Psychological medicine · 2025
Unraveling attachment - A network analysis of the cognitive pathways linking attachment and prolonged grief.
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Smith Kirsten V, Skjerdingstad Nora, Ebrahimi Omid V, Maccallum Fiona, Ehlers Anke
Аннотация
BACKGROUND: Attachment style is widely recognized as influential in shaping responses to bereavement and prolonged grief disorder (PGD). Although theorized extensively, empirical clarity regarding how attachment styles specifically impact PGD symptoms and therapeutic implications remains limited. This study aimed to identify cognitive-behavioral mechanisms linking attachment styles to PGD symptoms.
METHODS: Data were collected from a community sample of 695 bereaved adults. Network analysis explored interactions between attachment styles (anxious and avoidant) and various cognitive-behavioral factors associated with PGD, including appraisals, memory characteristics, maladaptive coping strategies, and a sense of social disconnection.
RESULTS: The findings reveal attachment styles as peripheral within the network, suggesting that their direct influence on PGD symptoms may be less central than previously theorized. However, anxious attachment correlated positively with injustice rumination and altered social self, while avoidant attachment was positively associated with perceived loss of future and relationships and preferences for solitude, and negatively associated with proximity-seeking behaviors and fear of losing connection to the deceased. Cognitive-behavioral factors, particularly memory characteristics and social disconnection, held central positions within the network, mediating relationships between attachment styles and PGD.
CONCLUSIONS: Attachment styles indirectly influence PGD through cognitive-behavioral pathways rather than exerting strong direct effects. By bridging the gap between attachment theory and cognitive-behavioral approaches to grief, this study offers a more nuanced understanding of its relationship with PGD and points toward potential new avenues for future interventions aimed at addressing attachment-related challenges in bereaved individuals.
METHODS: Data were collected from a community sample of 695 bereaved adults. Network analysis explored interactions between attachment styles (anxious and avoidant) and various cognitive-behavioral factors associated with PGD, including appraisals, memory characteristics, maladaptive coping strategies, and a sense of social disconnection.
RESULTS: The findings reveal attachment styles as peripheral within the network, suggesting that their direct influence on PGD symptoms may be less central than previously theorized. However, anxious attachment correlated positively with injustice rumination and altered social self, while avoidant attachment was positively associated with perceived loss of future and relationships and preferences for solitude, and negatively associated with proximity-seeking behaviors and fear of losing connection to the deceased. Cognitive-behavioral factors, particularly memory characteristics and social disconnection, held central positions within the network, mediating relationships between attachment styles and PGD.
CONCLUSIONS: Attachment styles indirectly influence PGD through cognitive-behavioral pathways rather than exerting strong direct effects. By bridging the gap between attachment theory and cognitive-behavioral approaches to grief, this study offers a more nuanced understanding of its relationship with PGD and points toward potential new avenues for future interventions aimed at addressing attachment-related challenges in bereaved individuals.