Significance of anger suppression and preoccupied attachment in social anxiety disorder: a cross-sectional study.
Anger expression
Anger suppression
Attachment style
Mediation
Preoccupied attachment
Social anxiety disorder
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
22 02 2021
22 02 2021
Historique:
received:
21
10
2020
accepted:
31
01
2021
entrez:
23
2
2021
pubmed:
24
2
2021
medline:
27
4
2021
Statut:
epublish
Résumé
There is evidence for the relevance of attachment style and anger expression for the manifestation of social anxiety disorder (SAD). In a cross-sectional study 321 individuals with social anxiety disorder (41% men, age 38.8 ± 13.9) were compared with 94 healthy controls (37% men, age 35.8 ± 15.1) on several questionnaires (Attachment Styles Questionnaire, State Trait Anger Inventory, Social Phobia Inventory, Beck Depression Inventory). Individuals with SAD showed moderate-sized reduced levels of secure and large-sized increased levels of fearful and preoccupied attachment style compared to healthy controls (all p < 0.001) as well as small-sized increased levels of trait anger (p = 0.03) and moderate-sized increased levels of anger-in (p < 0.001). Attachment style and anger regulation could predict 21% (R Study findings confirm the relevance of preoccupied attachment style and anger suppression for social anxiety. Disentangling the role of anger regulation in early attachment patterns has significant therapeutic implications in SAD.
Sections du résumé
BACKGROUND
There is evidence for the relevance of attachment style and anger expression for the manifestation of social anxiety disorder (SAD).
METHOD
In a cross-sectional study 321 individuals with social anxiety disorder (41% men, age 38.8 ± 13.9) were compared with 94 healthy controls (37% men, age 35.8 ± 15.1) on several questionnaires (Attachment Styles Questionnaire, State Trait Anger Inventory, Social Phobia Inventory, Beck Depression Inventory).
RESULTS
Individuals with SAD showed moderate-sized reduced levels of secure and large-sized increased levels of fearful and preoccupied attachment style compared to healthy controls (all p < 0.001) as well as small-sized increased levels of trait anger (p = 0.03) and moderate-sized increased levels of anger-in (p < 0.001). Attachment style and anger regulation could predict 21% (R
CONCLUSION
Study findings confirm the relevance of preoccupied attachment style and anger suppression for social anxiety. Disentangling the role of anger regulation in early attachment patterns has significant therapeutic implications in SAD.
Identifiants
pubmed: 33618700
doi: 10.1186/s12888-021-03098-1
pii: 10.1186/s12888-021-03098-1
pmc: PMC7898747
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
116Références
First MB, Gibbon M. The structured clinical interview for DSM-IV Axis I disorders (SCID-I) and the structured clinical interview for DSM-IV Axis II disorders (SCID-II). In: Comprehensive handbook of psychological assessment, Vol 2: personality assessment. Hoboken, NJ, US: John Wiley & Sons Inc; 2004. p. 134–43.
Association AP. Diagnostische Kriterien DSM-5: Deutsche Ausgabe herausgegeben von Peter Falkai und Hans-Ulrich Wittchen, mitherausgegeben von Manfred Döpfner, ... Winfried Rief, Henning Saß und Michael Zaudig. 2., korrigierte Auflage 2020. Hogrefe Verlag; 2020. 533 S.
Bartholomew K, Cobb RJ, Poole JA. Adult Attachment Patterns and Social Support Processes. In: Pierce GR, Lakey B, Sarason IG, Sarason BR, Herausgeber. Sourcebook of Social Support and Personality [Internet]. Boston, MA: Springer US; 1997 [zitiert 16. Januar 2021]. S. 359–78.
Laczkovics C, Fonzo G, Bendixsen B, Shpigel E, Lee I, Skala K, u. a. Defense mechanism is predicted by attachment and mediates the maladaptive influence of insecure attachment on adolescent mental health. Curr Psychol. 2020;39(4):1388–1396.
Eng W, Heimberg RG, Hart TA, Schneier FR, Liebowitz MR. Attachment in individuals with social anxiety disorder: the relationship among adult attachment styles, social anxiety, and depression. Emotion. 2001;1(4):365–80.
doi: 10.1037/1528-3542.1.4.365
Brumariu LE, Kerns KA. Mother-child attachment and social anxiety symptoms in middle childhood. J Appl Dev Psychol. 2008;29(5):393–402.
doi: 10.1016/j.appdev.2008.06.002
Esbjørn BH, Bender PK, Reinholdt-Dunne ML, Munck LA, Ollendick TH. The development of anxiety disorders: considering the contributions of attachment and emotion regulation. Clin Child Fam Psychol Rev. 2012;15(2):129–43.
doi: 10.1007/s10567-011-0105-4
Schore JR, Schore AN. Modern attachment theory: the central role of affect regulation in development and treatment. Clin Soc Work J. 2008;36(1):9–20.
doi: 10.1007/s10615-007-0111-7
Weinfield NS, Sroufe LA, Egeland B, Carlson E. Individual differences in infant-caregiver attachment: conceptual and empirical aspects of security. In: Handbook of attachment: theory, research, and clinical applications. 2nd ed. New York, NY, US: The Guilford Press; 2008. p. 78–101.
Mennin DS, McLaughlin KA, Flanagan TJ. Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. J Anxiety Disord. 2009;23(7):866–71.
doi: 10.1016/j.janxdis.2009.04.006
Werner KH, Goldin PR, Ball TM, Heimberg RG, Gross JJ. Assessing emotion regulation in social anxiety disorder: the emotion regulation interview. J Psychopathol Behav Assess. 2011;33(3):346–54.
doi: 10.1007/s10862-011-9225-x
Asberg K. Hostility/anger as a mediator between college students’ emotion regulation abilities and symptoms of depression, social anxiety, and generalized anxiety. J Psychol. 2013;147(5):469–90.
doi: 10.1080/00223980.2012.715601
O’Toole M, Jensen M, Fentz H, Zachariae R, Hougaard E. Emotion differentiation and emotion regulation in high and low socially anxious individuals: an experience-sampling study. Cogn Ther Res. 2014;68:460–3.
Schwenkmezger P, Hodapp V, Spielberger CD. Das State-Trait-Ärgerausdrucks-Inventar STAXI: Handbuch. Bern; Göttingen. Toronto: Huber; 1992.
Erwin BA, Heimberg RG, Schneier FR, Liebowitz MR. Anger experience and expression in social anxiety disorder: pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behav Ther. 2003;34(3):331–50.
doi: 10.1016/S0005-7894(03)80004-7
Breen WE, Kashdan TB. Anger suppression after imagined rejection among individuals with social anxiety. J Anxiety Disord. 2011;25(7):879–87.
doi: 10.1016/j.janxdis.2011.04.009
Versella MV, Piccirillo ML, Potter CM, Olino TM, Heimberg RG. Anger profiles in social anxiety disorder. J Anxiety Disord. 2016;37:21–9.
doi: 10.1016/j.janxdis.2015.10.008
Kashdan TB, Roberts JE. Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences. J Anxiety Disord. 2007;21(3):284–301.
doi: 10.1016/j.janxdis.2006.05.009
Forstner AJ, Rambau S, Friedrich N, Ludwig KU, Böhmer AC, Mangold E, u. a. Further evidence for genetic variation at the serotonin transporter gene SLC6A4 contributing toward anxiety. Psychiatr Genet 2017;27(3):96–102.
Rambau S, Forstner AJ, Wegener I, Mücke M, Wissussek CTS, Staufenbiel SM, u. a. Childhood adversities, bonding, and personality in social anxiety disorder with alcohol use disorder. Psychiatry Res. 2018;262:295–302.
Ernstmann N, Heuser C, Halbach S, Wegener I, Rambau S, Forstner AJ, u. a. [Interactive Health Literacy, Sociodemographic Characteristics and the Uptake of Psychotherapeutic or Pharmacological Interventions - are there Social Inequalities in the Treatment of Social Anxiety Disorder?]. Psychiatr Prax. 24. November 2020; online ahead of print.
Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the social phobia inventory (SPIN). New self-rating scale. Br J Psychiatry J Ment Sci. 2000;176:379–86.
doi: 10.1192/bjp.176.4.379
Sosic Z, Gieler U, Stangier U. Screening for social phobia in medical in- and outpatients with the German version of the social phobia inventory (SPIN). J Anxiety Disord. 2008;22(5):849–59.
doi: 10.1016/j.janxdis.2007.08.011
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version: Administration Booklet. American Psychiatric Association Publishing; 1996. 98 S.
Fydrich T, Wittchen H-U, Zaudig M. SKID: Strukturiertes Klinisches Interview. für DSM-IV; Achse I und II. SKID-II SKID-II. Göttingen: Hogrefe; 1997.
Beck AT, Steer RA, Brown GK. Beck depression inventory. San Antonio, Tex. Toronto: The Psychological Corporation; 1996.
Oudenhoven JPV, Hofstra J, Bakker W. Ontwikkeling en evaluatie van de Hechtingstijlvragenlijst (HSL). Ned Tijdschr Voor Psychol. 2003;58:95–102.
Hofstra J, van Oudenhoven J, Buunk BP. Attachment styles and majority members’ attitudes towards adaptation strategies of immigrants. Int J Intercult Relat. 2005;29(5):601–19.
doi: 10.1016/j.ijintrel.2005.05.009
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, N.J.: L. Erlbaum Associates; 1988.
(USA) Hayes AF (Ohio SU). Introduction to Mediation, Moderation, and Conditional Process Analysis, Second Edition: A Regression-Based Approach. 2 New edition. New York: Guilford Publications; 2018. 692 S.
Warren SL, Huston L, Egeland B, Sroufe LA. Child and adolescent anxiety disorders and early attachment. J Am Acad Child Adolesc Psychiatry. 1997;36(5):637–44.
doi: 10.1097/00004583-199705000-00014
Bar-Haim Y, Dan O, Eshel Y, Sagi-Schwartz A. Predicting children’s anxiety from early attachment relationships. J Anxiety Disord. 2007;21(8):1061–8.
doi: 10.1016/j.janxdis.2006.10.013
Bartholomew K. Avoidance of intimacy: an attachment perspective. J Soc Pers Relatsh. 1990;7(2):147–78.
doi: 10.1177/0265407590072001
Hart TA, Turk CL, Heimberg RG, Liebowitz MR. Relation of marital status to social phobia severity. Depress Anxiety. 1999;10(1):28–32.
doi: 10.1002/(SICI)1520-6394(1999)10:1<28::AID-DA5>3.0.CO;2-I
Karatzias T, Shevlin M, Ford JD, Fyvie C, Grandison G, Hyland P, u. a. Childhood trauma, attachment orientation, and complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment. Dev Psychopathol. 2021;1–6.
Woodhouse S, Ayers S, Field AP. The relationship between adult attachment style and post-traumatic stress symptoms: a meta-analysis. J Anxiety Disord. 2015;35:103–17.
doi: 10.1016/j.janxdis.2015.07.002
Mikulincer M, Shaver PR. Attachment theory and emotions in close relationships: exploring the attachment-related dynamics of emotional reactions to relational events. Pers Relatsh. 2005;12(2):149–68.
doi: 10.1111/j.1350-4126.2005.00108.x
Cassidy J. Emotion regulation: influences of attachment relationships. Monogr Soc Res Child Dev. 1994;59(2–3):228–49.
doi: 10.1111/j.1540-5834.1994.tb01287.x
Altmann U, Gawlytta R, Hoyer J, Leichsenring F, Leibing E, Beutel M, u. a. Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis. J Anxiety Disord. 2020;71:102200.
Strauß B, Altmann U, Manes S, Tholl A, Koranyi S, Nolte T, u. a. Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder: Results from the SOPHO-Net trial. PloS One. 2018;13(3):e0192802.
Dozier M, Stevenson AL, Lee SW, Velligan DI. Attachment organization and familial overinvolvement for adults with serious psychopathological disorders. Dev Psychopathol. 1991;3(4):475–89.
doi: 10.1017/S0954579400007641
Clay DL, Anderson WP, Dixon WA. Relationship between anger expression and stress in predicting depression. J Couns Dev. 1993;72(1):91–4.
doi: 10.1002/j.1556-6676.1993.tb02283.x
Begley TM. Expressed and suppressed anger as predictors of health complaints. J Organ Behav. 1994;15(6):503–16.
doi: 10.1002/job.4030150603
Geiser F, Imbierowicz K, Conrad R, Schilling G, Liedtke R. Differences between patients classified as “recovered” or “improved” and “unchanged” or “deteriorated” in a psychotherapy outcome study. Z Psychosom Med Psychother. 2001;47(3):250–61.
pubmed: 11568863