Understanding Suspicious Thinking: What Mediates the Relationship Between Attachment Style and Psychosis?

Abstract

Psychosis is characterised by difficulties in interpreting reality. Cognitive Behavioural Therapy for psychosis primary targets cognitions and behaviour to effect therapeutic change, and yields modest results, warranting further research into the psychological factors contributing to the development and maintenance of distressing psychosis. It is now well-established that insecure attachment is related to psychosis, but little is known about the mediating mechanisms underlying this relationship.

A systematic review was conducted which examined 17 studies exploring mediating mechanisms between attachment style and psychosis. The attachment and psychosis relationship was found to be mediated by four variables, with strong evidence for affective factors (e.g. affective dysregulation) and cognitive factors (e.g. self-beliefs), and tentative evidence for duration of untreated psychosis and negative symptoms. The results suggest that, in addition to cognitive factors, it may be beneficial to target affective factors and attachment style in psychological interventions for psychosis. Based on this review, an empirical study was conducted to explore the mediating role of affect regulation in the attachment and psychosis relationship. Sixty-two individuals with elevated paranoia were recruited from NHS and community settings. As predicted, affect dysregulation mediated the association between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the association between attachment avoidance and paranoia, possibly due to power.

Collectively, these findings highlight the key role of attachment and affect regulation in psychosis and provide a guide to future research, including the need to evaluate the effectiveness of emotion regulation skills training for people with psychosis.

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ORCID for Katherine Newman-Taylor: orcid.org/0000-0003-1579-7959

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