Object Attachment and the Compensatory Process in Hoarding Disorder

Hoarding disorder (HD) is a highly disabling psychological disorder and although current treatments are effective, many individuals respond poorly or discontinue treatment prematurely. An obstacle to better outcomes is the strong emotional attachment that people with HD have for their possessions. This object attachment leads to a need to save items, triggers emotional distress when discarding objects, and perpetuates the avoidance of dealing with clutter. Thus, the aim of my PhD is to gain a better understanding of the nature and aetiology of object attachment in HD. I conducted several studies, which are presented in Chapters 2 to 7. I first examined the facets of object attachment and showed that insecure object attachment made a unique contribution to hoarding severity (Chapter 2). I then explored emotions associated with object attachment in people with and without HD. I found that people with HD have mixed emotions about their possessions, indicating the presence of an insecure object attachment (Chapter 3). Informed by attachment theory, I proposed that object attachment in HD is an attempt at compensating for unmet relatedness needs and that due to insecure object attachment in HD, the compensatory process does not truly satisfy these needs. I tested the compensatory process in Chapter 4 and as predicted, showed that loneliness was positively associated with HD, and that object attachment mediated the relationship between loneliness and hoarding. Following a critical review of the evidence for the compensatory process (Chapter 5), I conducted further studies to address gaps in the evidence and showed that people with HD reported extremely high rates of loneliness compared to controls and that loneliness was associated with hoarding even after accounting for depression (Chapter 6). Finally, I showed that reducing loneliness in people with high hoarding symptoms led to a decrease in object attachment for novel items relative to an active control, and that change in loneliness was associated with change in insecure object attachment (Chapter 7). My research contributes to the growing body of evidence supporting the compensatory process in HD and indicates that reducing loneliness could lead to lower object attachment and better treatment outcomes

Perceived Parenting Style and Adolescent Self-Compassion : A Longitudinal, Within-Person Approach

Objectives: Caregiver responses are important in shaping how children, and later adolescents, engage in their own self-compassionate responding and uncompassionate self-responding. However, longitudinal research exploring the relationship between parenting style and adolescent self-compassion is limited. We examined the degree to which psychologically controlling and supportive parenting styles were linked to changes in compassionate self-responding (CSR) and uncompassionate self-responding (USR), both contemporaneously and longitudinally. We further explored the extent that any effects were heterogeneous: Does parenting influence self-compassion for some adolescents but not others? Method: We measured CSR, USR, parental support, and parental psychological control in a group of 2596 adolescents annually over 4 years (Grades 9 to 12 inclusive, Mages = 14.65 (T1) to 17.73 (T4) years). Results: The multi-level modelling analysis of individual relationships between parenting and self-compassion revealed relatively independent effects of perceived parenting on CSR and USR respectively. Individual changes in supportive parenting were more strongly associated with changes in CSR than with USR, and within-person changes in psychologically controlling parenting were more strongly associated with USR than with CSR. Further, the strength of these relationships was heterogeneous, with parenting having a larger effect on some than others. Longitudinally, controlling parenting predicted the development of USR. Conclusions: Overall, the link between parenting and adolescent self-compassion significantly varied, with some adolescents reporting a large change in self-compassion in years when parenting changed, and some reporting little to no change in self-compassion in years when parenting practices changed. The present study therefore highlights the importance of parenting in understanding self-compassion and the need for further research that seeks to identify factors that moderate the link between parenting and self-compassion

The association between OCD and shame : A systematic review and meta-analysis

Background Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive–compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed. Objectives Our review systematically examines the association of shame with OCD and unacceptable thoughts. Methods The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model. Results The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [−0.467, 0.9708], harm obsessions r = .224, CI [−0.190, 0.638] and symmetry concerns r = .200, CI [−0.108, 0.509]. Limitations Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant. Conclusions Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment

An online experimental test of the compensatory process in hoarding disorder : reducing loneliness and its effects on object attachment

Attachment theory suggests that strong object attachment in hoarding disorder (HD) may be due to an attempt at compensating for unmet relatedness needs. We tested this compensatory process with an online experiment and hypothesized that reducing loneliness among participants with high hoarding symptoms would result in lower object attachment, and that change in loneliness would mediate the impact of an online loneliness intervention on object attachment. A pretest-posttest control group design was used. Participants were 298 MTurk workers pre-screened for high hoarding symptoms recruited via cloudresearch.com. At Time 1, participants completed measures of hoarding severity, loneliness, and four aspects of object attachment: overall object attachment to possessions, insecure object attachment, attachment to an old cherished item, and attachment to a novel item. We randomly assigned participants to either a loneliness intervention (n = 142) or an active control (a health education program; n = 156). All participants completed follow-up questionnaires after two weeks. We conducted ANCOVAs to assess for group differences at Time 2 whilst controlling for Time 1 variables. Results showed small but significant improvements in loneliness, thwarted belongingness, and object attachment for the novel item for participants who received the loneliness intervention relative to control participants. Mediational analyses revealed that the change in loneliness mediated the effect of the intervention on insecure object attachment. Consistent with attachment theory, these results indicate that reducing loneliness might lead to lower object attachment in hoarding disorder. Trials with clinical participants using more intensive loneliness interventions are warranted

Gender differences in self-compassion: a latent profile analysis of compassionate and uncompassionate self-relating in a large adolescent sample

Self-compassion, a healthy way of relating to oneself, may promote psychological resilience during adolescence. How adolescents engage with self-compassion, and whether they have distinct self-compassionate or uncompassionate psychological profiles, is unclear. This study investigated potential self-compassion profiles based on responses to the Self-Compassion Scale–Short Form (SCS-SF) and examined their relationship with a range of mental health symptoms and cognitive and emotional tendencies. A large cross-sectional sample of high school students (N = 950; Mage = 13.70 years, SDage = 0.72, range = 12 to 16 years; 434 female and 495 male) completed several online self-report measures including the SCS-SF. Latent profile analysis identified parsimonious self-compassion profiles by gender using the six SCS-SF subscales. Five female profiles included ‘Low Self-Relating’, ‘Uncompassionate’, ‘High Self-Relating’, ‘Moderately Compassionate’ and ‘Highly Compassionate’. Comparatively, two male profiles included ‘Low Self-Relating’ and ‘Moderately Self-Relating’. Low Self-Relating involved low levels of both compassionate and uncompassionate responding, and Moderately Self-Relating involved higher levels of both. Low Self-Relating and Highly Compassionate profiles for females consistently reported lower levels of anxiety and depression symptoms, maladaptive perfectionism, intolerance of uncertainty, repetitive thinking and avoidance-fusion thinking patterns compared to the other female profiles. Low Self-Relating males reported more adaptive outcomes compared to Moderate Self-Relating males. These findings illustrate important adolescent gender differences in compassionate and uncompassionate self-response profiles. Results suggest self-compassion is an important psychological construct with diverse mental health benefits for females, whereas for males a lack of attachment to either response styles are linked with better psychological outcomes

The Compassion Balance: Understanding the Interrelation of Self- and Other-Compassion for Optimal Well-being

Objectives: This study examined the role of self-other harmony in the relations between self-compassion, other-compassion, and well-being. Past research has shown self- and other-compassion to be positively related. But we hypothesised that self-compassion can be perceived as incompatible with other-compassion, and that self-compassion and other-compassion might be uncorrelated or negatively correlated in daily life for some individuals. We termed this pattern lack of self-other harmony in compassion and hypothesised that it would undermine the benefits of compassion. Method: Using an experience sampling method in patients (n=154) with a variety of diagnoses, we measured self-compassion, other-compassion, life-satisfaction, mood, and contextual variables six times per day for 42 time points. Results: For most participants, self-compassion was positively associated with other-compassion. However, there was substantial heterogeneity in this effect. The degree of self-other harmony moderated the link between compassion directed towards self or other and well-being. Higher levels of compassion were associated with higher levels of well-being, but only for those who experienced the harmony. When the two forms of compassion were not in harmony, levels of self/other-compassion were largely unrelated to well-being. Conclusions: The findings emphasise the importance of personalised compassion interventions rather than a one-size-fits-all approach. Increasing self-compassion or other-compassion is likely to improve well-being for most people. However, for a minority lacking the self-other harmony, it may be necessary to assess their interpretation of self- and other-compassion, then work with them to promote the compassion balance optimal for their well-being

A Personalised Approach to Identifying Important Determinants of Well-being

Purpose: To develop effective and personalized interventions, it is essential to identify the most critical processes or psycho- logical drivers that impact an individual’s well-being. Some processes may be universally beneficial to well-being across many contexts and people, while others may only be beneficial to certain individuals in specific contexts. Method: We conducted three intensive daily diary studies, each with more than 50 within-person measurement occasions, across three data sets (n1 = 44; n2 = 37; n3 = 141). We aimed to investigate individual differences in the strength of within- person associations between three distinct process measures and a variety of outcomes. We utilized a unique idiographic algorithm, known as i-ARIMAX (Autoregressive Integrated Moving Average), to determine the strength of the relationship (Beta) between each process and outcome within individuals (“i”). All of the computed betas were then subjected to meta- analyses, with individuals treated as the “study”. Results: The results revealed that the process-outcome links varied significantly between individuals, surpassing the homo- geneity typically seen in meta-analyses of studies. Although several processes showed group-level effects, no process was found to be universally beneficial when considered individually. For instance, processes involving social behavior, like being assertive, did not demonstrate any group-level links to loneliness but still had significant individual-level effects that varied from positive to negative. Discussion: Using i-ARIMAX might help reduce the number of candidate variables for complex within-person analyses. Additionally, the size and pattern of i-ARIMAX betas could prove useful in guiding personalized interventions

Does Chinese medicine consultation share features and effects of cognitive-behavioural therapy? Using traditional acupuncture as an example

Background: Acupuncture, as part of Chinese medicine (CM), is based on a holistic therapeutic theory. Individualised differential diagnosis is the essence and an integral part of its practice. It leads to an individualised treatment plan. Little research on the nature and effects of the CM consultation has been conducted. Previous studies showed behavioural and cognitive changes after traditional acupuncture treatment. In this article, through a hypothetical case, we illustrated a CM consultation process, examined the changes produced and compared the features between CM consultation and cognitive–behavioural therapy (CBT). Main text: The two therapies share nine out of eleven features, including five specific factors that took different forms in CM and CBT and four non-specific factors known to partially mediate the relationship between psychological therapies and positive therapeutic outcomes. Although Chinese medicine treatments induce changes in behaviours as well as cognition, CM consultation does not share two essential features of CBT, namely a framework of the interaction between behaviour and cognition and teaching patients how to identify and dispute dysfunctional thoughts. Discussion: CM consultation has CBT-like features and effects. Existing qualitative studies suggest that changes in behaviours and cognition after traditional acupuncture treatment are probably due to the CM consultation process or its combined effect with needling, rather than acupuncture needling alone. This hypothesis provides a new perspective on the contributing factors to acupuncture effect. CBT-like features and effects of traditional acupuncture is underestimated by practitioners and researchers, and need to be taken into consideration in acupuncture trial design and clinical practice

An examination of gambling behaviour in relation to financial management behaviour, financial attitudes, and money attitudes

This study was designed to examine the relationship between gambling behaviour (gambling frequency and problem gambling severity) and financial management practices (cash management, risk management, and general management), financial management attitudes, and money attitudes (materialism, achievement, budget, obsession, and anxiety) in a sample of 118 participants (45 males, 73 females) recruited from a university. The findings revealed that gambling frequency was not significantly associated with any financial management, financial attitude, or money attitude variable but that problem gambling severity was significantly positively associated with financial management attitudes and obsession and negatively associated with budget. However, problem gambling severity scores were no longer significantly correlated with these factors after controlling for demographic and socio-economic factors. It was concluded that future research evaluating multiple dimensions of practices and attitudes with reliable and valid standardised instruments in large community or clinical samples is required in order to design cognitive interventions for problem gambling that facilitate changes in general beliefs about the importance of money