Unresolved States Of Mind Research Articles

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

ABSTRACT Mary Main’s conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

The Attachment Script Assessment: Introduction of a coding system to evaluate deactivation, hyperactivation, and anomalous content

ABSTRACT Although research on adult attachment has yielded insight into the legacy of attachment for functioning in adulthood, methodological challenges persist in the assessment of adult attachment. The Adult Attachment Interview (AAI) offers a rich assessment of secure, insecure, and unresolved states of mind. However, it is resource intensive to administer and code. Attachment Script Assessment (ASA) offers a resource-effective alternative to the AAI. However, the ASA coding system only yields a single, security-like dimension: secure base script knowledge. Here, we introduce a complementary coding system for the ASA to assess attachment deactivation (i.e. script characterized by limited interpersonal connection and minimization of attachment problems/emotions), hyperactivation (i.e. script in which attachment-relevant problems and negative emotions are heightened), and anomalous content (i.e. script in which attachment problems contain elements of fear and/or disorientation); and we discuss the conceptual convergence of these scripts with corresponding patterns of attachment insecurity and disorganization.

Do Turkish mothers’ emotion regulation, psychological symptoms and caregiving helplessness vary based on attachment states of mind?

ABSTRACT Mothers’ emotion regulation, mental health, and feeling of helplessness in caring for their child may vary based on maternal attachment classifications. Particularly, insecure attachment and unresolved state of mind can act as risk factors. Therefore, we examined how emotion regulation strategies of suppression and cognitive reappraisal, maternal symptoms of depression and anxiety, and caregiving helplessness differ based on maternal attachment classifications in the Adult Attachment Interview (AAI). Fifty mothers of children in the early childhood (AgeRange = 12-56 months) completed a pack of questionnaires, including Emotion Regulation Questionnaire, Brief Symptom Inventory, and Caregiving Helplessness Questionnaire. Then AAI interview protocol was administered and coded. Mothers did not vary in emotion regulation strategies, indicating emotion regulation balance. However, mothers with secure/autonomous AAIs reported less anxiety than mothers whose AAIs were judged to show unresolved loss or unresolved trauma. The mothers who provided AAIs judged to be secure/autonomous scored lower in depression and caregiving helplessness than mothers whose AAIs were judged to show unresolved loss or unresolved trauma. To our knowledge, this is one of the first studies conducting AAI in Turkish mothers. We revealed the critical role of secure attachment for mental health and caregiving helplessness that can facilitate interventions targeting maternal attachment mind state.

Japanese mothers' prebirth Adult Attachment Interview predicts their infants' response to the Strange Situation Procedure: The strange situation in Japan revisited three decades later.

The current study investigated the intergenerational transmission of attachment in Sapporo, Japan, using the Adult Attachment Interview (AAI) and the Strange Situation Procedure (SSP). This is the first SSP study in Sapporo in three decades, after a study in the mid-1980s reported controversial results. The SSP distributions found in the current study, however, were similar to those reported in the earlier Sapporo study, including its controversial finding that ambivalent attachment was predominant in insecure infants. The current study used the AAI and the SSP to study the intergenerational transmission of attachment in Japan and found a strong categorical match consistent with those reported elsewhere in the world. A proportion of infants who were judged disorganized as the first report in this Japanese sample was also found to be similar to the reported global norm. Disorganized attachment in Japanese infants was strongly predicted by the mother's unresolved state of mind as was found across normative samples. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind

Childhood adversity has been found to be an important aetiological factor in the development of personality disorder (PD) in several studies. However, the role of disorganized attachment with unresolved mental states for traumatic experiences requires further investigation. This study explores the relationship between childhood adversities, unresolved states of mind, PD diagnosis and psychiatric distress. Two hundred forty-five adult participants, 124 from a clinical PD group and 121 non-psychiatric controls were assessed using the Structured Clinical Interview for DSM-IV, the Cassel Baseline Questionnaire, the Symptom Checklist-90-R and the Adult Attachment Interview, in order to ascertain presence of PD, childhood adversity, level of psychiatric distress and unresolved states of mind. Within the overall unresolved (U-overall) attachment category, a distinction was made between unresolved for abuse (U-abuse) and unresolved for loss (U-loss). The results indicated that childhood adversity was significantly associated with unresolved states of mind, as well as with overall PD diagnosis, paranoid PD, borderline PD, avoidant PD and psychiatric distress. Mediation analyses confirmed that U-overall and U-loss were significant mediators between childhood adversity and PD diagnoses, but surprisingly, U-abuse was not a significant mediator. The strength, limitations and clinical implications of the findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Attachment in eating-disordered outpatients with and without borderline personality disorder.

This study aims at examining the attachment states of mind in 50 female outpatients with eating disorders compared with 50 matched control participants using the Adult Attachment Interview. Moreover, the differences in attachment states of mind among eating-disordered women with and without borderline personality disorders' diagnosis were explored. The results showed an over-representation of insecure-dismissing and unresolved states of mind in clinical group compared to controls. Patients with both diagnosis showed higher scores on involving anger and unresolved loss compared with those with only eating disorder. Implications for further research and clinical practice are discussed.

When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders.

Introduction: In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients’ families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters’ evaluations of maternal alexithymia.Methods: 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of “ED” mothers (n = 20) and “non-ED” ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia.Results: Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs.Discussion: Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Trauma and traumatic loss in pregnant adolescents: the impact of Trauma-Focused Cognitive Behavior Therapy on maternal unresolved states of mind and Posttraumatic Stress Disorder

Pregnant adolescents are a group at high risk for exposure to traumatic experiences. The present study aimed to examine if Trauma-Focused Cognitive Behavior Therapy (TF-CBT) typically applied to Posttraumatic Stress Disorder (PTSD), could also be applied to unresolved states of mind in a sample of socially at-risk pregnant adolescents. Forty-three adolescents who were in their second trimester of pregnancy and who also had positive indices of unresolved states of mind or symptoms of PTSD were randomly assigned to either the treatment as usual (parenting classes) or intervention (parenting classes + TF-CBT) group. Adolescent mother–infant dyads were then re-assessed at infant ages 6 and 12 months on a broad range of measures, including those specific to attachment, as well as to PTSD, and adolescent behavioral adjustment. Twenty-six of the 43 (60%) recruited subjects completed all components of the study protocol. Although there were no significant effects of the TF-CBT intervention on maternal attachment, infant attachment, PTSD diagnosis and adolescent behavioral adjustment, several study limitations restrict our ability to draw firm conclusions about the efficacy of TF-CBT for use in pregnant adolescents with complex trauma. The discussion offers insight and guidance for clinical work and future intervention research efforts with this vulnerable population.

Activation of the attachment system and mentalization in depressive and healthy individuals: An experimental control study

From a developmental and clinical point of view attachment theory and mentalization are closely connected and have become increasingly important to understand the origins of psychopathological development. However, very little is known about how exactly different inner working models of attachment are related to diverse mentalizing abilities and this is particularly true for adult populations - healthy as well as clinical populations. In the present study we investigated this relation with a sample of inpatients diagnosed with depression and a sample of healthy individuals. In an experimental setting the attachment system was activated using the Adult Attachment Projective Picture System (AAP). Mentalization was assessed during activation and in comparison to a control condition using a modified version of the Reading the Mind in the Eyes Test (RMET). We expected that an activation of the attachment system i) diminishes the capacity to take another?s perspective in individuals with unresolved state of mind, ii) has no impact in individuals with secure attachment representation and iii) is dependent of clinical status in individuals with insecure (but organized) working models of attachment. Overall, these hypotheses were confirmed. However, the impact of clinical status on mentalization in insecure attachment has to be further explored. We summarize that attachment state of mind has a mediating influence on mentalization basically in such situations where the attachment system is activated.

The reporting of maltreatment experiences during the Adult Attachment Interview in a sample of pregnant adolescents

This present student examines maltreatment experiences reported by 55 high-risk pregnant adolescents in response to a slightly adapted version of the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Previous research has suggested that the rates of unresolved states of mind regarding trauma in response to the AAI may be underestimated due to the lack of direct questions and associated probes regarding physical, sexual, and emotional abuse. We address this concern by including behaviorally phrased questions and probes regarding maltreatment experiences into the original format of the AAI and examine the concordance between reports of maltreatment experiences in response to the AAI and the Childhood Trauma Questionnaire (CTQ). Maltreatment experiences in response to the AAI were evaluated using the Maltreatment Classification Scale developed by Barnett, Manly, and Cicchetti (1993). We also examine the association between unresolved states of mind and dissociation using the Adolescent Dissociative Experience Scale. Results revealed a significant concordance between reports of maltreatment in response to the AAI and CTQ measures. Reports of maltreatment were prevalent in this sample: across the AAI and CTQ measures, 96% of pregnant adolescents reported some form of emotional abuse, 84% physical abuse, 59% sexual abuse, and 88% reported neglect. Sexual abuse history uniquely predicted unresolved status in response to the AAI. Self-reports of dissociation were significantly associated with unresolved states of mind. Results suggest that the inclusion of behaviorally focused questions and probes regarding maltreatment in the AAI protocol can further contribute to the clinical and theoretical value of this tool.

Exploration of the links among fathers' unresolved states of mind with respect to attachment, atypical paternal behavior, and disorganized infant-father attachment.

Atypical maternal behavior has consistently been identified as a precursor of disorganized infant-mother attachment, but to date, no research has examined the role of atypical paternal behavior in the development of disorganized infant-father attachment. This study aims to enhance our understanding and conceptualization of infant-father attachment by examining the role of fathers' unresolved states of mind and the display of atypical paternal behavior in the development of disorganized infant-father attachment. Thirty-one middle-class couples participated in this study. Maternal and paternal Adult Attachment Interviews (C. George, N. Kaplan, & M. Main, 1996) were completed prenatally and at infant age 6 months, respectively. Infant-mother and infant-father dyads participated in the Strange Situation paradigm (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978) when the infants were 12 and 18 months of age, respectively. The Atypical Maternal Behavior Instrument for Assessment and Classification (E. Bronfman, E. Parsons, & K. Lyons-Ruth, 1999) was used to assess maternal and paternal behavior during the Strange Situation. Maternal states of mind regarding attachment predicted infant-mother attachment relationships, and paternal states of mind predicted infant-father attachment relationships. Atypical maternal behavior was associated with infant-mother disorganized attachment; however, atypical paternal behavior did not predict infant-father disorganized attachment. Thus, it is possible that other factors, yet to be uncovered, might contribute to the development of infant-father disorganized attachment.

Loss and Disorganization from an Attachment Perspective

In this article, it is hypothesized that disorganizing, disorienting, and unresolved states of mind about loss experiences, as classified by the Adult Attachment Interview (AAI) coding system, may offer insight into the bereaved mind and may guide clinical treatment approaches. This article discusses pre-loss attachment organizations and the disorganizing/disorienting markers of unresolved loss found in the AAI. Although sometimes subtle in nature, the unresolved, disorganized, and disorienting indices—defined as lapses in monitoring of reason, discourse and behavior—provide concrete markers for assessing the degree of resolution for loss experiences. An attachment-based grief treatment model can add to existing models implemented in prolonged grief disorder treatment.

Insecure attachment states of mind and atypical caregiving behavior among foster mothers

The current study examined the links between attachment state of mind (assessed with the Adult Attachment Interview) and atypical parenting behavior among 39 foster mothers. Insecure states of mind were associated with increased atypical parenting while interacting with the foster child, whereas unexpectedly, an unresolved state of mind was not. Furthermore, caregivers with higher coherence and lower passivity scores on the AAI were less likely to display atypical parenting behaviors. Finally, presence of abuse in the caregiver's history and overall unresolved attachment state of mind were found to relate specifically to fearful/disoriented parenting. The results suggest that an insecure state of mind may be a risk factor for atypical caregiving in certain populations, even in the absence of unresolved attachment representations.

Attachment representations in Dutch veterans with and without deployment-related PTSD

In this study we tested for a protective effect of secure attachment representations in the development of posttraumatic stress disorder (PTSD). In a design with a control group, we replicated and extended a recent study that found no underrepresentation of secure attachment representations in veterans with PTSD (Nye, Katzman, Bell, Kilpatrick, Brainard, & Haaland, 2008). Furthermore, we examined the association of the Adult Attachment Interview (AAI) classification of unresolved loss or trauma and PTSD symptomatology. The Adult Attachment Interview and the Clinician Administered PTSD Scale (CAPS) were administered with 31 veterans with PTSD and 29 trauma-exposed veterans without PTSD of similar age and country of deployment. Patient and control groups did not differ in the prevalence of secure attachment representations, neither did unresolved and not unresolved subjects differ in prevalence of secure attachment representations. Unresolved state of mind with respect to deployment related trauma was found to correlate strongly with total CAPS score. This study shows no protective effect of secure attachment representations in the development of PTSD. AAI unresolved state of mind with respect to deployment related trauma and PTSD correlate strongly, due to the common core phenomenon of lack of integration.

III. The Progression from Rapprochement to Adolescence

thinking allows the adolescent to concern himself with the past and future as well as the present. The self-concept is no longer limited to concrete images. The capacity to construct and test hypotheses expands the scope of the self-concept. The adolescent can generate options and explore them systematically. The adolescent can imagine possible selves which are more future oriented, idealistic, and related to worlds less personal and realitybound. The self concept is time-oriented rather than merely present-oriented. Of course, self-esteem regulation still depends on current perception as well as anticipated worth. In the same way, self-esteem regulation is influenced by qualitative differences in the contents of the superego and ego ideal. Hypothetical idealized selves are evaluated alongside the adolescent’s current self. (p. 54) At least one part of this process has to do with separation of the sense of self from involvement with the parents—and one vehicle for this dynamic is laying claim to one’s own body and THE GENESIS OF THE SELF: III. 283 possessing it as one’s own. The pubertal and postpubertal changes of adolescence involve not only changes of the physical body with regard to genital maturation and secondary sexual characteristics, but also significant changes in body image (Laufer, 1989). This maturation of the body self as integral component of the self-as-agent and consolidation of the body image as integral part of the self-as-object (Meissner, 1997) significantly modify the adolescent’s self-experience, and this especially, if not primarily, in sexual terms. Separation from parental dependence and influence and self-possession is facilitated by establishing a secure sexual identity and/or consolidation of one’s gender identity as component aspects of the sense of personal identity. Whether the resolution is ultimately heterosexual or homosexual, however this developmental dynamic can be accomplished, resolution in either term may also have interpersonal and social consequences of a different order that can, but need not, complicate the achievement of a meaningful personal identity. In all this, the dialectic of attachment and separation continues to play out (Blatt & Levy, 2003). Recent findings from longitudinal study of childhood and early adolescence indicate that attachment statuses established in infancy and childhood tend to remain relatively stable during adolescence, with greater stability in individuals characterized by dismissing and secure attachment states and greater variability in those with preoccupied and unresolved states of mind (Ammaniti, van Ijzendoorn, Speranza, & Tarnbelli, 2000; Sroufe et al., 2005). Persistence of conflictual or contradictory internal mental models can be reflected in contradictory self-concepts and difficulties in identity formation (Ammaniti & Sergi, 2003). Writing from the perspective of attachment theory, Ammaniti and Sergi delineate the major changes in adolescence as the following: (1) Body and sexual puberty transformations that deeply influence the perception of the self and of others . . . , (2) Affective changes due to the progressive detachment from the attachment figures . . . . (3) Cognitive changes with the advent of more mature functioning, such as the formal operations, the ability to reflect on one’s own cognitive processes (i.e., metacognition, self-reflective function, and the ability to understand and explain ambivalence). . . .

The association of unresolved attachment status and cognitive processes in maltreated adolescents

AbstractThis exploratory investigation sought to gain a better understanding of the mental representations of attachment in maltreated adolescents, and how, if at all, unresolved attachment representations are related to cognitive processes in this population. Measures of cognitive functioning, attachment state of mind and parent ratings on attention were obtained from 38 adolescents with a history of maltreatment. Results showed that maltreated adolescents with unresolved states of mind in regard to attachment scored significantly lower on measures of cognitive processes of attention, working memory and cognitive efficiency, even when intelligence was controlled for in the analyses. Theoretical considerations, implications for future research and clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd.

A Comparison of Unresolved versus Resolved Status and its Relationship to Behaviour in Maltreated Adolescents

This exploratory investigation sought both to gain a better understanding of the mental representations of attachment in high-risk, maltreated adolescents and to explain how, if at all, unresolved attachment representations are related to behavioural maladjustment. Parent ratings, self-report ratings and attachment state of mind were obtained from 34 adolescents with a history of maltreatment. Results showed that maltreated adolescents with unresolved states of mind in regard to attachment were rated higher on maladaptive behaviour and lower on adaptive behaviour than maltreated adolescents who were resolved. Implications for school-based mental health intervention and future research are discussed.

A Differential Analysis of the Subtypes of Unresolved States of Mind in the Adult Attachment Interview

Abstract Disorganized attachment is most prevalent among high-risk populations, such as maltreated children. Recent attachment literature has demonstrated that one of the best predictors of attachment disorganization is an “Unresolved” parental state of mind regarding a loss or an abuse in the parent's own attachment history. However, although classification in the Unresolved (U) category is always accompanied by specification of the type of trauma that is unresolved (loss, physical abuse, or sexual abuse), much of attachment research has focused on unresolved attachment as one category. The current paper reviews the empirical literature on the parenting outcomes associated with different subtypes of U. The literature demonstrates that parents who have experienced loss or abuse in childhood, which remains unresolved, exhibit atypical care-giving behaviors. Specifically, a history of loss or childhood sexual abuse is found to be associated with more passively withdrawn parental interactions, whereas a hist...

Bindungsmuster von Psychotherapeuten/ Attachment patterns in psychotherapists

Therapist characteristics are relevant for the outcome of psychotherapies. Attachment measures related to aspects of personality are well introduced. We studied a sample of psychotherapists using attachment interviews and questionnaires. 31 psychodynamically oriented psychotherapists who worked in two inpatient institutions were interviewed with the Adult Attachment Interview. We report the results of the distribution of attachment patterns according the Adult Attachment Prototype Rating (Strauss et al. 1999). 14 therapists (45.2%) showed a secure, 4 (12.9%) an insecure-ambivalent and 7 (22.6%) an insecure-avoidant attachment pattern. A comparably high proportion of therapists was rated as mixed-insecure, a pattern of clinical relevance. Discrepancies to other samples lie in the expected direction. There were no correlations with gender, experience or profession. Depression and insecure attachment did correlate; interpersonal problems showed no connection to attachment status. The distribution resembles the general population with a slightly lower proportion of secure subjects. Further assessments, among others, will investigate the occurrence of ,,unresolved states of mind" with respect to attachment trauma.

Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap

The current meta-analysis examines the links between unresolved representations of attachment, anomalous parental behavior, and disorganized attachment relationships in 12 studies including 851 families. We found moderate effect sizes for the associations between unresolved states of mind and anomalous behavior (r = .26), unresolved states of mind and infant disorganized attachment relationships (r = .21), and anomalous behavior and disorganized attachment relationships (r = .34). Sample characteristics, observational context, and observational measure were not associated with differences in effect sizes. Only a small part of the association between unresolved states of mind and disorganized attachment relationships was explained by the mediation of anomalous parental behavior (.26* .34 = .09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted.