Yetişkin Bağlanma Stilleri ile Travma Sonrası Stres Bozukluğu Arasındaki İlişkide Belirsizliğe Tahammülsüzlüğün Aracı Rolü

Year 2023, Volume: 20 Issue: Human Behavior and Social Institutions, 929 - 937, 30.10.2023

Şeyda Eruyar , Merve Yılmaz

https://doi.org/10.26466/opusjsr.1350680

Abstract

Bulgular belirsizliğe tahammülsüzlüğün (BT) hem yetişkin bağlanması hem de travmatik stres ile ilişkili olduğunu ileri sürmektedir, ancak BT'nin bağlanma ile travma sonrası stres bozukluğu (TSSB) arasındaki temel mekanizma olarak rolü henüz ortaya konulmamıştır. Bu çalışmanın amacı yetişkin bağlanma stilleri ile TSSB arasındaki ilişkide BT’nin aracı etki rolünü incelemektir. Türkiye’de yaşayan 335 üniversite öğrencisinin katıldığı çalışmada kesitsel araştırma yöntemi kullanılmıştır. Potansiyel travmatik olaylar (PTO), yetişkin bağlanma stilleri, belirsizliğe tahammülsüzlük ve TSSB’yi ölçmek üzere sırasıyla Yaşam Olayları Kontrol Listesi (YOKL), Yakın İlişkilerde Yaşantılar Envanteri-II (YİYE-2), Belirsizliğe Tahammülsüzlük Ölçeği (BTÖ) ve DSM-5 TSSB Kontrol Listesi (TSSBBKI) kullanılmıştır. Sonuçlar, BT'nin kaygılı ve kaçıngan bağlanma ile TSSB arasındaki ilişkiye aracılık ettiğini ortaya koymuştur. Çalışmanın bulguları bağlanma stilleri ile TSSB arasındaki karmaşık etkileşimi anlamamıza yardımcı olarak, TSSB semptomlarının ortaya çıkmasına ve kalıcı olmasına katkıda bulunan altta yatan faktörlere ışık tutmaktadır. Travmaya maruz kalmış ve kaygılı ya da kaçınmacı bağlanma stillerine sahip kişiler için, belirsizliğe karşı tahammülsüzlüğü azaltmaya yönelik stratejileri bağlanma odaklı terapilerle birleştirmek, nesiller arasında aktarılan TSSB semptomları açısından faydalı etkiler sağlayacaktır.

Keywords

Belirsizliğe tahammülsüzlük, kaygılı bağlanma, kaçıngan bağlanma, travma sonrası stres bozukluğu

Supporting Institution

n/a

Project Number

n/a

Thanks

Bu çalışmaya katkıda bulunan katılımcılarımıza teşekkür ederiz.

Intolerance of Uncertainty as a Mediator on the Relationship Between Adult Attachment and PTSD

Abstract

Established evidence suggests that intolerance of uncertainty (IU) is associated with both adult attachment and traumatic stress, yet the role of IU as an underlying mechanism between attachment and posttraumatic stress disorder (PTSD) is to be explained. This study aimed to examine the mediating role of IU in the relationship between adult attachment styles and PTSD. A cross-sectional study with 335 university students was conducted in Turkiye. Life Events Checklist for DSM-5 (LEC-5), The Experiences in Close Relationships Revised (ECR-R) Questionnaire, The Intolerance of Uncertainty Scale (IU) and PTSD Checklist for DSM-5 (PCL-5) were used to measure potential traumatic events (PTE), adult attachment styles, intolerance of uncertainty and PTSD, respectively. Results revealed that IU mediated the relationship between anxious and avoidant attachment and PTSD. The results offer a valuable understanding of the intricate interplay between attachment styles and PTSD, shedding light on the underlying factors that contribute to the emergence and persistence of PTSD symptoms. For those who have experienced trauma and show anxious or avoidant attachment patterns, combining strategies to address intolerance of uncertainty with attachment-oriented therapies could have beneficial effects on conditions like PTSD, which are often passed down between generations.

Keywords

Intolerance of uncertainty, anxious attachment, avoidant attachment, post taumatic stress disorder

Project Number

n/a

References

• Atwoli, L., Stein, D. J., Koenen, K. C., & McLaughlin, K. A. (2015). Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences. Current Opinion in Psychiatry, 28(4), 307. https://doi.org/10.1097/YCO.0000000000000188
• Barazzone, N., Santos, I., McGowan, J., & Donaghay-Spire, E. (2018). The links between adult attachment and post-traumatic stress: A systematic review. Psychology and Psychotherapy: Theory, Research and Practice, 92(1), 131-147. https://doi.org/10.1111/papt.12181
• Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., ... & Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327-343.
• Benoit, M., Bouthillier, D., Moss, E., Rousseau, C., & Brunet, A. (2010). Emotion regulation strategies as mediators of the association between level of attachment security and PTSD symptoms following trauma in adulthood. Anxiety, Stress & Coping, 23(1), 101-118. https://doi.org/10.1080/10615800802638279
• Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: A common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69(6), 630-645. https://doi.org/10.1002/jclp.21965
• Boysan, M., Guzel Ozdemir, P., Ozdemir, O., Selvi, Y., Yilmaz, E., & Kaya, N. (2017). Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, (PCL-5).
• Psychiatry and Clinical Psychopharmacology, 27(3), 300-310. https://doi.org/10.1080/24750573.2017.1299637 Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behavior Research and Therapy, 40, 931-945. https://doi.org/10.1016/S0005-7967(02)00009-6
• Candel, O. S., & Turliuc, M. N. (2019). Insecure attachment and relationship satisfaction: A meta-analysis of actor and partner associations. Personality and Individual Differences, 147, 190-199. https://doi.org/10.1016/j.paid.2019.04.035
• Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26(3), 468-479. https://doi.org/10.1016/j.janxdis.2012.01.011
• Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105-117. https://doi.org/10.1016/j.janxdis.2006.03.014
• de Bruin, G. O., Rassin, E., & Muris, P. (2007). The prediction of worry in non-clinical individuals: The role of intolerance of uncertainty, meta-worry, and neuroticism. Journal of Psychopathology and Behavioral Assessment, 29, 93-100. https://doi.org/10.1007/s10862-006-9035-x
• Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research, 25, 551-558. https://doi.org/10.1023/A:1005553416838
• Fetzner, M. G., Horswill, S. C., Boelen, P. A., & Carleton, R. N. (2013). Intolerance of uncertainty and PTSD symptoms: Exploring the construct relationship in a community sample with a heterogeneous trauma history. Cognitive Therapy and Research, 37, 725-734. https://doi.org/10.1007/s10608-012-9506-1
• Fraley, R. C. (2019). Attachment in adulthood: Recent developments, emerging debates, and future directions. Annual Review of Psychology, 70, 401-422. https://doi.org/10.1146/annurev-psych-010418-102755
• Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of personality and social psychology, 78(2), 350. https://doi.org/10.1037/0022-3514.78.2.350
• Fredette, C., El-Baalbaki, G., Palardy, V., Rizkallah, E., & Guay, S. (2016). Social support and cognitive–behavioral therapy for posttraumatic stress disorder: A systematic review. Traumatology, 22(2), 131. https://doi.org/10.1037/trm0000059
• Groh, A. M., Fearon, R. P., Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Steele, R. D., & Roisman, G. I. (2014). The significance of attachment security for children’s social competence with peers: A meta-analytic study. Attachment & Human Development, 16(2), 103-136. https://doi.org/10.1080/14616734.2014.883581
• Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
• Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., ... & Kessler, R. (2017). Posttraumatic stress disorder in the world mental health surveys. Psychological Medicine, 47(13), 2260-2274. https://doi.org/10.1017/S0033291717000803
• Leary, M. R., & Hoyle, R. H. (Eds.). (2009). Handbook of individual differences in social behavior. Guilford Press.
• Mikulincer, M., Shaver, P. R., Solomon, Z. (2015). An Attachment Perspective on Traumatic and Posttraumatic Reactions. In: Safir, M., Wallach, H., Rizzo, A. (Eds.), Future Directions in Post-Traumatic Stress Disorder. Springer, Boston, MA.
• Nielsen, S. K. K., Lønfeldt, N., Wolitzky-Taylor, K. B., Hageman, I., Vangkilde, S., & Daniel, S. I. F. (2017). Adult attachment style and anxiety–The mediating role of emotion regulation. Journal of Affective Disorders, 218, 253-259. https://doi.org/10.1016/j.jad.2017.04.032
• Ogle, C. M., Rubin, D. C., Berntsen, D., & Siegler, I. C. (2013). The frequency and impact of exposure to potentially traumatic events over the life course. Clinical Psychological Science, 1(4), 426-434. https://doi.org/10.1177/2167702613481601
• Oglesby, M. E., Boffa, J. W., Short, N. A., Raines, A. M., & Schmidt, N. B. (2016). Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. Journal of Anxiety Disorders, 41, 82-87. https://doi.org/10.1016/j.janxdis.2016.01.005
• Oglesby, M. E., Gibby, B. A., Mathes, B. M., Short, N. A., & Schmidt, N. B. (2017). Intolerance of uncertainty and post-traumatic stress symptoms: An investigation within a treatment seeking trauma-exposed sample. Comprehensive Psychiatry, 72, 34-40. https://doi.org/10.1016/j.comppsych.2016.08.011
• Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52. https://doi.org/10.1037/0033-2909.129.1.52
• Pietromonaco, P. R., DeBuse, C. J., & Powers, S. I. (2013). Does attachment get under the skin? Adult romantic attachment and cortisol responses to stress. Current Directions in Psychological Science, 22(1), 63-68. https://doi.org/10.1177/0963721412470138
• Pietromonaco, P. R., & Powers, S. I. (2015). Attachment and health-related physiological stress processes. Current Opinion in Psychology, 1, 34-39. https://doi.org/10.1016/j.copsyc.2014.12.010
• Rimane, E., Steil, R., Renneberg, B., & Rosner, R. (2021). Get secure soon: Attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. European Child & Adolescent Psychiatry, 30, 1591-1601. https://doi.org/10.1007/s00787-021-01847-2
• Rosser, B. A. (2019). Intolerance of uncertainty as a transdiagnostic mechanism of psychological difficulties: A systematic review of evidence pertaining to causality and temporal precedence. Cognitive Therapy and Research, 43(2), 438-463.
• Schuman, D. L., Whitworth, J., Galusha, J., Carbajal, J., Ponder, W. N., Shahan, K., & Jetelina, K. (2023). Differences in resilience and mental health symptoms among US first responders with secure and insecure attachment. Journal of Occupational & Environmental Medicine, 65(5), 378-386. https://doi.org/10.1097/jom.0000000000002799
• Sternheim, L. C., Fisher, M., Harrison, A., & Watling, R. (2017). Predicting intolerance of uncertainty in individuals with eating disorder symptoms. Journal of Eating Disorders, 5(1). https://doi.org/10.1186/s40337-017-0152-4
• Stalker, C. A., Gebotys, R., & Harper, K. (2005). Insecure attachment as a predictor of outcome following inpatient trauma treatment for women survivors of childhood abuse. Bulletin of the Menninger Clinic, 69(2), 137-156. https://doi.org/10.1521/bumc.2005.69.2.137
• Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov, 10(4), 206. https://doi.org/10.1037/t02564-000
• Woodhouse, S., Ayers, S., & Field, A. P. (2015). The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis. Journal of Anxiety Disorders, 35, 103-117. https://doi.org/10.1016/j.janxdis.2015.07.008
• Zdebik, M. A., Moss, E., & Bureau, J. F. (2018). Childhood attachment and behavioral inhibition: Predicting intolerance of uncertainty in adulthood. Development and Psychopathology, 30(4), 1225-1238. https://doi.org/10.1017/S0954579417001650