The relationship between mentalizing, attachment, and the negative symptoms of psychosis.

Abstract

Objective: Negative symptoms are a major cause of social and functional disability in psychosis and current treatment approaches are yet to meet this therapeutic need (Fusar-Poli et al., 2015). Attachment has been proposed to play a significant role in the development of psychotic symptomology, with mentalizing suggested as a potential pathway through which attachment may impact psychosis (Korver- Neiberg, Berry, Meijer, & 2014; Carr, Hardy, & Fornells-Ambrojo, 2017). This study set out to test this hypothesis by examining the relationship between insecure attachment (anxiety and avoidance dimensions), mentalizing, and the negative symptoms of psychosis in first episode psychosis and general population samples. Design: A quantitative cross-sectional design was used. The hypotheses were tested using correlation, regression, and mediation analysis. Participants: 32 participants experiencing first episode psychosis and 149 general population participants took part in the current study. Participants experiencing first episode psychosis were recruited from Early Intervention in Psychosis services and general population participants were recruited via social media and university networks. Results: Insecure attachment dimensions (anxiety and avoidance) were associated with increased levels of negative symptom severity, distress resulting from symptoms, and mentalizing impairment (hypomentalizing). Mentalizing impairments (hypomentalizing) were linked with increased levels of negative symptom severity and distress. Mentalizing was found to mediate the relationship between insecure attachment and negative symptom severity and distress. These findings were significant across both samples tested. Mediation models were non-significant for social anhedonia. Conclusions: This study’s findings support an aetiological model of psychosis where, mentalizing, specifically hypomentalizing impairments, constitute a pathway through which insecure attachment impacts on the development of negative symptom frequency and distress. Clinical implications and future research directions are discussed. Keywords: Psychosis, Schizophrenia, First-episode, Negative symptoms, Attachment, Mentalizing, Mentalization, Distress, Social Anhedonia, Mediation, Cross-sectional design.