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  • Comorbidity of problematic substance use and other addictive behaviors and anxiety, depression, and post-traumatic stress disorder: a network analysis

  • Dvora Shmulewitz, Maor Daniel Levitin, Vera Skvirsky, Merav Vider, Roi Eliashar, Mario Mikulincer, Shaul Lev-Ran
  • Journal:
    Psychological Medicine / Volume 54 / Issue 16 / December 2024
    Published online by Cambridge University Press:
    06 December 2024, pp. 4635-4645
    • Article
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      • Open access
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  • Background

    Among those with common mental health disorders (e.g. mood, anxiety, and stress disorders), comorbidity of substance and other addictive disorders is prevalent. To simplify the seemingly complex relationships underlying such comorbidity, methods that include multiple measures to distill which specific addictions are uniquely associated with specific mental health disorders rather than due to the co-occurrence of other related addictions or mental health disorders can be used.

    Methods

    In a general population sample of Jewish adults in Israel (N = 4002), network analysis methods were used to create partial correlation networks of continuous measures of problematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription sedatives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexual behavior, pornography, internet, social media, and smartphone) addictions and common mental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]), adjusted for all variables in the model.

    Results

    Strongest associations were observed within these clusters: (1) PTSD, anxiety, and depression; (2) problematic substance use and gambling; (3) technology-based addictive behaviors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, the strongest unique associations were observed for PTSD and problematic technology-based behaviors (social media, smartphone), and sedatives and stimulants use; depression and problematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; and anxiety and problematic smartphone use.

    Conclusions

    Network analysis isolated unique relationships underlying the observed comorbidity between common mental health problems and addictions, such as associations between mental health problems and technology-based behaviors, which is informative for more focused interventions.

  • Echoes from the past: adjustment of aging former prisoners of war to the COVID-19 pandemic

  • Karni Ginzburg, Mario Mikulincer, Avi Ohry, Zahava Solomon
  • Journal:
    Psychological Medicine / Volume 52 / Issue 16 / December 2022
    Published online by Cambridge University Press:
    18 March 2021, pp. 4188-4196
    • Article
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  • Background

    The aim of this study was to examine whether exposure to previous traumatic events is a risk factor for stress reactions during this pandemic. Capitalizing on a 29-year longitudinal study of Israeli ex-prisoners of war (ex-POWs) and combat veterans, we examined whether captivity is a risk factor for fear of coronavirus disease 2019 (COVID-19) and COVID-19-induced acute stress disorder (COVID-19 ASD) beyond the effects of combat exposure and other stressful life events. In addition, we examined the contribution of captivity experiences (severity of captivity, experience of solitary confinement, and suffering during captivity) and veterans' appraisal of the impact of their war-related experiences on adjustment to the current quarantine and isolation to fear of COVID-19 and COVID-19 ASD.

    Methods

    One-hundred-and-twenty Israeli ex-POWs from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) filled out self-report questionnaires 18 (T1), 35 (T2), 42 (T3), and 47 (T4) years after the war.

    Results

    Findings revealed that although ex-POWs and controls did not differ in their level of exposure to COVID-19, ex-POWS reported higher levels of fear of COVID-19 and COVID-19 ASD than controls. Suffering during captivity, measured at 1991, and participants' appraisal of the extent to which their war-related experiences affected adjustment to COVID-19 were significantly associated with fear of COVID-19 and COVID-19 ASD.

    Conclusions

    The findings of the study demonstrate the long-term effects of exposure to traumatic experiences (captivity) during young adulthood on adjustment to an unrelated collective stress, such as COVID-19, 40 years later.

  • 15 - Attachment Theory

  • from Part III - Development, Health and Change: Life Span and Health Outcomes
  • Edited by Philip J. Corr, City, University London, Gerald Matthews, University of Central Florida
  • Book:
    The Cambridge Handbook of Personality Psychology
    Published online:
    18 September 2020
    Print publication:
    03 September 2020, pp 208-220

  • Summary

    Attachment theory, created by British psychoanalyst John Bowlby (1973, 1980, 1982) and initially operationalized by Mary Ainsworth and colleagues (e.g., Ainsworth, Blehar, Waters & Wall, 1978), began its intellectual life as a modest attempt on Bowlby’s part to understand why separations from mother early in life later cause so much psychological difficulty for children, adolescents and adults (e.g., Bowlby, 1958). As Bowlby worked his way deeper and deeper into this problem area, he eventually created a broad alternative to psychoanalytic theory, one much more solidly grounded in primate ethology, cognitive developmental psychology and clinical research. Ainsworth et al. (1978) added important ideas and assessment procedures, which allowed her and Bowlby’s theory to be rigorously tested, revised and expanded for more than forty years. Today, because of this auspicious theoretical and psychometric foundation, attachment theory has generated a large and complex literature comprising thousands of empirical studies, a literature that continues to reflect Bowlby’s psychoanalytic origins. As a personality theory, attachment theory combines psychoanalytic, evolutionary, developmental, social-cognitive and personality trait constructs in a systematic framework that transcends the usual typologies of personality traits.

  • 13 - Attachment Theory as a Framework for Studying Relationship Dynamics and Functioning

  • from Part IV - Individual Differences
  • Edited by Anita L. Vangelisti, University of Texas, Austin, Daniel Perlman, University of North Carolina, Greensboro
  • Book:
    The Cambridge Handbook of Personal Relationships
    Published online:
    11 June 2018
    Print publication:
    21 June 2018, pp 175-185

  • Summary

    Social support is an important topic area within the study of personal relationships; however, the broader social support literature has not historically considered social support in terms of the interpersonal process that it is. This chapter describes the literature linking social support to health and well-being, considers issues of perceived and received support, and summarizes research showing effects of receiving social support in close relationships on important personal and relational outcomes. In particular, we summarize existing observational studies that examine the dyadic social support process as it unfolds in close relationships, research that examines effects of received support on physiological and neural reactivity, and research that considers the interpersonal social support process in both adverse and non-adverse (positive) life contexts. We describe important theoretical perspectives that have provided a foundation for research on social support in close relationships, discuss ways that both support-seekers and support-providers might cultivate effective social support, and discuss the importance of mutual responsiveness in close relationships. Finally, we outline an agenda for the next generation of research on social support in adult close relationships.

  • 3 - Attachment theory as a framework for the promotion of optimal relationships

  • from Part I - Major theoretical perspectives
  • Edited by C. Raymond Knee, University of Houston, Harry T. Reis, University of Rochester, New York
  • Book:
    Positive Approaches to Optimal Relationship Development
    Published online:
    05 April 2016
    Print publication:
    08 April 2016, pp 56-78

  • Summary

    One basic tenet of attachment theory is that interactions with loving, caring, and supportive relationship partners and the resulting sense of attachment security (confidence that one is socially valued and that others will be available and helpful when needed) are building blocks of mental health and social adjustment. Moreover, attachment theory provides a valuable conceptual framework for the study of optimal relationship development. In this chapter, we first present a brief overview of attachment theory and our model of attachment processes in adulthood, an extension of Bowlby’s theory that is now supported by 25 years of research by personality and social psychologists. Next, we focus on the anchoring of attachment security in expectations concerning relationship partners’ sensitivity and responsiveness (expectations organized within a secure-base script), and review research findings showing that the sense of security is associated with positive appraisals of self and others and with social adjustment. We then review studies of dating and marital relationships showing that dispositional and experimentally induced feelings of security can transform otherwise destructive reactions to relationship partners’ undesirable, hurtful behavior, improve a person’s handling of interpersonal conflict, foster empathy and support for a partner in need, and promote positive relational emotions.

The Self in Understanding and Treating Psychological Disorders
  • Edited by Michael Kyrios, Richard Moulding, Guy Doron, Sunil S. Bhar, Maja Nedeljkovic, Mario Mikulincer
  • Foreword by Aaron T. Beck
  • Published online:
    05 February 2016
    Print publication:
    10 March 2016
  • This must-have reference is a unique exploration of how the individual notion of 'self' and related constructs, such as early schemas and attachment styles, impact on psychopathology, psychotherapy processes and treatment outcomes for psychological disorders across DSM-5, such as depression, bipolar and schizophrenia spectrum disorders, anxiety and trauma, eating disorders, obsessive-compulsive and related disorders, autism, personality disorders, gender identity disorder, dementia and somatic problems such as chronic fatigue syndrome. It discusses the role of the concept of self in a wide range of existing theoretical and treatment frameworks, and relates these to real-life clinical issues and treatment implications. Emphasizing the importance of integrating an awareness of self constructs into evidence-based conceptual models, it offers alternative practical intervention techniques, suggesting a new way forward in advancing our understanding of psychological disorders and their treatment.

  • Age and depression in patients with metastatic cancer: the protective effects of attachment security and spiritual wellbeing

  • CHRISTOPHER LO, JUDY LIN, LUCIA GAGLIESE, CAMILLA ZIMMERMANN, MARIO MIKULINCER, GARY RODIN
  • Journal:
    Ageing & Society / Volume 30 / Issue 2 / February 2010
    Published online by Cambridge University Press:
    24 September 2009, pp. 325-336
    Print publication:
    February 2010

  • Psychological distress in cancer patients is inversely related to age, although the reasons are unclear. The adult development literature suggests that ageing may be associated with the development of adaptive capacities, specifically greater attachment security (the sense that others will be available and supportive when needed) and spirituality (the capacity to view one's life as having meaning, purpose and value), that enable older people to cope better with disease. We examined whether age-related patterns in attachment security and spiritual wellbeing account for the protective effect of age against distress. Measures of depression, attachment security, spiritual wellbeing and disease burden were collected from 342 patients aged from 21 to 88 years with advanced, metastatic cancer. Attachment security and spiritual wellbeing were tested as mediators of the effect of age on depression, controlling for disease burden. It was found that age was associated inversely with depression and positively with spiritual wellbeing and attachment security. Depression was inversely related to attachment security and spiritual wellbeing, and the effect of age on depression was fully mediated by attachment security and spiritual wellbeing. The relative protection from psychological distress among older cancer patients may be the result of age-related developmental accomplishments and/or differences in the response to adverse life-events.

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