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Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up

  • A. I. Gumley (a1), M. Schwannauer (a2), A. Macbeth (a3), R. Fisher (a4), S. Clark (a5), L. Rattrie (a6), G. Fraser (a7), R. McCabe (a7), A. Blair (a5), K. Davidson (a8) and M. Birchwood (a9)...
Abstract
Background

Increasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses.

Aims

To describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months.

Method

The study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis.

Results

Of the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months.

Conclusions

Attachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.

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Copyright
Corresponding author
Andrew I. Gumley, Chair of Psychological Therapy, Institute of Health and Wellbeing, Mental Health and Wellbeing Research Group, University of Glasgow, Academic Centre, Glasgow, UK. Email: andrew.gumley@glasgow.ac.uk
Footnotes
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The authors acknowledge the financial support of NHS Research Scotland (NRS), through the Chief Scientist Office (CZH/4/295), and of the Scottish Mental Health Research Network. M.B. was partly supported by the NIHR Birmingham and Black Country Collaboration for Leadership in Applied Healthcare Research (CLAHRC).

Declaration of interest

None.

Footnotes
References
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Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up

  • A. I. Gumley (a1), M. Schwannauer (a2), A. Macbeth (a3), R. Fisher (a4), S. Clark (a5), L. Rattrie (a6), G. Fraser (a7), R. McCabe (a7), A. Blair (a5), K. Davidson (a8) and M. Birchwood (a9)...
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eLetters

Attachment and Expressed Emotion

jeremy a holmes, Visiting Professor
10 July 2014

It is good to see that Attachment research beginning to have an impact on psychological therapies for psychosis (1). Gumley et al show that Attachment insecurity is the norm in people presenting with first episode psychosis, and that restricted mentalising in dismissing patterns of insecure Attachment impairs the processing of negative affect and constitutes an adverse prognostic feature. />
Although the authors state that 'affect (dys) regulation...can contaminate interpersonal experiences', they fail to elucidate this 'contamination' or link their work with that of Leff et al (2) on Expressed Emotion (EE). The patterns of adverse 'interpersonal experience' associated with raised EE are a) 'hostility' and b) 'over-involvement'. These correspond closely with the constructs of dismissing and preoccupied patterns of insecure attachment. Dismissing individuals have learned to dampen affect in response to brusque and hostile reactionsin care-givers, while preoccupied people's parents have been inconsistent,leading to clinging and emotional hyper-reactivity on the part of care-seekers (3).

The therapeutic implication therefore is that family interventions lowering EE will facilitate more secure attachment relationships between psychosis sufferers and their intimates, whether these be parents, partners or indeed therapists. Reciprocally, individual therapy which fosters secure attachment capacities such as mentalising and the processing of negative affect will make for more secure interpersonal relationships.

While childhood adversity is known to be associated with both increased propensity to psychosis, and also with Disorganised/Unresolved attachment, the relationship between psychosis, adversity and Disorganisation remains to be clarified. Let's hope Gumley continue to bring more evidence to bear on the relationship between the intrapsychic and the interpersonal, leading to attachment-informed therapies capable of improving the still all-too-poor prognosis of psychosis.

1) A. I. Gumley, M. Schwannauer, A. Macbeth, R. Fisher, S. Clark, L. Rattrie, G. Fraser, R. McCabe, A. Blair, K. Davidson, and M. Birchwood (2014)Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-upThe British Journal of Psychiatry 205:60-67; doi:10.1192/bjp.bp.113.126722

2) Vaughn, C. & Leff, J. (2011) The measurement of expressed emotion in the families of psychiatric patients, British Journal of Socialand Clinical Psychology 15, 157-165DOI: 10.1111/j.2044-8260.1976.tb00021.x

3) Holmes, J. (2013) John Bowlby and Attachment Theory. 2nd Edition. London:Routledge.

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Conflict of interest: None declared

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