Attachment style predicts 6-month improvement in psychoticism in persons with at-risk mental states for psychosis

Authors

  • Yanet Quijada,

    1. Department of Clinical and Health Psychology, Autonomous University of Barcelona
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  • Jorge L. Tizón,

    1. Early Care Team for At-Risk of Psychosis Patients
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  • Jordi Artigue,

    1. Early Care Team for At-Risk of Psychosis Patients
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  • Thomas R. Kwapil,

    1. Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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  • Neus Barrantes-Vidal

    Corresponding author
    1. Department of Clinical and Health Psychology, Autonomous University of Barcelona
    2. Department of Mental Health, Sant Pere Claver – Fundació Sanitària
    3. Institute of Health Carlos III, Center of Biomedic Research in Network of Mental Health, CIBERSAM, Barcelona, Spain
    4. Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Dr Neus Barrantes-Vidal, Departamento de Psicología Clínica y de la Salud, Facultad de Psicología, Universidad Autónoma de Barcelona, Edificio B, 08193 Bellaterra, Barcelona, Spain. Email: neus.barrantes@uab.cat

Abstract

Aim: Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA).

Methods: Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning.

Results: Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism.

Conclusions: The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

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