Attachment and Trauma: A Historical and Empirical Study of the Meaning of Unresolved Loss and Abuse in the Adult Attachment Interview

This thesis comprises three studies of the meaning of adults’ unresolved states of mind with respect to attachment (U/d) in the Adult Attachment Interview. The first study is a historical analysis of the conceptualisation of “trauma” in the unresolved state of mind classification, drawing on published and unpublished texts by Mary Main and colleagues. The paper traces the emergence of the construct of an unresolved state of mind, and places this in the context of wider contemporary discourses of trauma, in particular posttraumatic stress disorder and discourses about child abuse. In the second study, individual participant data were used from 1,009 parent-child dyads across 13 studies. Interviewees with or without unresolved loss/abuse were differentiated by subsets of commonly occurring indicators of unresolved loss/abuse. Predictive models suggested a psychometric model of unresolved states of mind consisting of a combination of these common indicators, which was weakly predictive of infant disorganised attachment. There was no significant association between unresolved “other trauma” and infant disorganised attachment. The findings provide directions for further articulation and optimisation of the unresolved state of mind construct. In the third study, first-time pregnant women (N = 235) participated in the Adult Attachment Interview while indicators of autonomic nervous system reactivity were recorded. Unresolved speech about loss was associated with increased heart rate. Participants classified as unresolved showed a decrease in pre-ejection period and blunted skin conductance level throughout the interview. Unresolved states of mind may be associated with physiological dysregulation, but questions remain about the psychological mechanisms involved. This thesis contributes towards further clarification of the unresolved state of mind construct by examining its historical context, psychometric characteristics, and psychophysiological mechanisms. Further exploratory and theoretical work should focus on improving the definition and validity of the unresolved state of mind construct, to gain a better understanding of how attachment-related experiences of loss and trauma are processed and how this might affect parenting behaviour

A longitudinal study on the effects of psychological stress on proteinuria in childhood steroid-sensitive nephrotic syndrome.

OBJECTIVE: Steroid-sensitive nephrotic syndrome (SSNS) in children is often complicated by one or more relapses, as manifested by the appearance of proteinuria. Besides health-related triggers, psychological stress might be related to relapse. This longitudinal study examined the link between perceived stress, emotional valence (feeling happy vs. unhappy) and daily reported proteinuria, and investigated the temporal relation between stressful events and proteinuria. METHOD: Sixteen children (4-13 years) diagnosed with SSNS were included. Patients kept an online diary for an average of 124 days, wherein they reported proteinuria (n = 1985 urine samples), perceived stress, emotional valence, medication use and health complaints. Stressful days were determined at the start of the study. Using multilevel analysis, the following associations were tested: (1) the relation between perceived stress, emotional valence and proteinuria, and (2) the temporal relation between stressful days and proteinuria. RESULTS: Appearance of proteinuria was reported in 410/1985 urine samples. Perceived stress and not emotional valence significantly predicted proteinuria (95% CI [0.11, 0.27]), even five days later. There was a significant temporal association between stressful days and proteinuria (95% CI [0.22, 1.14]). The effect sizes of these associations were small, f = 0.04 and f = 0.12, respectively. CONCLUSIONS: Our findings suggest that psychological stress may trigger proteinuria in children with SSNS. Future research in larger samples is needed to support our findings.The funder of this research is the Dutch Kidney Foundation, The Netherlands [SB191]. Lianne Bakkum is supported by the Wellcome Trust [208155/Z/17/Z]

People with intellectual disabilities living in care facilities engaging in virtual social contact: A systematic review of the feasibility and effects on well-being.

Funder: Project Digitaal op bezoek bij mensen met beperkingenFunder: Academische Werkplaats Leven met een verstandelijke beperking, Tranzo, Tilburg UniversityFunder: Academische Werkplaats EMB, Rijksuniversiteit GroningenFunder: Academische Werkplaats's Heeren Loo ‐ VUFunder: Academische Werkplaats Sociale relaties en gehechtheid, Bartiméus ‐ VUBACKGROUND: During the initial phase of the COVID-19 pandemic, many people with disabilities living in home care facilities could not receive visitors. The use of virtual social contact has been recommended by health authorities. This systematic review examined the scientific evidence of the use and feasibility of information and communication technology (ICT) for social contact by people with intellectual disabilities living in care facilities, and potential effects on well-being. METHODS: Five databases were searched using traditional systematic screening and machine-learning supported screening. Findings are presented in a narrative synthesis using thematic analysis. RESULTS: Nine studies were included. We described three themes: means of ICT used for social contact; effects on well-being; and benefits, barriers, and preconditions. CONCLUSIONS: Engaging in virtual social contact may be feasible for people with severe to mild intellectual disabilities, but there is little concrete evidence that this can be used as an alternative for in-person contact

Exploring the meaning of unresolved loss and trauma in more than 1,000 Adult Attachment Interviews

Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent-child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided

Mary Main's written legacy: a bibliometric analysis.

Mary Main's written work profoundly changed the direction of attachment research through her publications and through her teachings. The current study describes the scientific impact of her her published and unpublished work. We identified 85 such works. Web of Sciences contained k = 7,571 citations to these works from by 13,398 unique authors. The topics of citing work clustered around clinical psychological research, early dyadic relationships, romantic attachment, traumatic experiences, and the adult attachment interview itself. Based on co-citation patterns, Main shared an intellectual space with authors known for developmental psychopathology and child development, parent-child relationships, adult attachment, psychodynamic theorizing, and reciprocity in interaction and infant mental health. We discuss the impact of the "move to the level of representation" and how new ties with researchers unfamiliar with these ideas will be important to realize unused potential in the ideas and methods given to the field by Mary Main

Impact of the Care and Coercion Act on recorded involuntary care in intellectual disability care: a time-series analysis

Background On 1 January 2020, the Care and Coercion Act came into effect in the Netherlands, subjecting involuntary care to more strict regulations and monitoring. This study tested changes in recordings of involuntary care during the transitional year of 2020 and after full implementation in 2021, which coincided with the first severe test of the new regulations, when COVID-19 lockdown measures were taken on 16 March 2020. Methods Data consisted of weekly counts of involuntary care from 1 January 2017 to 31 December 2021, taken from the care data of more than 3000 clients with intellectual disabilities and challenging behaviour of 's Heeren Loo, a large long-term care organisation in the Netherlands. An interrupted time series design was used to compare the period under the former law with the period under the new law and to the period during and after implementation, taking into account the impact of the COVID-19 lockdown measures on recordings of involuntary care. Results Under the new act in Week 1 of 2020, a statistically significant drop occurred in involuntary care counts, after which these counts gradually decreased. The start of 2021, the year in which the act was fully implemented, showed an initial increase in counts of involuntary care, followed by a decrease (all Ps < .001). The introduction of the COVID-19 lockdown measures did not statistically affect the weekly counts of involuntary care. Conclusions The decrease in registered involuntary care after the Care and Coercion Act came into effect is a first indication of the efficacy of this new law that requires careful multidisciplinary consultations around the right of clients to respect their self-determination. Follow-up research should examine whether the impact of the new law aligns with clients' experiences of self-determination

Mary Main’s Written Legacy: A Bibliometric Analysis

Mary Main’s written work profoundly changed the direction of attachment research. She disseminated her ideas partly through her publications and partly through her teachings in which she circulated both published and unpublished materials. The aim of the current study was to describe the scientific impact of her writings through her published and unpublished work. Based on existing bibliographies and systematic searching, we identified k = 86 works. Citation analysis found k = 7,571 citing published sources, written by 13,398 unique authors. The topics of citing work clustered around clinical psychological research, early dyadic relationships, romantic attachment, traumatic experiences, and the adult attachment interview itself. Based on co-citation patterns, Main occupied an intellectual space shared with authors known for work on developmental psychopathology and child development, parent-child relationships, adult attachment, psychodynamic theorizing, and reciprocity in interaction and infant mental health. We conclude by discussing the impact of the ‘move to the level of representation’ and how forging new ties with researchers unfamiliar with these ideas will be important to realize some of the remaining unused potential in the ideas and methods given to the field by Mary Main

Mary Main's written legacy:a bibliometric analysis

Mary Main's written work profoundly changed the direction of attachment research through her publications and through her teachings. The current study describes the scientific impact of her her published and unpublished work. We identified 85 such works. Web of Sciences contained k = 7,571 citations to these works from by 13,398 unique authors. The topics of citing work clustered around clinical psychological research, early dyadic relationships, romantic attachment, traumatic experiences, and the adult attachment interview itself. Based on co-citation patterns, Main shared an intellectual space with authors known for developmental psychopathology and child development, parent-child relationships, adult attachment, psychodynamic theorizing, and reciprocity in interaction and infant mental health. We discuss the impact of the "move to the level of representation" and how new ties with researchers unfamiliar with these ideas will be important to realize unused potential in the ideas and methods given to the field by Mary Main.</p

Mary Main's Legacy

Mary Main’s written work profoundly changed the direction of attachment research. She disseminated her ideas partly through her publications and partly through her teachings in which she circulated both published and unpublished materials. The aim of the current study was to describe the scientific impact of her writings through her published and unpublished work