Family therapy and EMDR after child abuse and neglect: moderating effects of child attachment style and PTSD symptoms on treatment outcome.

Background: Effective and appropriate care and treatment for children in order to decrease the psychosocial problems that arose after experiencing child abuse and neglect (CAN) is of vital importance, given the severity of symptomatology that may develop.Objective: The purpose of the present study was to examine whether attachment style and core cluster Posttraumatic Stress Disorder symptoms acted as moderators for treatment outcomes of a new integrative treatment model for trauma and attachment. In this treatment model, family therapy is combined with EMDR and obstacles for trauma processing are tackled first.Method: we included children, ages 6-12 years, with a history of CAN, who did not respond to evidence-based trauma treatment. Target treatment outcomes were problems in attachment, posttraumatic stress symptoms, behaviour, and emotion regulation. We conducted a multiple-baseline ABC Single-Case Experimental Design (SCED). We categorized 12 participants into four groups of attachment style and core cluster PTSD symptoms: (1) non-disorganized & re-experiencing; (2) non-disorganized & avoidance/hyperarousal; (3) disorganized & re-experiencing; & (4) disorganized & avoidance/hyperarousal. We compared the four groups with each other and across time, and the interaction between groups and effect over time. We conducted non-parametric permutation tests and estimated q-values for false discovery rate control.Results: Children with a disorganized attachment style had more severe symptomatology in general, except for posttraumatic stress symptoms. The treatment appeared more effective in targeting and successfully treating children with a non-disorganized attachment style, and specifically children with a non-disorganized attachment style and re-experiencing as core cluster PTSD symptoms.Conclusion: Our study underlines the complexity of treating children who developed a complicated combination of symptomatology after CAN and calls for the continuous development of innovative interventions.

The purpose of the present study was to identify possible moderators for the treatment outcome of children with early childhood abuse in the integrative treatment model for trauma and attachment.Type of attachment style and type of core cluster PTSD symptoms seem to moderate treatment outcomes.This study underlines the complexity of treating children who suffer from a complicated combination of posttraumatic stress symptoms, attachment problems, and behaviour and emotion regulation problems after child abuse & neglect.

The meaning of touch: Relational and individual variables shape emotions and intentions associated with imagined social touch.

Touch is a key channel for conveying meaning in social interactions. The affective quality of touch and its effects on well-being are shaped by relational context (relationship between touch giver vs. recipient) and person variables (e.g. adult attachment style). Yet, such effects have not been explored in relation to the meaning ascribed to touch. We used data from the Touch Test, the world's largest touch survey, which included questions on the degree to which people felt and related specific emotions and intentions to imagined gentle stroking touch and hugs. In N = 23,428, we examined how relational context (imagined source of touch) and person variables (gender, recalled positive childhood touch and adult attachment style) were associated with positive (e.g. love, desire, support) and negative (e.g. fear, anger, warning) emotions and intentions related to imagined touch. Love, desire and support were endorsed more when participants had had their partner (vs. someone else) in mind, and women (vs. men) gave lower ratings for desire overall. Gentle stroking touch was most linked with arousal when participants had had their partner in mind. Further, more positive childhood touch and secure and anxious attachment scores were associated with more positive emotions and intentions, while the opposite was found for avoidant attachment scores. Lastly, positive childhood touch and higher anxious attachment scores were related to greater discrimination between distinct emotion and intention categories, while higher attachment avoidance was associated with reduced discriminability. Thus, contextual and person variables matter in shaping the meaning of social touch.

Attachment Styles and Parenting Attitudes in Adults With "Pseudo-Attention-Deficit/Hyperactivity Disorder".

Background The number of individuals who experience the onset of attention-deficit/hyperactivity disorder (ADHD)-like symptoms after the age of 12 years has been growing, which does not meet the diagnostic criteria for adult ADHD. We designated this condition as "pseudo-ADHD" and investigated its psychological implications by comparing the parenting attitudes in childhood and attachment styles among individuals with "pseudo-ADHD," those with adult ADHD, and healthy controls. Methods We conducted an online cross-sectional survey of adults aged 18 years. Participants in the analysis included individuals with "pseudo-ADHD" (n = 46), adults with ADHD (n = 23), and healthy controls (n = 758). The Parental Bonding Instrument (PBI) was used to evaluate parenting attitudes, and the Experiences in Close Relationships Inventory for the Generalized Other (ECR-GO) was used to evaluate attachment styles. One-way analysis of variance was performed to compare the PBI and ECR-GO scores among the three groups. Results Regarding the PBI scores, a significant main effect of group was found for the paternal care scores (p = 0.002), and the "pseudo-ADHD" group did not differ significantly from the adult ADHD group or healthy control group (p = 0.378, p = 0.228, respectively). A significant main effect of the group was found for the maternal care scores (p < 0.001). The "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p = 0.005), whereas there was no significant difference compared to the healthy control group (p = 1.000). A significant main effect of the group was also found for the paternal overprotection scores (p < 0.001). The "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p = 0.002), whereas there was no significant difference compared to the healthy control group (p = 0.571). A significant main effect of group was found for the maternal overprotection scores (p < 0.001), and the "pseudo-ADHD" group did not differ significantly from either the adult ADHD group or the healthy control group (p = 0.060, p = 0.161, respectively). Regarding ECR-GO scores, a significant main effect of group was found for the fear of abandonment score (p < 0.001), and the "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p < 0.001) and significantly higher than the healthy control group (p = 0.005). Conclusion This study suggested that the parenting attitudes of parents of individuals with "pseudo-ADHD" were not different from those of the healthy controls. For attachment styles, the fear of abandonment was higher in individuals with "pseudo-ADHD" than in healthy controls, but not as high as in patients with adult ADHD. This study highlights, for the first time, the importance of considering attachment styles in the diagnosis and treatment of individuals with ADHD symptoms in adulthood.

A cluster analysis of attachment styles in patients with borderline personality disorder, bipolar disorder and ADHD.

BACKGROUND: Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses. METHODS: K-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD. RESULTS: Three distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses. CONCLUSIONS: The three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Losing a parent during childhood: The impact on adult romantic relationships.

The disruption of the parent-child attachment bond due to parental death (PD) may lead to lingering feelings of unsafety or insecurity that might potentially transfer to adult intimate relationships. The aim of the current study was to investigate whether experiencing childhood parental death (CPD) was associated with adult romantic relationship formation and stability, attachment style, and relationship satisfaction, and whether this is dependent on (in)secure parental bonding. In this cross-sectional study, relationship indicators were assessed using self-report questionnaires in adults (25-45 years old) who experienced PD during childhood (n = 236), in adulthood (n = 301), and who did not experience PD (n = 278). Experiencing CPD was not associated with relationship formation, relationship stability indicators, and relationship satisfaction. However, individuals who experienced CPD reported higher levels of attachment anxiety and avoidance within their current romantic relationship compared to individuals who did not experience (childhood) PD. Furthermore, insecure bonding with the deceased parent was associated with higher levels of attachment anxiety, while this was not the case for the quality of bonding with the surviving parent or new partner of the surviving parent. These findings on the association between CPD and adult attachment insecurity provide new insight in how attachment insecurity to the deceased parent may be related to attachment insecurity in adult relationships, which is important to discuss when working with individuals who experienced CPD.

Difficulties in emotion regulation and attachment styles among Kurdish individuals in Eastern Turkey with substances use disorders.

The aim of this study was to investigate the relationship between attachment style and emotion dysregulation in Kurdish individuals with substance use disorders (SUDs) in Eastern Turkey, a non-Western, Islamic society, in a descriptive cross-sectional design. This study was conducted with 216 individuals with SUDs who were treated at the SBU Van Training and Research Hospital Alcohol and Substance Addiction Treatment Center in Eastern Turkey between April 2023 and June 2023. Almost half of the participants (44.5%, n = 96) were between 18 and 30 years old and almost all were men (96.3%, n = 208). The most commonly used substances were heroin (46.3%, n = 100), marijuana (28.7%, n = 62) and synthetic cannabinoids (7.9%, n = 12). The results showed that higher levels of emotion dysregulation were associated with increased avoidant attachment and anxious attachment style. The study found that anxious and avoidant attachment styles were a significant predictor of emotion dysregulation. These findings suggest that attachment styles may play an important role in emotion dysregulation in Kurdish individuals with SUDs. Future research should investigate whether interventions targeting attachment-based interventions could be effective in reducing emotion dysregulation in Kurdish individuals with SUDs.

Bereavement guilt among young adults impacted by caregivers' cancer: Associations with attachment style, experiential avoidance, and psychological flexibility.

OBJECTIVES: This paper focuses on the experiences of bereavement guilt among young adults bereaved by a caregiver's cancer, examining associations with attachment style, experiential avoidance, and psychological flexibility with the aim of informing psychosocial interventions for this population. METHODS: Ninety-seven young adults (18-25 years) bereaved by a parent/guardian's cancer completed an online survey, including measures of bereavement guilt, attachment style, experiential avoidance, and psychological flexibility. Mediation analyses explored the associations between attachment style (anxious, avoidant) and bereavement guilt, and if these associations were mediated by experiential avoidance or psychological flexibility. RESULTS: Bereavement guilt was significantly positively associated with anxious, but not avoidant, attachment to the deceased; the relationship between anxious attachment and bereavement guilt was partially mediated by experiential avoidance. Bereavement guilt was also negatively associated with psychological flexibility and engagement with bereavement counseling. SIGNIFICANCE OF RESULTS: Given the limited literature on cancer-related bereavement in young adulthood, this study offers important theoretical and clinical insights into factors associated with more complex aspects of grief in this population. Specifically, this work identified that anxious attachment is associated with ongoing bereavement complications in the years following the death of a caregiver to cancer, with experiential avoidance partially mediating this relationship. While further research is needed to better understand the interaction between these factors and other related constructs, such as psychological flexibility, these findings may be helpful in selecting therapeutic approaches to use with this population.

Childhood trauma and suicide risk: Investigating the role of adult attachment.

BACKGROUND: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population. METHODS: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days. RESULTS: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance. LIMITATIONS: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases. CONCLUSIONS: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.

Neural correlates of distress and comfort in individuals with avoidant, anxious and secure attachment style: an fMRI study.

Despite a growing literature, experiments directly related to attachment are still needed. We explored brain processes involved in two aspects of attachment, distress and comfort. Seventy-eight healthy adult males with different attachment styles (secure, avoidant, and anxious) viewed distress, comfort, complicity-joy and neutral images (picture database BAPS-Adult) in an fMRI block design. ROIs from the modules described in the functional Neuro-Anatomical Model of Attachment (Long et al. 2020) were studied. Secure participants used more co- and self-regulation strategies and exhibited a higher activation of the reward network in distress and comfort viewing, than insecure participants. Avoidant participants showed the lower brain activations. Their approach and reward modules were the least activated in distress and comfort. Anxious participants presented both higher activations of the approach and aversion modules during complicity-joy. In addition, comfort and complicity-joy were processed differently according to attachment styles and should be differentiated among positive stimuli to disentangle attachment processes.

Attachment styles and empathy in trainee nurses: the mediating and moderating roles of attitudes toward death.

Aim: A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses. Methods: A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis. Results: We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment-related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking. Conclusion: Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue.

Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Insecure Attachment, Oxytocinergic System and C-Tactile Fibers: An Integrative and Translational Pathophysiological Model of Fibromyalgia and Central Sensitivity Syndromes.

Although the pathophysiology of fibromyalgia syndrome has been better understood in recent decades, a unified model of its pathogenesis and an effective therapeutic approach are still far from being realized. The main aim of this article will be to delve into the fundamental mechanisms of the pathophysiology of fibromyalgia conceptualized as stress intolerance syndrome. Using the biopsychosocial model of chronic pain syndromes, we will describe the potential role of the attachment system, C-tactile fibers, and oxytocinergic system dysfunction in the pathophysiology of fibromyalgia syndrome and other central sensitivity syndromes. At the end of the article, the therapeutic implications of this new global and translational pathophysiological model will be briefly discussed.

Mother-child memory conversation and children's independent memory: the roles of maternal characteristics.

Mother-child memory conversations are a nuanced and important factor in children's memory development. The current study focuses on maternal characteristics that are related to individual differences in maternal elaborative style. It also examines the role of maternal elaborative style in children's elaborativeness in the context of reminiscing and recounting. Two hundred and nine Turkish mothers (Mage = 36.32, SD = 4.99) and their 5- to 6-year-olds (Mage in months = 66.88, SD = 4.04) (110 girls, 99 boys) participated in the current study. Results revealed that maternal individuation and balanced self-construal type predicted maternal elaborativeness, which in turn predicted child elaborativeness in reminiscing and recounting. Yet, such a relation was not observed for maternal attachment styles or sensitivity. Findings suggested the importance of maternal individuation and balanced self-construal for mothers' and children's elaborativeness in memory conversations.

The Quality of Interpersonal Relationships, Intrusive and Deliberate Rumination and Adjustment to the Death of a Spouse.

The aim of the presented study was to gain a better understanding of relationships between the pre-loss quality of marriage, global attachment style, rumination, the severity of complicated grief and the level of posttraumatic growth among widowed individuals. After the researchers obtained the consent of the ethics board to conduct the study, they examined widowed individuals (n = 152) using the Experiences in Close Relationships - Revised, the Dyadic Adjustment Scale, the Event Related Rumination Inventory, the Inventory of Complicated Grief, and the Posttraumatic Growth Inventory. Results show a positive relationship between attachment anxiety and complicated grief via intrusive rumination, as well as a positive relationship between attachment anxiety and posttraumatic growth via intrusive and deliberate rumination. Results also show that the greater the attachment avoidance the higher the severity of complicated grief, but only in the case of perceived low quality of the marriage. The presented research provides insight into the complex associations between the quality of interpersonal relationships, rumination and adjustment to loss among individuals who experienced the death of a spouse.

Natural clues to danger: attachment behavior in threatening situations.

A fundamental principle of attachment theory is that threatening situations give rise to individual differences in the extent to which people seek proximity to close others. The current research examines the way in which attachment styles predict individual differences in attachment-relevant behavior during threatening events. We tested alternative theoretical perspectives concerning the association between adult attachment (specifically, attachment avoidance) and attachment behavior in the presence of natural clues to danger by observing couples (N = 204) when they were watching horror vs. control film excerpts. Results suggest that highly avoidant people engaged in less attachment behavior across both threatening and non-threatening situations. These findings have implications for the understanding of attachment-related processes and how working models of the self and others facilitate (or inhibit) the expression of attachment behavior.

Beyond the symptoms: Exploring attachment styles and reality-testing among schizophrenia clients from a nursing perspective.

WHAT IS KNOWN ON THE SUBJECT?: The insecure attachment styles are associated with mental health problems and can influence reality perception, particularly in individuals with schizophrenia. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides empirical evidence for the correlation between insecure attachment styles and reality-testing impairment in clients with schizophrenia. Higher reality testing impairment scores were observed in specific demographics: males who were unmarried and aged between 40 and 50 years old, as well as those with a duration of illness of less than 5 years. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings underscore the importance for nurses to understand insecure attachment styles, particularly anxious and avoidant styles, in clients with schizophrenia. Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Imply early intervention through educating mothers on fostering secure bonds can potentially prevent future occurrences of schizophrenia. WHAT ARE THE IMPLICATIONS FOR FUTURE RESEARCH?: Conducting empirical studies to explore the associations between insecure attachment style, social functioning, and poor service engagement is essential. Research is needed to investigate specific techniques for managing insecure attachment styles, particularly the avoidant ones, and reality testing impairments within the therapeutic setting. ABSTRACT: INTRODUCTION: Insecure attachment styles are associated with mental health problems and may influence reality perception. AIM: This study investigated the link between attachment styles and reality-testing impairment in individuals with schizophrenia. METHODS: A cross-sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality-testing abilities (Bell Reality Testing Inventory). RESULTS: A significant positive correlation emerged between insecure attachment and poorer reality testing (r = .394, p < .001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality-testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40-50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61). DISCUSSION: Insecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains. IMPLICATION FOR PRACTICE: Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers-to-be) and their children to promote healthy attachment styles as a preventive measure.

Changes in peripheral oxytocin and vasopressin during a silent month-long Insight meditation retreat.

Background: Given its putative roles in mediating prosocial behavior, attachment bonds, and stress physiology, oxytocin modulation has been hypothesized to be a biological correlate of the salubrious effects of meditation practice. Here we investigated the effects of a month-long silent meditation retreat on changes in oxytocin, and the related hormone and vasopressin, in relation to psychosocial changes in attachment style, anxiety, personality measures, and feelings of social connectedness with fellow meditators. Methods: Plasma oxytocin and vasopressin and self-report questionnaires were measured in retreat participants (n = 28) at the beginning of, and 3 weeks into, a residential meditation retreat. Control participants (n = 34), who were similar in age, gender, and meditation experience, were also assessed across a 3-week interval. Linear mixed effects models were used to assess outcomes. Results: The retreat group showed a small but significant decrease in oxytocin compared to controls who showed no change. In the retreat group, higher openness to experience at Time 1 predicted greater reductions in oxytocin during the retreat, and lower oxytocin at Time 2 was related to stronger feelings of personal connection with fellow meditators. The changes in oxytocin were not related to attachment style or anxiety. Vasopressin decreased over time across both groups, suggesting no specific effect of retreat. Conclusion: These preliminary findings suggest that meditation training in the context of a silent residential retreat may reduce circulating levels of oxytocin. We interpret this finding from multiple theoretical perspectives, discussing key measurement limitations and proposing future study designs that may help to differentiate the effects of different meditation practices and contexts on oxytocin signaling.

Individual factors as predictors of secondary traumatic stress and burnout in forensic inpatient staff.

WHAT IS KNOWN ON THE SUBJECT: Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long-term work-related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited. One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs. Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn-out. Unexpectedly, staff who reported a more anxious attachment style were burnt-out; however, there are limitations to this finding. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Policies and practices in forensic settings should reflect the risk of STS and burnout. Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT). ABSTRACT: INTRODUCTION: Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences. AIMS: This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs. METHOD: 98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff. RESULTS: Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style. DISCUSSION: This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor. IMPLICATION FOR PRACTICE: The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals.

Intimate Partner Violence and Attachment Styles as Factors Associated with Coping Stress Styles Among Iranian Women.

The current study sought to examine attachment styles as mediators between intimate partner violence (IPV) and stress coping styles among Iranian women. Data were collected from September to December 2020. The study population was composed of 102 women who were referred to Social Emergency Centers in Isfahan and affected by domestic violence. They were given self-report questionnaires to measure IPV (the Haj-Yahia Violence Questionnaire), Stress Coping Styles (CISS), and Attachment Styles (AAQ). Structural Equation Modeling was used to test the hypothesized relationships. Sexual IPV victimization was related to both avoidant attachment (ß = .229, p = .015) and anxious attachment (ß = .245, p = .008). Anxious attachment style was related to emotion-oriented coping (ß = .437, p = .000). There was a negative relationship between avoidant attachment and anxious attachment (ß = -.237, p = .032) with avoidance-oriented coping. Sexual IPV victimization and economic IPV victimization were associated with avoidance-oriented coping (ß = -.225, t = 0.816, p = .015; ß = .188, t = 0.816, p = .044). Women who had experienced IPV and had an insecure attachment style were more likely to utilize avoidance and emotional coping strategies. For women who had a secure attachment style, there was no association was found between IPV victimization and coping styles. Attachment styles may influence the relationship between IPV and coping strategies in Iranian women who have experienced violence.