Introduction: Depression is one of the most dominant universal mental health disorders and has a high rate of persistency and recurrence. Interpersonal theories posit that it is interpersonal, or relational, factors that serve to cause and maintain depression, which is supported by a growing evidence base. CBASP is an interpersonally-focused psychotherapy specifically designed for the treatment of chronic depression and employs a variety of cognitive, behavioural and interpersonal techniques within the therapeutic relationship to help individuals evaluate their interpersonal exchanges and consider the implications. Research has highlighted the effectiveness of CBASP for this client group, however there is limited research investigating therapist and client factors that contribute to positive outcomes. Attachment style and mentalization are two such factors that are theoretically and empirically linked to an individual’s way of relating to others but have not been investigated in relation to outcomes in CBASP. Aims: A systematic review aimed to identify and evaluate significant social and interpersonal mediators that account for the relationship between attachment style and depressive symptoms. An empirical study then explored the role of therapist and client attachment style, mentalisation, and therapeutic alliance on clinical outcomes in CBASP. Methods: A systematic search of the literature exploring social and interpersonal mediators between attachment style and depressive symptoms was conducted in order to identify and evaluate mediators. The empirical study used a longitudinal case series design where both therapist and client attachment style, mentalization and the therapeutic alliance were assessed, and clinical outcomes were measured at each session to allow evaluation of change over time. Results: The systematic review provided evidence that specific social and interpersonal variables mediate the relationship between attachment and depressive symptoms, specifically social support, social anxiety, social self-efficacy, relationship satisfaction, interpersonal negative events, and interpersonal dependency. Two studies failed to find mediating effects of social support and social self-efficacy. The findings of this review are interpreted with caution as there contained several methodological limitations that affect the ability to generalize to other populations and infer causation. Findings from the empirical study provided evidence for the role of therapist attachment style and mentalization in relation to the therapeutic alliance and clinical outcomes in chronic depression in CBASP. Client attachment style and mentalization were not found to have a significant impact on the process of change but did account for some variance in symptoms of depression. Findings should be cautioned due to the small sample size and lack of statistical power to detect smaller effects. Discussion: The findings of this thesis suggests that there exist social and interpersonal factors that mediate the relationship between attachment style and depressive symptoms, and this has clear socio-political and clinical implications. However more research using robust methods of design and statistical analysis are needed in order to provide clarity in this field. The empirical study provided rich and novel data that suggests that therapist attachment style and mentalization, more so than client factors, are important in developing the therapeutic alliance and promoting symptom reduction over the course of treatment. Further research utilizing a larger sample size could provide more robust evidence for this association.

This dissertation identified key parallels between the theories of place attachment and interpersonal attachment, a comparison that then informed three objectives of the research program: (1) to explore the functions of place attachment and describe which are shared with interpersonal attachment; (2) to examine how these functions differ according to stable individual differences in place and person attachment; and (3) to assess whether these functions differ according to the geographical scale at which the attachment rests. An additional methodological goal was to bring a new approach to the study of place attachment, drawing on experimental paradigms used in interpersonal attachment research. Research objectives were achieved through the completion of three separate studies. Study 1 began the inquiry into the functions of place attachment with a content analysis of community members’ open-ended descriptions about places to which they consider themselves attached. Thirteen categories of benefits were revealed: memories, belonging, relaxation, positive emotions, activity support, comfort--security, self-growth, freedom--control, entertainment, connection to nature, practical benefits, privacy, and aesthetics. These functions were discussed with reference to the functions of interpersonal attachment previously identified in the literature. The next two studies used experimental methodologies to further evaluate, and expand upon, the functions of place attachment identified in Study 1. Study 2 evaluated whether a security function exists for place attachment by assessing the impact of threat exposure on the mental accessibility of place attachment words. Specifically, threat exposure was operationalized by mistakes made on a lexical decision task, and place attachment proximity was represented by participants’ subsequent reaction times to place attachment words in this task. Results showed that exposure to threats increased proximity-seeking to places of attachment, but not to other types of places. Study 3 evaluated the ability of place attachment to provide belongingness, control, meaningfulness, self-esteem, and improved affect, and this was done within the context of a commonly-used ostracism paradigm. Place attachment was manipulated using a visualization exercise, and ostracism was manipulated using a bogus rejection paradigm. The dependent variables included participants’ current moods and experienced levels of psychological need satisfaction (i.e., meaning, self-esteem, control, and belongingness). Although ostracism did not interact with the place attachment visualization, the latter was found to increase individuals’ current levels of self-esteem, meaning, belongingness, control and negative affect, but only among participants without an avoidant place attachment style. This comparison between interpersonal attachment and place attachment revealed some overlap between the two types of bonding, and most importantly, inspired new research questions and methodological approaches to advance the study of place attachment – a less mature theory, but one with much applied value and theoretical potential. / Graduate / 0451

Notre recherche a pour objectif de montrer que le modèle de l’attachement adulte constitue un facteur de vulnérabilité psychologique explicatif de la dépression des femmes et de son évolution sur deux aspects : la perturbation de la régulation émotionnelle (stratégies d’attachement) et l’insécurité des représentations des liens d’attachement passés (expériences parentales) et actuels (styles d’attachement amoureux et interpersonnel). Il s’agit de déterminer aussi les liens existants entre la personnalité des femmes déprimées et l’attachement adulte. Nous portons un intérêt plus spécifique à l’évolution des liens entre la dépression et les styles d’attachement (stabilité ou modification) durant l’hospitalisation. Les résultats principaux de notre étude indiquent des liens significatifs entre la dépression et l’insécurité des stratégies (à dominance préoccupée), des représentations des expériences passées (préoccupée et non résolues) et des styles d’attachement (à dominance craintive) amoureux et interpersonnel. Quant aux femmes déprimées ayant un trouble de personnalité, elles sont davantage préoccupées dans les représentations des relations actuelles. Enfin, les résultats montrent que seul le style d’attachement interpersonnel secure se modifie en fonction de la diminution de la dépression durant l’hospitalisation tandis que l’ensemble des styles d’attachement amoureux reste stable. Ces résultats permettent de mettre en évidence des caractéristiques psychopathologiques spécifiques chez les femmes déprimées concernant la perturbation de la régulation émotionnelle (hyper-activation des affects en lien avec les « troubles psychopathologiques internalisés », stratégies défensives de détachement, difficultés de mentalisation) et les représentations insécurisées des liens d’attachement passés (focalisation excessive sur les relations parentales, ambivalence, dépendance, expériences traumatiques) et présents (anxiété affective et relationnelle mais défiance par peur d’être rejetée). L’étude de l’attachement permet d’apporter des éléments de compréhension sur le lien insecure à l’autre chez les femmes déprimées présentant une personnalité pathologique. Nous discutons également des rapports entre la vulnérabilité dépressive et la stabilité ou la modification des styles d’attachement. Enfin, nous évoquons les perspectives thérapeutiques (notamment le travail sur la mentalisation) de l’étude et les limites / The purpose of our research is to show that the model of adult attachment constitute a factor of psychological vulnerability that explain women depression and its evolution on two levels: the disturbance of the emotional regulation (attachment strategies) and the insecurity of the representation of the past links of attachment (parental experiences), and the current ones (love and interpersonal attachment). The aim is also to determine the existing links between the personality of the depressed women and adult attachment. We have a more interest more specific in the study of the evolution between the depression and the patterns of attachment (stability or alteration) during hospitalization. The main results of our study show significant links between the depression and the insecurity of attachment strategies (mainly preoccupied), representations of the past experiences (preoccupied and unresolved) and love and interpersonal attachment styles (mainly fearful). As regards to depressed women suffering from a personality disorder, they are more preoccupied in the representations of the current attachment relations. At least; the results show than only interpersonal attachment styles modified according to the decrease of the depression during hospitalization, while all loving attachment styles remain stable.These results obviously allow to specific psychopathological characteristics in depressed women concerning the disturbance of the emotional regulation (hyper-activation of the affects, linked with internalizing psychopathological disorders, defensive strategies of detachment, and difficulties of mentalization) and the insecure representations of the past links of attachment (excessive focus of the parental relations, ambivalence, dependence, traumatic experiences) and present (relational and affective anxiety, but mistrust for fearof being rejected). The study of the attachment allows us to bring comprehensive elements about the insecure relationship to the other in the depressed women with a pathological personality. We also discuss about links between depressive vulnerability and stability or the modification of the attachment styles. At least we evoke the therapeutic perspectives (in particular the work of the mentalization) of the study and the limits.