The Effect of Attachment Style on Posttraumatic Growth in Maintenance Hemodialysis Patients: the Mediating Roles of Self-Warmth and Self-Coldness

Attachment style, as a stable personal trait, may influence posttraumatic growth (PTG) in patients with maintenance hemodialysis (MHD). Therefore, further exploration of the mediating factors that can intervene between these two variables to improve mental health is of great clinical significance. The current study aimed to examine the parallel mediating roles of self-warmth and self-coldness between attachment style and PTG among MHD patients.

A total of 301 MHD patients were required to complete self-reported measures of attachment style, self-warmth, self-coldness, and PTG. Structural equation modeling (SEM) using Amos (version 23.0) was conducted to test the mediating effect.

The results showed that neither attachment anxiety (β =  − 0.118, 95%CI [− 0.385, 0.143]) nor attachment avoidance (β =  − 0.121, 95%CI [− 0.307, 0.072]) had a significant direct effect on PTG. However, attachment anxiety had a significant indirect effect on PTG through self-warmth (β =  − 0.105, 95%CI [− 0.206, − 0.011]). In contrast, the indirect effect of attachment avoidance on PTG was not significant through either self-warmth (β =  − 0.075, 95%CI [− 0.175, 0.026]) or self-coldness (β =  − 0.005, 95%CI [− 0.049, 0.010]).

The significant indirect effect of attachment anxiety on PTG occurred through self-warmth rather than self-coldness, which further demonstrated the necessity of distinguishing between the positive and negative components of self-compassion. More research is needed in the future to explore the different mediating mechanisms of self-warmth and self-coldness and their different roles in leading to psychological outcomes.