Do emotion regulation difficulties mediate the association between neuroticism, insecure attachment, and prolonged grief?

This study investigated the role of emotion regulation difficulties and intrusive/deliberate rumination in the relationship between insecure attachment and prolonged grief symptoms. A total sample of 342 bereaved participants was included in the study. Both anxious and avoidant attachment styles were found to be associated with prolonged grief symptoms, with an avoidant attachment showing a stronger effect. Emotion regulation difficulties and rumination mediated the relationships between attachment styles and prolonged grief symptoms, supporting the proposed mediation model. The study identified specific mediating pathways for anxious and avoidant attachment styles. Additionally, female gender, higher age, unexpected death, and closeness of the relationship with the deceased were significant predictors of prolonged grief symptoms.

Difficulties with dissociation and emotion regulation are well-documented reactions to early adverse childhood experiences (ACEs). Although findings identify dissociation and emotion dysregulation as explaining the relationship between various forms of ACEs and adult psychopathology, less is known about their combined effect in the relationship between ACEs and insecure attachment in adulthood. This study examined the indirect effects of dissociation and emotion regulation difficulties in the relationship between early adverse experiences and insecure attachment traits. Participants (N = 260) completed an online questionnaire measuring ACEs, dissociation, emotion regulation difficulties, and anxious and avoidant attachment. Results indicated that, after controlling for mental health treatment, dissociation and emotion regulation difficulties explained the relationship between ACEs and insecure (anxious and avoidant) attachment. Emotion regulation difficulties were not a significant predictor of avoidant attachment. Findings provide support for greater research on mediating factors in the maintenance of insecure attachment across development and potential implications of dissociation and emotion regulation in clinical and nonclinical populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chapter 1 The prevalence of PGD following natural loss, such as diseases and older age was estimated to equal about 10% The prevalence of PTSD following unexpected deaths, including violent deaths and/or sudden deaths, was estimated at approximately 5% There was not much information yet about the cooccurrence of symptoms in bereaved individuals or possible temporal and causal relationships between the symptoms. Some authors have argued that PTSD symptoms could develop into PGD symptoms It makes intuitive sense that the presence of PTSD symptoms after loss may impair the processing of the loss itself, thereby prolonging grief symptoms. However, one other study Studies in other samples are needed to further elucidate the relationships among PGD, PTSD, and depression.

Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms

A two-generation study: The transmission of attachment and young adults’ depression, anxiety, and social media addiction

Drug-death bereaved parents are at risk of high levels of prolonged grief (PG) symptoms. We included 93 Norwegian drug-death bereaved parents in a cross-sectional survey and aimed to explain PG symptoms. High levels of PG symptoms (M = 30.69) were identified. Low level of self-efficacy and withdrawal from others were the most strongly associated with high levels of grief symptoms (p < .001). However, contrary to our expectations, social support, gender, employment, demanding life situations, and perceived proximity did not correlate significantly to PG symptoms. Our findings can enhance individual follow-up of drug-death bereaved parents.

The COVID-19 pandemic has been a devastating and enduring mass-bereavement event, with uniquely difficult sets of circumstances experienced by people bereaved at this time. However, little is known about the long-term consequences of these experiences, including the prevalence of Prolonged Grief Disorder (PGD) and other conditions in pandemic-bereaved populations. A longitudinal survey of people bereaved in the UK between 16 March 2020 and 2 January 2021, with data collected at baseline (n = 711), c. 8 (n = 383), 13 (n = 295), and 25 (n = 185) months post-bereavement. Using measures of Prolonged Grief Disorder (PGD) (Traumatic Grief Inventory), grief vulnerability (Adult Attitude to Grief Scale), and social support (Inventory of Social Support), this analysis examines how participant characteristics, characteristics of the deceased and pandemic-related circumstances (e.g., restricted visiting, social isolation, social support) are associated with grief outcomes, with a focus on symptoms of PGD. At baseline, 628 (88.6%) of participants were female, with a mean age of 49.5 (SD 12.9). 311 (43.8%) deaths were from confirmed/suspected COVID-19. Sample demographics were relatively stable across time points. 34.6% of participants met the cut-off for indicated PGD at c. 13 months bereaved and 28.6% at final follow-up. Social isolation and loneliness in early bereavement and lack of social support over time strongly contributed to higher levels of prolonged grief symptoms, while feeling well supported by healthcare professionals following the death was associated with reduced levels of prolonged grief symptoms. Characteristics of the deceased most strongly associated with lower levels of prolonged grief symptoms, were a more distant relationship (e.g., death of a grandparent), an expected death and death occurring in a care-home. Participant characteristics associated with higher levels of prolonged grief symptoms included low level of formal education and existence of medical conditions. Results suggest higher than expected levels of PGD compared with pre-pandemic times, with important implications for bereavement policy, provision and practice now (e.g., strengthening of social and specialist support) and in preparedness for future pandemics and mass-bereavement events (e.g., guidance on infection control measures and rapid support responses).

First responders play a vital role in the response to natural disasters and are at a disproportionate risk for developing post-traumatic stress disorder (PTSD) symptoms following these events. The association between attachment style and PTSD is well-established and has been documented among first responders. Understanding the social cognitive and affective factors implicated in the association between insecure adult attachment style and PTSD symptoms among first responders has the potential to inform specialized treatments for this population. The present investigation examined the serial indirect effect of insecure adult attachment style (i.e. attachment avoidance; attachment anxiety) on PTSD symptom severity through trauma-related social cognition and emotion regulation difficulties (ERD). The sample was comprised of 115 first responders (Mage = 42.25, SD = 10.38, 80.0% male) who served during Hurricane Harvey and were recruited to complete an online survey in 2022. Attachment avoidance was indirectly related to PTSD symptom severity via the sequential effects of trauma-related social cognition and ERD (β=.13, SE = .07, CI = .02–.29). The model including attachment anxiety as a statistical predictor was not significant (β = .10, SE = .07, CI = −.01–.27). These findings suggest that there is value in examining the role of social processes and emotion regulatory factors among first responders to inform evidence-based PTSD intervention efforts.

Prolonged grief and attachment security: A latent class analysis

Dynamic networks of prolonged grief symptoms in daily life.

This study investigated emotion regulation (ER) difficulties and repetitive negative thinking (RNT) in individuals with depression, anxiety disorders, or both, compared to nonclinical controls. We aimed to determine which aspects of ER difficulties and RNT are transdiagnostic or specific to one of the disorders, and whether the presence of comorbidities is associated with greater ER difficulties and higher levels of RNT. A total of N = 731 participants, including n = 354 individuals with depression, anxiety disorders, or both (mixed group), and n = 377 nonclinical controls, completed the Difficulties in Emotion Regulation Scale (DERS) and the Perseverative Thinking Questionnaire (PTQ). Parametric and nonparametric analyses were conducted to assess group differences and comorbidity effects. The depression and anxiety disorders groups exhibited significantly greater ER difficulties and higher levels of RNT than nonclinical controls. The mixed group showed more pronounced difficulties in certain aspects of ER (nonacceptance of emotional responses, difficulties engaging in goal-directed behavior, impulse control difficulties, and limited access to ER strategies) and higher levels of RNT compared to the single-diagnosis groups. No significant differences were found in emotional awareness and clarity across clinical groups. Evidence regarding the relationship between the number of comorbid diagnoses and the severity of the difficulties was less clear. This suggests that specific disorders may have a more significant impact than comorbidity alone. Our findings highlight the transdiagnostic role of ER difficulties and RNT in depression and anxiety disorders and suggest that they may be a promising target for transdiagnostic interventions. Future research should further explore the nuanced ways in which ER difficulties and RNT vary across different mental disorders.

Although theory and research evidence indicate that less securely attached persons are more likely than their secure peers to experience emotion regulation difficulties, this is not necessarily a pre-ordained outcome. Emotion regulation difficulties may be more proximally predicted by individuals’ maladaptive psychological defenses such as humor styles. This study explored the interrelationships between adult attachment orientations (attachment anxiety and avoidance) and perceived bonds with parents (perceived levels of parental care and control), emotion regulation (cognitive reappraisal and expressive suppression), and maladaptive humor styles (aggressive and self-defeating humor). Attachment anxiety, avoidance, and maternal care and overprotection were associated in expected directions with aggressive and self-defeating humor, but paternal care and overprotection were not. Additionally, aggressive and self-defeating humor were positively associated with expressive suppression and negatively associated with cognitive reappraisal. Self-defeating humor partially mediated the relationship between a number of attachment predictors (attachment anxiety, avoidance, maternal care, and maternal control) and expressive suppression. For example, attachment anxiety predicted higher use of self-defeating humor, which in turn predicted higher levels of expressive suppression. Finally, aggressive humor partially mediated the relationship between avoidance and cognitive reappraisal. Avoidance predicted higher use of aggressive humor, which in turn predicted lower levels of reappraisal. Implications for future research and clinical practice are discussed.

Studies suggest that cognitive behavioral therapies (CBTs) may be efficacious in reducing symptoms of prolonged grief disorder (PGD), but no comprehensive overview and pooled estimate of CBTs' effect on PGD in adulthood exist. We conducted a systematic review and meta-analysis of randomized controlled trials. Studies were selected independently by two researchers based on a systematic literature search in Pubmed, APA PsycInfo, Web of Science, and Embase. Meta-analyses provided pooled effect sizes for the effects of CBTs on PGD symptoms and secondary outcomes. We explored potential moderators of effect, risk of bias of included studies, and evaluated the quality of the meta-analytical evidence through the Grading of Recommendations, Assessment, Development, and Evaluation system. The meta-analysis included 22 studies of 2,602 bereaved adults (averaged study Mage = 49 years). CBTs had a statistically significant medium effect on PGD symptoms at postintervention (K = 22, g = 0.65, 95% CI [0.49, 0.81]), and a large effect at follow-up (K = 7, g = 0.90, 95% CI [0.37, 1.43]). Statistically significant small-to-medium effects were found at postintervention on posttraumatic stress symptoms (K = 10, g = 0.74, 95% CI [0.49, 0.98]), depression (K = 19, g = 0.53, 95% CI [0.36, 0.71]), and anxiety (K = 9, g = 0.35, 95% CI [0.22, 0.49]). The effects on PGD remained unchanged when adjusted for possible outliers. None of the moderator analyses reached statistical significance. This review suggests that CBTs are efficacious in reducing PGD symptoms in adulthood. Generalization of findings should be done with caution due to considerable inconsistency and indirectness of meta-analytic evidence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We examined associations between the severity of symptoms of prolonged grief disorder (PGD) and depression and recent suicidal ideation among bereaved family members. Individuals who survived the death of a family member 1-8year earlier (N=225) were surveyed using self-report measures in the cross-sectional study. Regression analyses were conducted to test the multivariable effects of PGD and depression symptom severity-including their interactive effect-on recent suicidal ideation among the full sample and subsample of suicidal ideators (n=38). The severity of PGD symptoms was positively associated with frequency of recent suicidal ideation in the full sample and subsample of suicidal ideators. Depressive symptoms were positively related to suicidal ideation in the full sample; however, they were significant only in the presence of PGD symptoms in the subsample of suicidal ideators. Severity of PGD and depression symptoms are positively associated with suicidal ideation among bereaved individuals, highlighting the need to attend to both PGD and depressive symptoms in understanding risk for suicidal ideation among bereaved individuals.

Background Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are potentially at a high risk of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and insomnia. Objective The current study aimed to estimate three network models in 310 shidu parents who met the ICD-11 criteria for PGD: (1) a PGD network to identify central symptoms; (2) a comorbidity network to explore bridge symptoms between PGD and PTSD; (3) a comorbidity network to examine the associations between PGD and insomnia symptoms. Methods The R-packages bootnet, qgraph and networktools were used to investigate the structure of network models and centrality indices of symptoms. In addition, robustness and significance analyses for the edge weights and the order of centrality were performed. Results Emotional pain and numbness emerged as the most central symptoms in the PGD network. In the PGD-PTSD comorbidity network, the highest bridge strength symptoms were inability to trust others (PGD) and feeling upset (PTSD). Inability to trust others (PGD), avoidance (PGD), and impairment of life quality (insomnia) were possible bridge symptoms connecting PGD and insomnia. Conclusions Reducing emotional pain and numbness may be a viable target in PGD interventions for shidu parents. Additionally, findings suggest that future studies could examine the role of inability to trust others and avoidance in PGD comorbidities. HIGHLIGHTS • Emotional pain and numbness were the most influential symptoms in shidu parents with PGD. The role of PGD symptoms of inability to trust others and avoidance in the comorbidities of PGD with PTSD and insomnia might be worthy of further study