How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms
How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms
Background: the relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis.
Method: we conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association.
Results: we identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self- and other-beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment-secure people with psychosis are more likely to seek help and engage with services than attachment-insecure people.
Conclusions: attachment styles impact help-seeking behaviours in people with psychosis and are likely to influence paranoia via self- and other-beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia.
Practitioner points: insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment-secure are more likely to seek help and engage with services than those who are attachment-insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help-seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.
attachment, mechanisms, mediators, paranoia, psychosis, review, schizophrenia
781-815
Sood, Monica
185fb97e-a111-45e1-bbe8-d865d301ef9f
Carnelley, Katherine
02a55020-a0bc-480e-a0ff-c8fe56ee9c36
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
September 2022
Sood, Monica
185fb97e-a111-45e1-bbe8-d865d301ef9f
Carnelley, Katherine
02a55020-a0bc-480e-a0ff-c8fe56ee9c36
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
Sood, Monica, Carnelley, Katherine and Newman-Taylor, Katherine
(2022)
How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms.
British Journal of Clinical Psychology, 61 (3), .
(doi:10.1111/bjc.12361).
Abstract
Background: the relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis.
Method: we conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association.
Results: we identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self- and other-beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment-secure people with psychosis are more likely to seek help and engage with services than attachment-insecure people.
Conclusions: attachment styles impact help-seeking behaviours in people with psychosis and are likely to influence paranoia via self- and other-beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia.
Practitioner points: insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment-secure are more likely to seek help and engage with services than those who are attachment-insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help-seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.
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How Does Insecure Attachment lead to Paranoia? A Systematic Critical Review of Cognitive, Affective, and Behavioral Mechanisms
- Accepted Manuscript
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British J Clinic Psychol - 2022 - Sood - How does insecure attachment lead to paranoia A systematic critical review of
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More information
Accepted/In Press date: 2 February 2022
e-pub ahead of print date: 17 February 2022
Published date: September 2022
Additional Information:
Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to thank our research assistant, Sophia Samuela De Araujo, for assisting with the systematic searches conducted in this review.
Keywords:
attachment, mechanisms, mediators, paranoia, psychosis, review, schizophrenia
Identifiers
Local EPrints ID: 454806
URI: http://eprints.soton.ac.uk/id/eprint/454806
ISSN: 0144-6657
PURE UUID: d128066c-91bf-47df-b39a-3c53ef973dea
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Date deposited: 24 Feb 2022 21:47
Last modified: 16 Aug 2024 17:27
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Author:
Monica Sood
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