Roles of attachment, reflective function and emotion regulation in the development of negative symptoms
Item statusRestricted Access
Embargo end date29/06/2020
In the context of developmental psychopathology and the psychological and social risk factors associated with psychosis and ‘schizophrenia’, this thesis proposes that early attachment interactions underlie the development of reflective function and emotion regulation which contribute to the emergence of negative symptoms. Attachment, reflective function and emotion regulation have been associated with mental health difficulties characterised by emotion dysfunction and interpersonal problems. However, there is very little research examining these factors in relation to the development of negative symptoms, perhaps due to historical conceptualisation of negative symptoms as ‘non-affective’ phenomena. Therefore, less research has been performed into possible interpersonal affective mechanisms driving negative symptoms than other disorders. Two studies, each using a quantitative cross-sectional design were used to examine the following primary questions: 1) Does attachment insecurity predict negative symptoms? 2) Is this relationship mediated by reflective function and emotion regulation? 3) Is psychological distress associated with negative symptoms? Secondary questions were: 1) Do attachment, reflective function and emotion regulation predict psychotic experiences? 2) Does self-agency mediate the relationship between attachment and negative symptoms? The first empirical study was a large-scale survey of 1647 participants aged between 16 and 35 years recruited online from the general population. Participants completed questionnaires measuring attachment, reflective function, emotion regulation, negative symptoms and distress. Data was analysed using univariate statistics, multivariate statistics and structural equation modelling. Results demonstrated that attachment insecurity predicted negative symptoms and this relationship was partially mediated by emotion regulation. Reflective function also predicted negative symptoms and distress significantly covaried with negative symptoms. Self-agency also acted as a partial mediator between attachment, reflective function and negative symptoms. Attachment, reflective function and emotion regulation also predicted psychotic experiences. Method The second empirical study examined attachment, reflective function, emotion regulation and negative symptoms in a help-seeking population of 52 young adults attending mental health and third sector services in Edinburgh and the Lothians. Participants were administered the Clinical Assessment Interview of Negative Symptoms (CAINS), Comprehensive Assessment of At-Risk Mental States (for psychosis) (CAARMS), and the Adult Attachment Interview (AAI) scored for attachment and reflective function. Participants also completed questionnaires measuring distress, emotion regulation, interpersonal problems and self-agency. Data was analysed using appropriate univariate statistics, multivariate statistics and path analysis. The sample was divided into three groups according to psychosis: non-at-risk mental state (n=17), at-risk mental state (n=18) and first-episode psychosis (n=17). Results The sample was characterised by high levels of distress, interpersonal problems, attachment insecurity, dysfunctional emotion regulation and low reflective function. Attachment insecurity significantly predicted reduced reflective function which mediated the relationship between attachment insecurity and negative symptoms. Emotion regulation was not predicted by attachment or reflective function, nor did it predict negative symptoms. Distress significantly covaried with negative symptoms. Discussion These results highlight the importance of investigating the underlying psychological mechanisms and considering the role of affect in the development of negative symptoms. Attachment insecurity, emotion regulation and reflective functioning play a role the emergence of negative symptoms which are related to psychological distress. Therefore, to improve understanding and treatment of negative symptoms, it is important to focus on these interpersonal affective mechanisms and consider how they interact with distress to contribute to negative symptoms.