Mindfulness and emotional regulation as sequential mediators in the relationship between attachment security and depression

https://doi.org/10.1016/j.paid.2016.04.091Get rights and content

Highlights

  • Depression was associated with the positive/negative self model of attachmentE.

  • A mediation relationship of mindfulness and emotional regulation was explored.

  • A sequential mediation role was found between attachment and depression.

  • Further study exploring the sequential mediation relationship is recommended.

Abstract

Depression is a significant global health issue that has previously been associated with negative early care experiences and insecure attachment styles. This has led to much interest in identifying variables that may interrupt this relationship and prevent detrimental personal, social and economic outcomes. Recent research has indicated associations between the two seemingly distinct constructs of secure attachment and mindfulness, with similar positive outcomes. One hundred and forty eight participants completed an online survey exploring a possible sequential cognitive processing model, which predicted that higher levels of mindfulness and then emotional regulation would mediate the relationship between attachment and depression. Full mediation was found in regards to secure, preoccupied and dismissive attachment, whereas partial mediation was identified in the case of fearful attachment. The results support the possibility of an alternative cognitive processing pathway that may interrupt the association between negative early care experiences and concomitant negative mental health outcomes. Further exploration of this relationship is indicated.

Introduction

Depression is a significant global health issue affecting quality of life, mortality and morbidity (Kessler & Bromet, 2013). By 2020, it is predicted to represent approximately 15% of the global burden of disease (Murray & Lopez, 1996). Previous research has identified a well-established link between attachment styles and developmental outcomes, including mental health, e.g. depression; physical health and social outcomes (Bifulco et al., 2004, Bowlby, 1980, Schore, 2001, Sroufe, 2005, Sroufe, 2005). According to Bowlby (1980), depression is associated with a perceived helplessness in developing and sustaining relationships, reportedly formulated from negative early care experiences instrumental in the development of internal working models that see one as unlovable and unworthy (Cummings & Cicchetti, 1990). Consistent with Bowlby (1980); Roepke and Seligman (2015) report negative prospections, i.e., mental representations of future scenarios, similarly underpinned by a pessimistic template, as the primary causal variable in the development and maintenance of depression. These perspectives match Beck's influential discoveries about cognitive distortions (Beck, 1963). The effect of preconceived beliefs on the aetiology of depression clearly indicates the importance of contrary mental activities such as current moment awareness, to allow an individual to experience self as an effective agent of change and reduce the incidence of depression. Increased mindfulness has previously been proposed to result in improved social functioning through a reduction in defensive responding on cognitive, emotional and behavioural levels (Brown et al., 2008, Carson et al., 2004). The current study explores the possible role of mindfulness and emotional regulation as sequential mediators in the cognitive process between attachment and depression.

Attachment styles were initially differentiated by Ainsworth, Blehar, Waters, and Wall (1978) identifying distinct categories of relationship between infants and their primary caregiver. The availability and accessibility of a sensitive caregiver was associated with a secure attachment style, typically characterised by effective emotional regulation. Conversely, the absence of a sensitive caregiver reportedly results in an insecure attachment style associated with largely ineffective strategies for need fulfilment. The insecure attachment styles are differentiated into three categories: insecure-ambivalent, insecure-avoidant and insecure-disorganised attachment styles (Ainsworth et al., 1978, Main and Cassidy, 1988) and are associated with poorer mental health outcomes, including depression (Cummings and Cicchetti, 1990, Sroufe, 2005). Adult classifications, i.e. secure, preoccupied, dismissive and fearful, paralleling those identified in childhood, support the continuity of attachment history (Bartholomew & Horowitz, 1991). Further, preoccupied and fearful attachment styles have been associated with a higher propensity for postpartum depression, mediated by low self-esteem and self-critical thoughts (Lee & Koo, 2015). The authors attribute this association to the ‘negative self’ model characteristic of these attachment styles (Bartholomew & Horowitz, 1991). Conversely, a dismissive style, associated with a ‘positive self’ model was not found to be significantly related to depression (Reis & Grenyer, 2004). The significant impact on mental wellbeing, health and social outcomes behoves us to identify variables that may alter attachment styles and/or their impact.

Internal working models reportedly provide a set of rules for processing attachment related information (Bowlby, 1973, Bretherton and Mulholland, 2008, Dykas and Cassidy, 2011). Bowlby (1980) referred to the “defensive exclusion” of potentially painful information. Essentially, this requires the individual to filter out such information from further processing. This strategy is seemingly less utilised by an individual with a secure attachment history, allowing for more open processing. Furthermore, secure individuals are reported to process non-attachment related information in a positively biased manner and insecure individuals, with a negative bias (Dykas & Cassidy, 2011).

Essentially, the internal working models provide expectation for future outcomes (Bretherton & Mulholland, 2008). An individual with a secure history tends to anticipate being capable in eliciting care and hence, confident in tolerating and recovering from difficult emotions. In their review of attachment and social processing, Dykas and Cassidy (2011) identify competence as including the ability to acknowledge, accept and recover from distressing emotions; a process consistent with mindful awareness and emotional regulation; supportive of literature identifying commonality between the constructs: secure attachment and mindfulness (Goodall et al., 2012, Siegel, 2007).

To interrupt the relationship between attachment styles and depression it is seemingly important to allow for the incorporation of new information regarding current context, which may then afford new experiences of lovability and worthiness. Automatic processing has been referred to as a “top down” approach, where schemas, memories, cognitions and emotions interpret and influence understanding of sensations and hence, shape experience, conversely mindfulness is the maintenance of awareness, to take in and process information as it is, in the current context (Siegel, 2007). It implies an open processing, without bias, affording a flexible response and deviation from organised behavioural patterns (Brown, Ryan, & Creswell, 2007). Kabat-Zinn (2003) indicates the importance of a curious mind in allowing one to process new experiences openly, a stance contrary to that engaged in when connected to pre-conceptualisations. This allows for the incorporation of novel information into schemas or working models, which may alter attachment style or limit their influence. Further, a more contextually appropriate response may provide new information regarding self. Behavioural manifestation of this is perhaps witnessed in the secure young child through exploratory behaviour, which occurs through the experience of safety, allowing deactivation of the attachment system (Cassidy, 2008).

Siegel (2007) highlights the overlap of outcome measures related to attachment security and mindfulness, specifically referring to the prefrontal cortex and its role in modulating fear, response flexibility, self-regulation, attunement, empathy and emotional balance. This is supported by a British online survey (Goodall et al., 2012) reporting a potential bidirectional relationship between mindfulness and attachment security, suggesting that increased mindfulness skills could reduce the behaviours more characteristic of insecure attachment styles. Further they indicate a conceptual overlap between aspects of dispositional mindfulness and emotional regulation, namely; the awareness of internal experiences and acceptance of emotional response. The authors highlight the importance of emotional awareness in reducing the cognitive bias common to a more automatic processing style. A further study by Pepping, Davis, and O'Donovan (2013) reported that the relationship between mindfulness and attachment security was fully mediated by emotional regulation difficulties. This is consistent with the underlying premise that a secure attachment results from the internalisation of soothing care experiences and facilitates the development of self-regulation strategies (Snyder et al., 2012, Sroufe et al., 2005a, Thorberg and Lyvers, 2010). Following the Minnesota longitudinal study, Sroufe (2005) reports infant attachment as critical to the development of emotional regulation and other functional capacities.

Section snippets

Current study

Mindfulness has been associated with a range of positive emotional and social variables, including wellbeing (Baker et al., 2015, Mitchell and Heads, 2015), relationship satisfaction (Jones, Welton, Oliver, & Thoburn, 2011) and a decrease in emotional distress factors, e.g. depression and anxiety (Pepping, O'Donovan, Zimmer-Gembeck, & Hanisch, 2014); findings that share similarity with a secure attachment history. Mindfulness is proposed to provide opportunity for perspective and space between

Participants

One hundred and fifty-one participants (111 female and 40 males ranging in age from 18 to 52 years, M = 21.28, SD = 5.89), enrolled in a first year psychology course at a regional university completed an online survey to receive credit for their course requirements. The Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) mean scores for the total sample revealed moderate depression (18.68, S.D. 9.45), severe anxiety (16.25, S.D. 7.65), and moderate stress (20.18, S.D. 10.12). This is

Procedure

Ethics approval was attained from the Human Research Ethics Committee (Health and Medical Science). Participants were recruited through the university's online research participation website and provided consent prior to completing the online survey. Participants received one credit point following completion of the survey.

Data preparation and analysis

All data was analysed using SPSS 22. Where data was missing on only one variable within a measure for a participant it was replaced using the series mean method in SPSS. Where more than two variables were missing from a measure the participant was not included in the analysis. Three participants failed to adequately complete the DASS and were removed from the study (n = 148).

Spearman's correlations were conducted between variables to provide a preliminary confirmation of expected associations.

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