Development and Validation of a Self-Report Measure of Existential Well-Being.

The measurement invariance of the Experiences in Close Relationships (ECR) questionnaire was investigated across four samples of non-clinical subjects (N = 222), dermatological patients (N = 458), psychiatric inpatients (N = 156), and patients with drug-resistant epilepsy (N = 101). The results provided evidence of configural, metric, and scalar invariance across groups. Overall, our findings provide further support to the reliability and validity of the ECR.

Abstract. Five studies were conducted to develop a short form of the Experiences in Close Relationships (ECR) questionnaire with optimal psychometric properties. Study 1 involved Item Response Theory (IRT) analyses of the responses of 2,066 adults, resulting in a 12-item form of the ECR containing the most discriminating items. The psychometric properties of the ECR-12 were further demonstrated in two longitudinal studies of community samples of couples (Studies 2 and 3), in a sample of individuals in same-sex relationships (Study 4), and with couples seeking therapy (Study 5). The psychometric properties of the ECR-12 are as good as those of the original ECR and superior to those of an existing short form. The ECR-12 can confidently be used by researchers and mental health practitioners when a short measure of attachment anxiety and avoidance is required.

Research on individual therapy suggests that the ability to build effective therapeutic alliances with clients is related to the therapist’s adult attachment style. This paper reports an on-line survey of the attachment styles of registered family therapists in the UK which investigated associations between therapist’s attachment style, prior profession, gender and preference for a model of therapy. All 443 UK registered family therapists were surveyed and 82 (19 percent) replied. The survey included two standardised self-report measures: the Relationship Questionnaire (RQ) (Bartholomew and Horowitz in Pers Soc Psychol 61:226–244, 1991) and the Experiences in Close Relationships Questionnaire (ECR) (Brennan et al. in Attachment theory and close relationship. The Guilford Press, New York, 1998). The RQ invites respondents to rate the extent to which descriptions of secure, preoccupied, dismissing and fearful attachment styles applied to themselves. The ECR is a more conventional measure similar to a personality inventory. Responses to the two measures were discrepant. On the RQ 61 self-reported as having a ‘secure’ attachment style, nine ‘preoccupied’, six ‘dismissing’ and six were ‘fearful’. Responses to the ECR indicated that 24 were ‘secure’, 16 ‘preoccupied’, 15 ‘dismissing’ and 27 ‘fearful’. Attachment style, as measured by the ECR, was not associated with therapists’ prior profession, gender and preference for a model of therapy. The discrepancy between measures may be attributable to the more transparent RQ measure. Participants’ responses may have been based on how they wanted others to view them or how they viewed themselves. These responses are challenged by the findings from the ECR which revealed apparently less desirable adult attachment styles in this sample.

The short version of the Bielefeld Partnership Expectations Questionnaire (BPEQ-12) assesses the partner-related attachment dimensions fear of rejection, readiness for self-disclosure, and conscious need for care. The presented study investigated the factor structure in two samples and evaluated the convergent validity of scales. The sample included N = 175 patients with panic disorder and/or agoraphobia and N = 143 healthy controls. Besides, the BPEQ, the Experiences in Close Relationships Questionnaire (ECR), and the Brief Symptom Inventory (BSI) were assessed as well, and the Adult Attachment Prototype Rating (AAPR) was conducted. A confirmatory factor analysis of the three factor model (using a WLSMV estimator) revealed an acceptable model fit for the entire sample, patients and controls in terms of low RMSEA and SRMR (< 0.08) and high CFI and TLI (> 0.95). We found metric, scalar, and strict measurement invariance for the presence of anxiety disorder (ΔCFI ≤ –0.01 and ΔRMSEA ≥ 0.01). However, only for fear of rejection and readiness for self-disclosure the reliability was acceptable (Cronbach’s α > 0.7), and convergent validity in terms of large correlations (r > 0.7) with the ECR scales was found in both samples. The scale conscious need for care had a questionable reliability (Cronbach’s α > 0.6) and correlated only slightly with ECR-R scales. We conclude that fear of rejection and readiness for self-disclosure of the BPEQ-12 are reliable and valid scales for measuring partner-related attachment in healthy and clinical samples.

In order to ensure the concentration, compliance and motivation of the participants, a short version of 12 items was extracted from the “Experiences in Close Relationships Questionnaire (ECR)”. Even though this short English version shows equally good validity and reliability as the long version, there have been no representative norm values and psychometric characteristics available for the short version in German. Therefore, the German 12-item ECR was implemented in a representative sample of 1,127 males and 1,237 females (mean age M = 49.93; SD = 12.31) from the general public (N = 2,364). The reliability values of the German 12-item ECR in the representative sample are not as good as the long version with the 36- items version (Alpha = .54–72), and the 12-item ECR factorial structure failed to show the factorial validity. Since the EFA revealed that only half the items loaded on the expected factors, an even shorter form with six items was construed and tested psychometrically. Even though the item numbers were reduced, the reliability values of the German 6-item ECR improved and were as good as the long version with 36 items (Alpha = .73–90). Furthermore, factorial validity could be shown by CFA (CFI = .981, SRMR = .038, RMSEA = .079, TLI = .964) with scalar invariance across gender and age. In sum, the 6-item ECR is a reliable and factorial scalar attachment questionnaire. Due to its shortness, it is applicable to different research fields. However, reference data from a clinical sample are still missing.

The Attachment and Clinical Issues Questionnaire (ACIQ; M. A. Lindberg & S. W. Thomas, 2011), was developed over an 18-year period containing 29 scales. The purpose of the present study was to test (a) the validity of the attachment scales in terms of how they predict to whom one turns in times of stress and for affective sharing, and (b) how the attachment scales compared with the Experiences in Close Relationship Questionnaire (ECR) in terms of concurrent, convergent, and discriminant evidence. The relevant secure scales of the ACIQ predicted to whom one turned in Study 1, and Study 2 demonstrated good convergent evidence with the ECR, but superior concurrent evidence in predicting partner satisfaction, and superior discriminant evidence in differentially correlating with mother and father warmth. Thus, the ACIQ passed essential validity and psychometric tests and was a more robust measure than the ECR with these defining characteristics of attachment.

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.

Depression and anxiety are common in patients with cancer and psychosocial screening in oncology and palliative care settings is suggested as a means to reduce emotional distress in cancer situations (Grassi et al., 2014). In their study, Grassi and colleagues report the results of a review investigating factors associated with depression and anxiety in cancer patients. As regards psychosocial screening, the findings are reassuring: assessment of distress enables the practitioner to attend to symptomatology, interpersonal dynamics and cultural aspects of distress, which captures distress as a multifaceted phenomenon. In particular, focusing on the interpersonal aspects, for example attachment, is highlighted as a way to detect distress. There is a long-standing tradition of attachment research within developmental and clinical psychology, but in the field of the psychosocial dimensions of cancer, studies of attachment are of only rather recent of origin. Introducing established attachment measures into health psychology seems, prima facie, a promising avenue. However, important theoretical and conceptual knowledge derived from investigating adult attachment in the contexts of clinical and developmental psychology has been omitted in the transition to the setting of health psychology. Ultimately, this has led to an uncertainty of the fundamental nature of attachment, as is also pointed out by Grassi et al. (2014) in their evaluation of attachment research in the fields of oncology and palliative care. They avoid conceptualizing and defining attachment and important questions therefore remain; to which definition of attachment do the authors adhere? How do they conceptualize attachment? What is the convergence between their definition and the conceptualization? Grassi and colleagues state that “the way in which the patient has experienced early relations with caregiving figures in the past relates to her view of herself and to the expectation (…).” The description of attachment is relevant to the understanding of the phenomenon, and the quotation above indicates that Grassi et al. consider past experiences to be crucial to the attachment construct. They emphasize past relationships in their description of attachment and they make reference to a self-report instrument for measuring attachment, namely the Experience in Close Relationships questionnaire (ECR). Historically, attachment research has split into two schools using two distinct methodological approaches, i.e., the social psychology tradition and the development of parent-child relations from the child psychology tradition (Bouthillier et al., 2002; Ravitz et al., 2010). Attachment measures involving self-report questionnaires such as the ECR (Brennan et al., 1998) and the Relationship Questionnaire (RQ) (Bartholomew and Horowitz, 1991) stem from the social psychological tradition and the aim is to assess adult attachment in the context of current close relationships with a spouse, a relative, or a close friend. Adult attachment, as measured with self-report questionnaires, varies according to the context in which it is measured and it expresses attachment within thoughts and feelings in current close relationships (Brennan et al., 1998). In contrast, adult attachment measured with the Adult Attachment Interview (AAI) originates from the child psychology tradition and it assesses the organization and the processing of attachment experiences in childhood (Hesse, 2008; Ravitz et al., 2010). Given that self-report measurements of attachment and attachment as measured with the AAI are intended to assess the same construct, then the two methodologies could be expected to show at least a moderate association. However, research shows that they fail to correlate (de Haas et al., 1994; Crowell et al., 1999; Bouthillier et al., 2002; Creasey and Ladd, 2005). The distinction between attachment measured with the AAI and attachment as measured with self-reports is important, because, in fact, the two approaches assess two distinct constructs. Therefore, it is necessary to define attachment consistently with the attachment measure being used. Little can be learnt about attachment and psychosocial distress if there is lack of convergence between the measurement instrument employed (e.g., self-report questionnaires) and the description of the phenomenon (e.g., thoughts and feelings in current close relationships or the organization of experiences of child-parent attachment). The evaluation of attachment research in Grassi et al. (2014) is encouraging, but it is also problematic since it omits important distinctions and specifications of the attachment phenomenon. These shortcomings may consequently lead investigators collectively to adhere to an imprecise definition of adult attachment and this in turn will lead to the impact of attachment research within the field of health psychology being considerably diminished. The psychological legacy of attachment research as an approach to improving the health, well-being and rehabilitation of patients and families, needs to continue its development. The challenge for clinicians, service providers and administrative authorities will be to build up the clarity of the phenomenon such that research will be able to establish what attachment is all about.

ObjectivesWithin a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments.Research design and methods495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance.ResultsLSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up.ConclusionsThe current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial.Trial registrationControlled-trials.com ISRCTN53517394

Early attachment relationships from infancy onward contribute to attachment patterns later in life, to the ability to build up close relationships and to well-being in general. Severely preterm birth may challenge the development of these attachment relationships. We studied whether there are differences in attachment patterns related to romantic relationships between young adults (mean age 22.4 years, s.d. 2.2 years) with very low birth weight (VLBW, <1500 g; n = 162) and their peers born at term (n = 172), who completed the Experiences in Close Relationships Questionnaire - Revised. Young adults born at VLBW showed lower attachment-related anxiety than their peers born at term (mean difference -9.5%, 95% CI -16.0 to -2.6) when adjusted for sex, age, parental education and being in a romantic relationship currently. The groups did not differ in attachment-related avoidance. In subgroup analyses, the VLBW women born small for gestational age (SGA, birth weight <-2 s.d.) scored on average 14.8% (95% CI 3.1-26.6) higher than the control women on attachment avoidance. The effects remained after the exclusion of 18 participants with neurosensory deficits. We found no evidence for a compromised attachment pattern in young adults born at VLBW, with a possible exception of women born SGA at VLBW. VLBW adults were rather characterized by a lower level of attachment-related anxiety.

The research explores the relationship between coping strategies and attachment styles in adolescents. Participants included 382 12th-grade students from high schools in the north-central region of Bulgaria, with 306 valid protocols analyzed. The participants completed the Coping Strategies Inventory (CSI) and the Experiences in Close Relationships Questionnaire - Revised (ECR-R). Descriptive statistics, correlation analyses, and ANOVA were conducted to examine the associations between different attachment styles and coping strategies. Results indicated that adolescents with secure attachment were more likely to use adaptive coping strategies, such as problem-solving and seeking social support. In contrast, those with insecure attachment styles were more prone to engage in maladaptive coping mechanisms, including wishful thinking and social withdrawal. Specifically, attachment-related anxiety was linked to higher use of emotion-focused coping, while attachment-related avoidance was associated with distancing and self-reliant coping strategies. Significant correlations were found between attachment styles and coping strategies, suggesting that insecure attachment is associated with less effective coping. ANOVA results revealed that normal levels of anxiety were associated with higher scores in problem-solving and emotional expression, while upper-normal levels of avoidance correlated with lower adaptive coping and higher maladaptive coping strategies.

Mother–child reminiscing at risk: Maternal attachment, elaboration, and child autobiographical memory specificity

• Child traumas, attachment styles and social cognition were assessed in bipolar adults. • Participants were grouped: secure vs insecure (anxious, avoidant) attachment styles. • Participants with insecure attachment styles had more psychiatric hospitalizations. • Attachment anxiety was associated with childhood trauma but improved social cognition. • Social cognition in bipolar disorder is associated with the quality of early relational context. • Limitations include cross-sectional study design, use of self-report measures. Individuals with Bipolar Disorder (BD) present problems in Social Cognition (SC), a process associated with the quality of early attachment experiences. The experience of traumatic events in childhood threatens the quality of attachment. Attachment theory provides a comprehensive paradigm for understanding the role of early adversity on psychological functioning. However, early experiences have been largely neglected in BD research and clinical practice. We examined the moderating role of attachment in the relationship between childhood traumatic experiences and SC in a sample of 76 adults with BD. Early traumatic experiences were assessed using the Childhood Trauma Questionnaire (CTQ), SC was measured with the Hinting Task Test and attachment was examined using the Experience in Close Relationships questionnaire (ECR). Higher scores on attachment anxiety were positively associated with early traumatic events and better SC performance. Results suggest that attachment anxiety may be acting as an adaptive strategy in bipolar people who have suffered traumatic childhood experiences. The present study was observational and cross-sectional. Therefore, findings cannot be used to infer causality. Additionally, we assessed both attachment and trauma using self-report measures. Future studies should consider longitudinal designs with observer-rated measures such as standardized interviews. Our findings reinforce the importance of early childhood experiences in the development of SC in people with BD, challenging some traditional understandings of SC deficits as part of the genetic dimension of the disorder.

The Bird's Nest Drawing: A study of construct validity and interrater reliability