis aimed to explore psychobiological markers of emotion regulation in order to develop and pilot a novel psychological intervention. The portfolio consists of six peer-reviewed published articles. Four studies were conducted involving 167 psychosis patients and 66 community controls resulting in four original articles, a theory paper and a metaanalysis. Paper 1- 3 explored emotion regulation using different methods (self-report, hormonal, attachment-based narrative). Paper 4 lays out a compassion-focused model for promoting emotional recovery from psychosis. Paper 5 presents data from a feasibility trial of Group Compassion Focused Therapy. Paper 6 presents an updated attachment- and compassion-focused model of emotion regulation and mentalization in the context of a meta-analysis of effects of intranasal oxytocin on symptoms and social cognition in psychosis. Childhood trauma – especially emotional abuse - was strongly associated with dissociation in psychosis patients compared to non-psychotic community controls – most strongly in chronic patients (Paper 1). Psychosis patients with childhood trauma showed significantly lower basal cortisol levels indicative of impaired stress regulation than those without childhood trauma (Paper 2). Impaired emotion regulation operationalised as attachment-based mentalisation was associated with problematic adolescent development and emotional and interpersonal adaptation to a first episode of psychosis in qualitative interviews. A novel attachment-based model for improving emotion regulation in psychosis by way of strengthening the caregiving/ receiving and affiliation system through Compassion Focused Therapy (CFT) was put forward (Paper 4). A feasibility trial showed that group CFT was safe, well-accepted and associated with greater clinical improvement and greater increases in compassion compared to treatment as usual. Increases in compassion in CFT were associated with reductions in shame, perceived social marginalisation, fear or relapse and depression (Paper 5). A metaanalysis of oxytocin administration as a biological way of strengthening the care-giving/receiving and affiliation system in psychosis was conducted yielding medium effects despite significant heterogeneity (Paper 6). Findings replicated the strong association between childhood trauma and dissociation in psychosis patients relative to controls highlighting the importance of emotional abuse and suggesting underlying difficulties with regulating distress related to early interpersonal trauma. Lower basal cortisol in patients with childhood trauma appeared to support the presence of emotion regulation difficulties due to early interpersonal trauma on a physiological level. Qualitative findings helped to generate hypotheses about inhibitors and facilitators of recovery and targets for intervention including the moderating role of mentalization. A novel attachment- and compassion-focused model was outlined and successfully piloted yielding important signals of change such as increases in compassion, which appear to reduce depression and social marginalisation in particular. This model helped account for inconsistencies in oxytocin studies of psychosis. In summary, findings extend existing research on emotion regulation in psychosis by supporting links to early interpersonal trauma and attachment and offer a promising novel attachment-and compassion-focused psychological intervention and a comprehensive biopsychosocial framework for further improving emotion regulation and mentalization in people with psychosis.

Idag är kärlek ett studerat område som blivit både populärt och mer vedertaget inom psykologiämnet. Denna studies grundläggande teori är The Colour Wheel Theory of Love, som beskriver sex attityder inför kärlek: Eros, Ludus, Pragma, Storge, Mania och Agape. Vidare användes anknytningsteori i form av vuxenanknytning. Studiens syfte var att studera huruvida det finns något samband mellan en persons anknytningsdimension samt dennes attityd inför kärlek. Studien var en enkätundersökning utifrån två instrument: ENR (Erfarenheter i Nära Relationer) samt The Love Attitudes Scale. I studien deltog 22 män och 59 kvinnor. Resultatet visade tre signifikanta modeller där anknytningsdimensionerna predicerade tre beroende variabler: kärleksattityderna Eros, Ludus och Mania. Hög grad av Ångest visade samband med Mania och hög grad av Undvikande med Eros och Ludus. Könsskillnader återfanns i Mania där kvinnor tenderade att se på kärlek mer maniskt än män. Studiens slutsats var att anknytningsdimensionerna till viss del predicerar en persons kärleksattityd.

Doctor of Philosophy / School of Family Studies and Human Services / Jared A. Durtschi / Perceptions regarding the causes and intentions behind partner transgressions are often just as important as the transgressions themselves. Although mindfulness-based interventions have been useful in clinical work with couples, the potential role that mindfulness plays in attributions is unclear. Using a sample of 542 young adults in romantic relationships, I explored the direct and indirect associations among attachment, trait mindfulness, and attributions. Specifically, I conducted a latent profile analysis, a person-centered approach, through which I identified four latent classes of trait mindfulness, including a High Mindfulness class, a Nonjudgmentally Aware class, a Low Mindfulness class, and a Judgmentally Observing class. I then ran a path analysis and found a number of significant direct effects. For example, relative to membership in the Low Mindfulness, membership in the High Mindfulness class and the Nonjudgmentally Aware class were associated with more benign attributions. I also found two significant indirect effects. First, heightened attachment anxiety was associated with an decreased probability of being Nonjudgmentally Aware class relative to the Low Mindfulness class, which was inversely linked with benign attributions. Second, avoidant attachment was linked with a decreased probability of membership in the High Mindfulness class relative to the Low Mindfulness class, which was linked to a decrease in benign attributions. The clinical implications and areas for future research based on the findings of this study are discussed.

Psychosocial research is increasingly focused on attachment, specifically on the potential mechanisms associating attachment with psychological functioning (Cassidy & Shaver, 2016). In past decades, attachment research has sought to better understand the development of individual psychological distress as well as relationship distress, given its major impacts on the overall well-being of individuals. It is worth noting that researchers have identified specific intrapersonal and interpersonal factors that are important variables to consider in the link between attachment and both individual distress and relationship dissatisfaction (Ensel & Lin, 1991; Hobfoll, 2002). However, little attention has been paid to investigating these mechanisms using a dyadic approach in order to gain a better understanding of reciprocal impacts within couple relationships. Since dyadic research methods have not been commonly utilized for understanding distress within an attachment framework, this has limited our understanding of the effect partners have on one another. Consequentially, the importance of dyadic effects has possibly been minimized in research. The present thesis, composed of two main studies, aims to verify if self-esteem and dyadic trust help explain the link between insecure romantic attachment (attachment anxiety and attachment avoidance) and individual and relationship distress using actor-partner interdependence mediation model analyses. The studies presented in the present thesis were approved by the University of Ottawa’s Research Ethics Board. The first study was comprised of two separate studies, both of which aimed to assess a conceptual model examining whether low self-esteem mediates the relationship between insecure romantic attachment and high psychological distress using two independent samples within unique periods in adulthood: a young adult student sample and a sample of couples in later adulthood who are parents. The first sample consisted of 485 Canadian university students (414 females; M age= 19.83 years) who were all in a couple relationship for at least 6 months at the time of participation. Bootstrapping procedures were utilized to assess indirect effects, and results supported our hypothesized model. As such, low self-esteem mediated the relationship between insecure romantic attachment and high psychological distress for both men and women. The second sample consisted of 35 couples in later adulthood who are parents (70 individuals, M age = 41.04 years). An actor-partner interdependence meditational model was tested to assess actor, partner, and indirect effects. Results showed that low male self-esteem partially mediated the relationship between male attachment anxiety and high male psychological distress. Similarly, low female self-esteem partially mediated the relationship between female attachment anxiety and high female psychological distress. Interestingly, high female self-esteem partially mediated the relationship between female attachment avoidance and low female psychological distress. Unexpectedly, low self-esteem in women fully mediated the relationship between female attachment anxiety and low male psychological distress. In the same vein, high self-esteem in women partially mediated the relationship between female attachment avoidance and high male psychological distress. The second study investigated whether low dyadic trust mediates the relationship between insecure romantic attachment and low relationship satisfaction in a third independent community sample of heterosexual couples engaged in a relationship for at least 12 months. The sample consisted of 199 Canadian couples ranging from young to later adulthood (398 individuals, M age = 31.02 years). An actor-partner meditational model was used to test hypothesized relations. Results revealed that lower dyadic trust partially explained the relationship between both male and female attachment avoidance and male attachment anxiety with lower relationship satisfaction. Findings from these studies have major implications for both clinical applications as well as future research directions. Specifically, gaining a better understanding of the role of romantic partners in the overall well-being of individuals can confirm as well as guide couple therapy conceptualizations and techniques. Uncovering existing dyadic patterns can also help support romantic relationship theories and shape future research avenues.

Background: It is estimated that adolescent offenders account for 65% of contact child sexual abuse. A range of explanatory theories and models of intervention have been proposed. These are mainly based on cognitive theories with Cognitive Behavioural Therapy (CBT) and psycho-education remaining as the dominant models of treatment intervention. This research explored the issue of harmful sexual behaviour from the psychosocial perspective, drawing on attachment theory and social constructionism. Aim: The research explored attachment strategies among young people with harmful sexual behaviour. It examined young people’s understanding and explanations regarding their sexually abusive behaviour. This included an exploration of how the participants’ accounts and defensive strategies were shaped by wider family and cultural discourses regarding masculinity and sexual activity. In selected cases, the family intergenerational patterns of attachment and emotional regulation were analysed. Furthermore, the research explored the prevalence of harmful sexual behaviour in the study area. This included an exploration of statutory responses and services which were offered to people who engaged in harmful sexual behaviour. Methods: The research employed three interconnected research methods: a) a quantitative audit data of fifty cases which had been reported to the Children’s Services; b) qualitative and descriptive quantitative exploration of eight Transition to Adulthood Attachment Interviews and semi-structured interviews; c) qualitative exploration of the family context and trans-generational patterns of defensive strategies by conducting an Adult Attachment Interview in three cases. The analysis of the attachment and open-ended interviews utilised a combination of the structured ‘discourse analysis’ developed for the Adult Attachment Interview and Critical Discourse Analysis. Findings: The research found that there was no clear and consistent pathway of social care for young people who engaged in harmful sexual behaviour. The analysis of psychological defensive processes found that all of the participants presented with complex insecure attachment strategies alongside intrusions of unresolved traumas or losses. The exploration of intergenerational patterns of attachment strategies identified that all parents showed complex avoidant attachment strategies with intrusion of unresolved trauma and loss. The qualitative study identified a range of discourse themes and strategies in the accounts the young people offered in order to explain their actions and to maintain their sense of self. The dominant discourse themes shared by the young people were: a) life is hard and violence is normal; b) a sense of powerlessness; c) sexual entitlement, d) bravado and denial of vulnerability. Conclusion: Complex insecure attachment strategies with intrusion of trauma and loss play a significant role in the development of harmful sexual behaviour. In addition, the study suggests that the complex relationship between care, comfort and sexual behaviour should be a central focus of clinical interventions with this group of young people and should be investigated further in future research studies.

The purpose of my study is to highlight the knowledge of toddlers introduction to preschoolfrom the educators perspective. Four educators have been interviewed about their experiences regarding toddlers introduction seen as a phenomenon. My thesis approach is inspired by phenomenology. My research questions focus on the following: educators experiences of different introduction models to preschool, what do the educators believe is significant for creating security for the child and can the educators see any changes regarding the introduction during their years in preschool? The surveys data is collected with the method of qualitative interviews followed by an analysis based on the phenomenological approach. In my findings I could see that the educators use what is called parent active introduction when introducing toddlers into preschool. The parents role during this model is to be active and helpin the daily activities along with their children. All the educators had experiences with the old, traditional model in which the parents took a more secluded role. All the educators where satisfied with the model they were using during the introduction. They all mentioned the importance of making the parents feel comfortable and safe in the environment and how that could help when bonding with the toddler. The educators expressed that making the toddlerand parent feel safe was the most important issue when introducing them to preschool.

Introduction Individual’s attachment style and coping styles have been suggested to be related to each other whereby early attachment experiences shape the coping behaviours that individuals are most likely to engage in at times of stress. A systematic review was carried out to examine the available literature on attachment status and coping style in both adolescent and adult populations with the aim of establishing what is currently known about the association between these two concepts. A research study was carried out with the aim of investigating the relationship between adolescents’ attachment type, coping style and participation in health risk behaviours. The study also aimed to explore the relationship between attachment, coping and personality state dominance. Method A literature search was conducted following PRISMA (2009) and Cochrane (2008) guidelines. Papers were quality assessed and strengths and limitations considered. With regards the empirical project, a cross-sectional survey design was adopted to investigate the mediating role of coping style on adolescent risk taking and its relationship with attachment and state dominance (negativism and telic). Seventy-six first year psychology undergraduate students participated in the study. Participants completed the A-RQ attachment questionnaire, the ACS coping questionnaire, the TDS and NDS personality trait questionnaires, the YRBS behaviour questionnaire and the SDQ mental health screening tool. Results The systematic review yielded an initial 812 papers from use of the search terms. Eleven papers met criterion for inclusion in the review. The papers were quality assessed and strength and difficulties of the papers were reviewed. The findings highlight the need for further robust investigations into the subject area, and recommendations are made for future investigations. With regards the empirical project, analysis revealed that the relationship between attachment security and risk taking related to feelings of sadness and plans or attempts to carry out suicide. This was not mediated by use of higher levels of unproductive coping in adolescents. Analysis also revealed that high negativism dominance predicted increased participation in alcohol, tobacco and drug misuse. This relationship was not mediated by increased use of unproductive coping behaviours. Conclusions The need to establish a more consistent conceptualisation of coping was apparent. It was suggested that future research needs to address limitations in the field including the validity of some self-report measures of attachment, inconsistency in selection of measures, over-reliance on self-report measures and an absence of research out with westernised cultures. Adolescents’ attachment insecurity in key relationships would seem to be one vulnerability factor that contributes to the development of emotional difficulties and adolescents’ preference for being in a rebellious state (high negativism dominance) would seem to contribute to participation in risky substance misuse and so at the very least, these should be considered as predictors for engagement in specific types of health risk behaviour.

Background. Recent research into attachment theory has suggested it provides a useful framework for understanding the psychological therapeutic process. Clinical application of attachment theory has been a recent development in adult mental health research. Previous studies have focused on patient attachment styles and a systematic review of the literature highlights the limited research that explores both patient and clinician attachment patterns. The reported study aims to explore both patient and therapist attachment and the dyadic interaction on the therapeutic process, and, in particular, how attachment influences the early engagement and development of the therapeutic alliance. Methods. Patient participants and clinician participants completed a self-report measure of attachment prior to commencing a psychological intervention. Early engagement was measured through appointment attendance and independent therapeutic alliance ratings from patients and clinicians were completed after the third appointment. Correlations and regression analysis explored the extent to which patient and clinician attachment predicts early engagement and the therapeutic alliance. Results. Fifty-five patients and 38 clinician’s self-report attachment styles indicate greater security amongst clinicians. Patients presenting to mental health services reported higher levels of anxious and avoidant attachment patterns, which were predictive of greater psychological distress. Patient avoidant attachment was associated with poor engagement and both patient anxiety and avoidance attachment were predictive of therapeutic alliance. No relationship was found between therapist attachment and early engagement or therapeutic alliance, and there were no significant interactions between patient and therapist attachments patterns. Conclusions. Findings from the current study suggest that patient attachment style is predictive of reported psychological distress, early engagement and therapeutic alliance. Applying the principles of attachment theory to clinical practice could therefore provide greater insight into the interpersonal dynamics between patient and therapist and help inform services as to how to improve engagement and alliance with insecure patients. The strengths and weaknesses of the study are discussed, which highlights the need for further research with larger samples to build on the current limited findings.

Objective: The Exeter Model is an integrative systemic-behavioural and systemic-empathic couple therapy for treating people with depression. ‘Attachment narratives’ is a component of the systemic-empathic approach, which seeks to help the couple understand how past relationships impact on the current relationship with the aim of rebuilding trust and security between the couple. This study sought to examine how attachment narratives in this Model are used by therapists. Method: Narrative Analysis was employed to explore attachment narratives in three couples who had completed therapy in an outpatient clinic where one member of the couple had been referred with depression. Results: Analysis highlighted four specific ways in which therapists used attachment narratives. These consisted of: therapist enabled stories of past relationships to be foregrounded; attachment theory employed to build hypothesis about attachment styles based on past relationships; therapist helped the couple understand how attachment styles maintain unhelpful cycles of relating and introduced alternative relationship narratives enabling improved trust and security. Analysis also demonstrated the structuring of these attachment narratives across the therapy sessions. Conclusion: This study shows that through the therapist paying attention to attachment styles, awareness of unhelpful cycles of relating within couples can be highlighted, and adjustments to how the couple can relate to each other suggested. This exploratory study serves to better inform the use of the Exeter Model.

Doctor of Philosophy / School of Family Studies and Human Services / Jared A. Durtschi / Despite previous literature illustrating strong links between social relations, mental health, and health outcomes, much remains unknown regarding the associations among adult romantic attachment, depression, and reports of physical health within those diagnosed with a chronic disease. Using a sample of 197 individuals who reported a diagnosed chronic disease and in a cohabiting or romantic relationship from the Flourishing Families Project, a mediated latent growth curve analysis was used to test to what extent trajectories of reported physical health across two years were a function of attachment and depression. Specifically, trajectories of physical health were modeled to examine changes over two years with time-invariant covariates of depressive symptoms and adult attachment predicting initial levels of physical health and changes in physical health over time. Results indicated that as depressive symptoms increased, initial levels of physical health were worse. Higher reports of attachment anxiety were linked with better initial reports of physical health. Further, higher reports of depressive symptoms and attachment anxiety predicted a significant upward shift in the expected trajectory of improved physical health. These results expand current research and theory by examining how adult attachment and depression are linked with expected trajectories in physical health over time.