Adult attachment anxiety is associated with night eating syndrome in UK and US-based samples: Two cross-sectional studies.

Previous research has shown that "attachment anxiety" is a robust predictor of disinhibited eating behaviours and that this relationship is underpinned by difficulties in managing emotion. Night eating syndrome (NES), a proposed eating disorder characterized by evening hyperphagia, nocturnal awakenings to eat, and morning anorexia, is also associated with eating to manage emotion. Across two studies (N = 276 & N = 486), we considered a relationship between attachment anxiety and NES. In Study 1, we hypothesised (pre-registered) that attachment anxiety would predict NES score and that this relationship would be mediated by disinhibited eating. Participants were asked to complete questionnaire measures of attachment orientation, disinhibited eating (emotional and uncontrolled eating) and NES. Our parallel mediation model confirmed a direct relationship between attachment anxiety and NES (p < .001) and showed an indirect path via both emotional (95% CI: 0.15-0.63) and uncontrolled eating (95% CI: 0.001-0.36). In Study 2, we showed that fear of negative evaluation of eating significantly mediated a reversed relationship between attachment anxiety and NES (95% CI: 0.02-0.04). Finally, across both studies we used a novel tool to assess "eating to cope". We showed a relationship with emotional eating but failed to show a robust relationship with NES. Attachment orientation may represent a potential intervention target for night eating syndrome. Future research should consider a longitudinal approach to strengthen our understanding of directionality amongst these factors.

Disorganized attachment predicts body mass index via uncontrolled eating.

BACKGROUND/OBJECTIVES: Previous research has demonstrated relationships between attachment orientations (expectations of ourselves and others in interpersonal relationships), eating behaviours and obesity. However, such research has been limited to investigations of 'organised' forms of attachment orientations (reflecting coherent and predictable patterns of behaviour). Theoretically, aberrant eating behaviours and body mass index, should also be related to 'disorganized attachment.' SUBJECTS: Here we test these relationships for the first time in a general population. Secondary data analyses of a pre-existing dataset were conducted (N = 537). METHODS USED: Questionnaire measures of organised (avoidant and anxious) and disorganized attachment were included alongside eating behaviour measures (emotional eating, uncontrolled eating and cognitive restraint) and body mass index (BMI). RESULTS: Parallel multiple mediation analysis (PROCESS) showed that uncontrolled eating (but not emotional eating or cognitive restraint) significantly mediated a relationship between disorganized attachment and body mass index (significant indirect relationship; LLCI = 0.02 ULCI = 0.16) when both attachment anxiety and avoidance were included as covariates. CONCLUSIONS: We suggest that the mechanism underpinning this indirect relationship is a form of maladaptive affect regulation, but that the behavioural motivators differ from those observed in anxiously attached individuals. Rather than eating being a premeditated strategy used by individuals high in disorganized attachment to manage emotion, opportunities to eat are simply taken as they present themselves. Professionals engaged in addressing eating problems and weight management should consider attachment orientations in their patient assessments and be mindful that attachment disorganized individuals are especially likely to engage in uncontrolled eating behaviours that are associated with a higher BMI.

Explaining the relationship between attachment anxiety, eating behaviour and BMI.

Previous research indicates that attachment anxiety (fear of abandonment) is predictive of overeating and higher body mass index (BMI). The current study explored the nature of the mechanisms underpinning this relationship. Study 1 assessed the relative contribution of 'emotional eating', 'susceptibility to hunger' and 'uncontrolled eating'. Study 2 assessed whether misperception of emotion and poor emotion management would mediate the relationship between attachment anxiety and stress-induced eating (and then BMI). Two cross-sectional online questionnaire studies were conducted (Study 1 N = 665, & Study 2 N = 548), in UK and US-based samples, which assessed attachment orientation and BMI alongside the potential mediators. The relative contribution of emotional eating, susceptibility to hunger and uncontrolled eating (Study 1) and difficulties in emotion regulation and stress-induced eating (Study 2) as mediators of this relationship were examined. In Study 1, parallel multiple mediation analysis (PROCESS) showed that emotional eating and susceptibility to hunger (but not uncontrolled eating) were significant mediators of the relationship between attachment anxiety and BMI. In Study 2, serial mediation analysis showed that difficulties in 'engaging with goal directed behaviours when upset' and stress-induced eating operated in series to significantly mediate the relationship between attachment anxiety and BMI. These findings suggest that attachment anxious individuals feel less capable in disengaging from negative emotions and go on to try to soothe themselves through eating which has a negative impact on their BMI. There was less support for an explanation of the relationship between attachment anxiety and BMI based around the misperception of emotion. Taken together, the findings highlight attachment anxiety and emotion regulation strategies as key targets for interventions that aim to reduce overeating and excess body weight.

Implementation of a Nurse Driven Pathway to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive Care Setting.

PURPOSE: A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention. The aim of this quality improvement project had two aims. First, to reduce HAPI incidence in the PICU by 10%. Second, to increase consistent usage of pressure injury prevention strategies as evidenced by a 10% increase in pressure injury bundle compliance. The third aim was to identify if there are differences in percentage of interventions implemented between two different groups of patients. Donabedian's model of Structure, Process, and Outcomes guided the development and implementation of this quality improvement project. Interventions focused on risk assessment subscale scores have the opportunity to mitigate specific risk factors and improve pressure injury prevention. RESULTS: Through implementation of the nurse driven pathway there was as 57% decrease in reported HAPIs in the PICU as well as a 66% increase in pressure ulcer prevention bundle compliance. CONCLUSIONS: Implementation of the nurse driven pressure injury prevention pathway was successful. There was a significant increase in bundle compliance for pressure ulcer prevention and a decrease in reported HAPIs. PRACTICE IMPLICATIONS: The pathway developed and implemented for this quality improvement project could be adapted to other populations and care settings to provide guidance across the continuum.

Integrating Safe Sleep Practices into a Pediatric Hospital: Outcomes of a Quality Improvement Project.

A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital. The intervention involved education of staff and standardization of infant sleep practices utilizing a multifaceted approach. Staff surveys and environmental audits were conducted pre- and post-intervention. Safe Sleep Environment (SSE) audits showed an improvement from 23% to 34% (p<0.001) post-intervention. Staff confidence to provide education to caregivers on SSP showed a significant increase. Results from this project demonstrate a successful approach to implement SSP in the hospital setting. Infant safe sleep practices have the potential to reduce infant mortality.

Texting "boosts" felt security.

Attachment security can be induced in laboratory settings (e.g., Rowe & Carnelley, 2003) and the beneficial effects of repeated security priming can last for a number of days (e.g., Carnelley & Rowe, 2007). The priming process, however, can be costly in terms of time. We explored the effectiveness of security priming via text message. Participants completed a visualisation task (a secure attachment experience or neutral experience) in the laboratory. On three consecutive days following the laboratory task, participants received (secure or neutral) text message visualisation tasks. Participants in the secure condition reported significantly higher felt security than those in the neutral condition, immediately after the laboratory prime, after the last text message prime and one day after the last text prime. These findings suggest that security priming via text messages is an innovative methodological advancement that effectively induces felt security, representing a potential direction forward for security priming research.

Validation of a new assessment of hostile attribution bias in romantic relationships: The Hostile Attributions in Romantic Relationships Test.

While hostile attributional bias (a tendency to interpret others' behaviors as intentionally hostile) is associated with negative outcomes in romantic relationships, no measure has been developed specifically for this context. Here, we describe the development and validation of a self-report questionnaire across three studies, named Hostile Attribution in Romantic Relationships Test. Study 1 introduces the development and preliminary validation (N = 152). Study 2 tests the validity and test-retest stability of the modified version revised based on findings in Study 1 (N = 151). Study 3 reports the translation and validation of a Chinese version (N = 630). The final 9-vignette scale is the first to specifically measure hostile attribution bias in romantic relationships, with good internal reliability, test-retest stability, and convergent validity. Factor analysis reveals a three-factor structure reflecting direct hostile attribution, indirect hostile attribution, and benign attribution to partners' behaviors. Implications regarding couple dynamics and clinical therapeutic interventions are discussed.

Insecure Attachment Orientation in Adults and Children and Negative Attribution Bias: A Meta-Analysis.

This is the first meta-analysis to synthesize the literature on insecure attachment and negative attribution bias (NAB) from both developmental and social/personality attachment traditions. This meta-analysis is important because extant studies report inconsistent associations, making it difficult to draw conclusions about the nature of these associations. Based on 41 samples (N = 8,727) from 32 articles, we specify and compare the effect sizes of these associations across studies. Results confirmed positive associations between NAB and anxious and avoidant attachment dimensions and an insecure composite, with a medium effect size. Correlations were moderated by age group, type of attachment measurement, and cultural background. Our findings advance knowledge and build on attachment and attribution theories, reconcile mixed findings, and inform the development of NAB interventions. Important gaps in the literature are revealed that will inspire future research.

Hemispheric processing of differently valenced and self-relevant attachment words in middle-aged married and separated individuals.

The reliance in experimental psychology on testing undergraduate populations with relatively little life experience, and/or ambiguously valenced stimuli with varying degrees of self-relevance, may have contributed to inconsistent findings in the literature on the valence hypothesis. To control for these potential limitations, the current study assessed lateralised lexical decisions for positive and negative attachment words in 40 middle-aged male and female participants. Self-relevance was manipulated in two ways: by testing currently married compared with previously married individuals and by assessing self-relevance ratings individually for each word. Results replicated a left hemisphere advantage for lexical decisions and a processing advantage of emotional over neutral words but did not support the valence hypothesis. Positive attachment words yielded a processing advantage over neutral words in the right hemisphere, while emotional words (irrespective of valence) yielded a processing advantage over neutral words in the left hemisphere. Both self-relevance manipulations were unrelated to lateralised performance. The role of participant sex and age in emotion processing are discussed as potential modulators of the present findings.

The Impact of Repeated Attachment Priming on Paranoia, Mood and Help-Seeking Intentions in an Analogue Sample.

Attachment security priming effects therapeutic change in people with depression and anxiety. Preliminary studies indicate that visualising secure attachment memories also reduces paranoia in non-clinical and clinical groups, probably due to a decrease in cognitive fusion. Benefits to clinical populations depend on the sustainability of these effects and the impact on help-seeking behaviours. The combination of paranoia and an insecure-avoidant attachment style is likely to be a particular barrier to help seeking. We used a longitudinal experimental design to test the impact of repeated attachment priming on paranoia, mood and help-seeking intentions and whether cognitive fusion mediates these effects. Seventy-nine people with high levels of non-clinical paranoia, aged 18-50 years (M = 20.53, SD = 4.57), were randomly assigned to a secure or insecure-avoidant priming condition. Participants rehearsed the visualisation prime on four consecutive days and were assessed on standardised measures of paranoia, positive and negative affect, help-seeking intentions and cognitive fusion. A series of mixed-model analyses of variance showed that security priming decreases paranoia, negative affect and cognitive fusion and increases positive affect and help seeking, compared to insecure-avoidant priming. Examining the impact of primed attachment (rather than measured attachment style) allows us to draw conclusions about the causal processes involved; mediation analyses showed indirect effects of the primes on paranoia and negative affect through cognitive fusion. With a growing understanding of (1) the impact of security priming on paranoia, affect and help-seeking behaviours, (2) causal mechanisms and (3) sustainability of effects, security priming may be developed into a viable intervention for clinical populations.

Constraints to liberty of movement and attachment styles significantly account for well-being in three Palestinian samples.

Background: Political violence and constraints on liberty of movement can have consequences for health and well-being but affect individuals differently. Objective: In three Palestinian samples, we sought to examine the relationship between key environmental and psychological factors and general and mental health, including the previously unexplored roles of constraints to liberty of movement and attachment orientation. Method: Participants (N = 519) in the Occupied Palestinian Territories and Jordan completed questionnaires on constraints to liberty of movement, attachment insecurity, resource loss, experience of political violence , demographics, general healthdepression, and anxiety. All measures were translated from English to Arabic and back-translated into English. Results: Findings from regression and mediation analyses indicated that (1) differences in general and mental health among Palestinians in the Occupied Palestinian Territories and the diaspora in Jordan can be explained by the assessed constructs; (2) constraints to liberty of movement, attachment avoidance, and resource loss significantly accounted for poor general health; (3) constraints to liberty of movement, attachment anxiety, and resource loss significantly explained general anxiety symptoms; and (4) attachment anxiety, resource loss, and experience of political violence significantly explained depression symptoms. Conclusion: The findings have theory-building implications for psychological models of human flourishing and suffering, suggesting that they are incomplete without consideration of liberty as a context, as well as implications for policymakers and champions of global health initiatives, as they highlight the psychological effects of constraints to liberty of movement on health.

Antecedentes: La violencia política y las restricciones a la libertad de movimiento pueden tener consecuencias para la salud y el bienestar, pero afectan a las personas de manera diferente.Objetivo: En tres muestras palestinas, buscamos examinar la relación entre factores ambientales y psicológicos clave y la salud general y mental, incluidos los roles previamente inexplorados de las restricciones a la libertad de movimiento y el estilo de apego.Método: Los participantes (N = 519) en los Territorios Palestinos Ocupados y Jordania completaron cuestionarios sobre restricciones a la libertad de movimiento (escala de 4 ítems ideada por los autores para el propósito del presente estudio), inseguridad en el apego (Escala de Experiencias en Relaciones Cercanas - Short Form), pérdida de recursos (escala de Evaluación de Conservación de Recursos), experiencia de violencia política (Experiencia y miedo a la violencia política), demografía, salud y salud mental (PHQ4 para la depresión evaluación de 2 ítems para la ansiedad). Todas las medidas se tradujeron del inglés al árabe y retrotraducidas al inglés.Resultados: Los resultados de los análisis de regresión y mediación indicaron que (i) las diferencias en la salud general y mental entre los palestinos en los Territorios Palestinos Ocupados y la diáspora en Jordania pueden explicarse por los constructos evaluados; (ii) las limitaciones a la libertad de movimiento, el apego evitativo y la pérdida de recursos explicaron significativamente la salud general deteriorada; (iii) las limitaciones a la libertad de movimiento, el apego ansioso y la pérdida de recursos explicaron significativamente los síntomas generales de ansiedad; y (iv) el apego ansioso, la pérdida de recursos y la experiencia de violencia política explicaron significativamente los síntomas de la depresión.Conclusión: Los hallazgos tienen implicaciones para la construcción de teorías para los modelos psicológicos del crecimiento y el sufrimiento humano, lo que sugiere que están incompletos sin la consideración de la libertad como contexto, así como implicaciones para los responsables de las políticas y los defensores de las iniciativas de salud global, ya que destacan los efectos psicológicos de las limitaciones a la libertad de circulación en la salud.

The Effectiveness of Attachment Security Priming in Improving Positive Affect and Reducing Negative Affect: A Systematic Review.

: Attachment security priming has been extensively used in relationship research to explore the contents of mental models of attachment and examine the benefits derived from enhancing security. This systematic review explores the effectiveness of attachment security priming in improving positive affect and reducing negative affect in adults and children. The review searched four electronic databases for peer-reviewed journal articles. Thirty empirical studies met our inclusion criteria, including 28 adult and 2 child and adolescent samples. The findings show that attachment security priming improved positive affect and reduced negative affect relative to control primes. Supraliminal and subliminal primes were equally effective in enhancing security in one-shot prime studies (we only reviewed repeated priming studies using supraliminal primes so could not compare prime types in these). Global attachment style moderated the primed style in approximately half of the studies. Importantly, repeated priming studies showed a cumulative positive effect of security priming over time. We conclude that repeated priming study designs may be the most effective. More research is needed that explores the use of attachment security priming as a possible intervention to improve emotional wellbeing, in particular for adolescents and children.

Oxytocin and social perception: oxytocin increases perceived facial trustworthiness and attractiveness.

The neuropeptide oxytocin is involved in the development and maintenance of attachment behaviours in humans and other species. Little is known, however, about how it affects judgements of unfamiliar others. In a double-blind placebo-controlled study we investigated the effect of a single intranasal dose of oxytocin on judgements of facial trustworthiness and attractiveness. We found that oxytocin administration increased ratings of trustworthiness and attractiveness of male and female targets in raters of both sexes relative to control ratings, suggesting that higher levels of this neuropeptide may enhance affiliative behaviour towards unfamiliar others. Our results provide evidence in support of a general facilitative role of oxytocin in promoting positive trait judgements.

Priming attachment security improves attitudes towards a range of therapies.

We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non-relational and distanced-relational therapies for those with a fearful-avoidant attachment orientation. For relational and distanced-relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help-seeking behaviour. Priming security may promote open-minded decision-making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.

The role of trait anxiety in the recognition of emotional facial expressions.

Previous work has suggested that elevated levels of trait anxiety are associated with an increased ability to accurately recognize the facial expression of fear. However, to date, recognition has only been assessed after viewing periods of 10s, despite the fact that the process of emotion recognition from faces typically takes a fraction of this time. The current study required participants with either high or low levels of non-clinical trait anxiety to make speeded emotional classification judgments to a series of facial expressions drawn from seven emotional categories. Following previous work it was predicted that recognition of fearful facial expressions would be more accurate in the high-trait anxious group compared with the low-trait anxious group. However, contrary to this prediction, no anxiety-related differences in emotion perception were observed across all seven emotions. This suggests that anxiety does not influence the perception of fear as has been previously proposed.

Effects of repeated attachment security priming in outpatients with primary depressive disorders.

BACKGROUND: The aim of this study was to assess the potential effectiveness of secure attachment priming in outpatients with depressive disorders. METHODS: Forty-eight participants engaged in secure attachment priming or neutral priming in the laboratory (Time 1), after which they received three daily consecutive primes via text message (Times 2-4), aimed at maintaining the effects from Time 1. A follow-up one day later (Time 5) was also included. Dependent measures were assessed at Times 1, 4 and 5. RESULTS: Participants in the secure attachment priming condition experienced higher felt-security than the control group at all time-points, indicating that the felt-security benefit was maintained through repeated priming. Secure priming had a greater impact on reducing symptoms of anxiety and depression in comparison to the control prime, though the differences were only significant at Time 4. LIMITATIONS: The moderate sample size limited our statistical power. CONCLUSIONS: This study was the first experiment using repeated secure attachment priming within a clinical sample. Our findings have potential clinical implications; security priming could be used alongside other treatments to improve outcome. Recommendations for further research are discussed.

THE OLYMPIC MOUNTAINS EXPERIMENT (OLYMPEX).

OLYMPEX is a comprehensive field campaign to study how precipitation in Pacific storms is modified by passage over coastal mountains.

Attachment Security and Self-compassion Priming Increase the Likelihood that First-time Engagers in Mindfulness Meditation Will Continue with Mindfulness Training.

Mindfulness practice has many mental and physical health benefits but can be perceived as 'difficult' by some individuals. This perception can discourage compliance with mindfulness meditation training programs. The present research examined whether the activation of thoughts and feelings related to attachment security and self-compassion (through semantic priming) prior to a mindfulness meditation session might influence willingness to engage in future mindfulness training. We expected both of these primes to positively influence participants' willingness to continue with mindfulness training. We primed 117 meditation-naïve individuals (84 female; mean age of 22.3 years, SD = 4.83) with either a self-compassion, attachment security, or a neutral control prime prior to an introductory mindfulness exercise and measured their post-session willingness to engage in further training. Both experimental primes resulted in higher willingness to engage in further mindfulness training relative to the control condition. The self-compassion prime did so indirectly by increasing state mindfulness, while the attachment security prime had a direct effect. This study supports theoretical links between self-compassion and mindfulness and reveals a causal role for these factors in promoting willingness to engage in mindfulness training. Our findings have implications for improving compliance with mindfulness intervention programs.

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context.

BACKGROUND AND OBJECTIVES: Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. DESIGN: A randomized, controlled study. METHODS: Students were randomly allocated to intervention ("Anxiety Relief": n = 43; "Insomnia Relief": n = 48; control: n = 47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. RESULTS: Significant within-group reductions in anxiety (t(31) = 2.00, p = .03) with moderate between-groups (compared to control) effect size (d = .64) and increases in sleep quality (t(31) = 3.46, p = .002) with a moderate between-groups effect size (d = .55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35) = 4.28, p > .001) with a moderate between-groups effect size (d = .51). CONCLUSIONS: Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.

Holding Back the Tears: Individual Differences in Adult Crying Proneness Reflect Attachment Orientation and Attitudes to Crying.

Despite being a universal human attachment behavior, little is known about individual differences in crying. To facilitate such examination we first recommend shortened versions of the attitudes and proneness sections of the Adult Crying Inventory using two independent samples. Importantly, we examine attachment orientation differences in crying proneness and test the mediating role of attitudes toward crying in this relationship. Participants (Sample 1 N = 623, Sample 2 N = 781), completed online measures of adult attachment dimensions (avoidance and anxiety), attitudes toward crying, and crying proneness. Exploratory factor analyses in Sample 1 revealed four factors for crying attitudes: crying helps one feel better; crying is healthy; hatred of crying; and crying is controllable; and three factors for crying proneness: threat to self; sadness; and joy. Confirmatory factor analyses in Sample 2 replicated these structures. Theoretically and statistically justified short forms of each scale were created. Multiple mediation analyses revealed similar patterns of results across the two samples, with the attitudes "crying is healthy" and "crying is controllable" consistently mediating the positive links between attachment anxiety and crying proneness, and the negative links between attachment avoidance and crying proneness. Results are discussed in relation to attachment and emotion regulation literature.