The underlying mechanisms: An investigation of attachment and mentalization within adolescent severe and enduring mental ill health
Background Regarding adolescence developmental psychopathology and the psychological correlates associated with the onset of severe and enduring mental health in adolescence, this thesis proposes that early attachment related experiences underlie the successful ability to regulate emotions, negotiate interpersonal interactions, assess and utilise social support and develop the necessary mentalizing skills for organizing and understanding both the self and others. Insecure attachment and poor reflective function appear to be linked to clinical samples yet the underlying mechanisms for how these constructs affect adolescent psychopathology and subsequent psychological adaptation have still to be examined. Objectives A quantitative cross sectional design was utilised to investigate the following research questions; 1) Is attachment and reflective function directly and indirectly associated with psychological adaptation to mental health difficulties in adolescence? 2) Do emotion regulation, interpersonal difficulties and social support mediate the effect of attachment and reflective function? Methods 75 participants were recruited from three Tier IV Child and Adolescent Mental Health Services in Edinburgh. They were asked to complete questionnaires measuring the variables of mood, interpersonal difficulties, emotion regulation and social support. The Adult Attachment Interview was administered and coded to ascertain the individual‟s attachment classification and was scored to measure their levels of reflective function when considering their childhood experiences. Structural equation modelling (SEM) was used to analyse the data. Results The emergent clinical picture of this sample was one of adolescents with interpersonal difficulties, moderate distress and poor psychological adaptation. The dominant attachment classification was insecure/ dismissing. The observed level of reflective function indicated that participants could refer to mental states but that these references were not made explicit and their understanding of the intentions of others was likely to be general or superficial. SEM analysis demonstrated that reflective function significantly and directly predicted psychological adaptation but not low mood. In contrast attachment demonstrated a significant indirect path to adaptation, being fully mediated by internally dysfunctional emotion regulation strategies. These maladaptive emotion regulation strategies directly predicted low mood and indirectly predicted psychological adaptation. In terms of the social support construct, the discrepancy between the support desired and the support received directly predicted adaption and partially mediated the relationship between reflective function and and psychological adaptation. Discussion The theoretical implications of the results centred on the importance of investigating the underlying mechanisms of attachment and mentalization in the psychological adaptation of adolescents with severe and enduring mental health difficulties. Emotion regulation, interpersonal difficulties and social support were found to play a significant role in low mood and adaptation thus enhancing the current understanding of psychological distress and chronic difficulties for this population. Further clinical implications were discussed concerning the recommendation of promoting and utilizing a mentalization based approach when working with clinical adolescent populations.