Attachment theory clinical applications and daily-well-being in adolescents: a systematic review and experience sampling methodology study

Abstract

Two independent pieces of research are presented within this thesis. Firstly, a systematic review is presented which investigated changes in attachment for adolescents following psychotherapeutic intervention. Insecure attachment has long been implicated as a risk factor for the development of mental health problems, whereas attachment security has been evidenced as a protective factor. Studies have shown that attachment is particularly amenable to change during adolescence, a developmental stage with the highest incidence rates of mental health problems. It is therefore important to synthesise research which has examined if attachment can change following psychotherapeutic intervention and what effect this may have on mental health related outcomes. The review identified 19 reports of 17 studies, utilising a range of psychotherapeutic interventions and across various mental health presentations. The results showed that adolescent attachment improved in 15 of the 17 studies; five studies employed appropriate analyses to find that changes in attachment preceded improvements in mental health related outcomes, suggesting a casual role of change in attachment. This review highlights the importance of considering attachment as a transdiagnostic treatment target, beyond that of assessment and formulation, within this vulnerable developmental period. The literature base would benefit from studies with appropriate control groups and homogenous use of attachment measures.

Secondly, an empirical research study investigated the attachment theory of emotion regulation, using a mix of cross-sectional and experience sampling methodology during the daily lives of 25 adolescents receiving mental health service interventions and peers attending mainstream schools. Attachment dimensions of avoidance and anxiety, emotion regulation, global anxiety and global depression were assessed with baseline questionnaires. Participants then completed items measuring daily negative and positive affect, social contextual factors, and attachment over a period of one week. Results of multiple regressions analyses found that baseline attachment styles were not associated with emotion regulation or global anxiety and global depression. However, results of multilevel models found that, when momentary attachment was added to attachment styles as a latent variable, lower attachment security predicted emotion regulation (p < 0.001) and daily negative affect (p < 0.001). Emotion regulation also predicted daily negative affect within this model (p < 0.001) and acted as a mediator between attachment and daily negative affect. For positive affect, attachment was not associated (p = 0.073). However, attachment predicted emotion regulation (p = 0.001), and emotion regulation predicted daily positive affect (p < 0.001). These results show the importance of measuring attachment within real-life contexts and support the attachment theory of emotion regulation during adolescence.