Web viewAttachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking About Negative Affect and About Mother. Abstract

Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS

Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking

About Negative Affect and About Mother

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Abstract

Two current studies aimed to investigate whether repetitive thinking about negative affect (RTna) and repetitive

thinking about mother (RTm) can be mechanisms in the association between attachment anxiety and depressive

symptoms in middle childhood. In Study 1 (N = 381) and Study 2 (N = 157) 9- to 12-year-olds completed self-

report questionnaires measuring attachment, RTna and depressive symptoms. In Study 2, additionally, a

questionnaire was developed to measure RTm, and a compound score for self- and mother-reported depressive

symptoms was calculated. Results showed positive associations between attachment anxiety, RTna and RTm,

and self-reported depressive symptoms and depressive symptoms agreed upon by mother and child. RTna and

RTm mediated the relationship between attachment anxiety and these depressive symptoms. RTm mediated this

relationship even beyond RTna for the multi-informant compound score. Thus, RTna and RTm seem

independent mechanisms explaining the association between attachment anxiety and depressive symptoms in

middle childhood.

Key words: attachment anxiety; depressive symptoms; heightening strategy; repetitive thinking about negative

affect; repetitive thinking about mother

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Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking

About Negative Affect and About Mother

Depression is a frequent problem in adolescence and adulthood with a great impact on development

(Hankin et al., 1998; Weller & Weller, 2000). For adolescent boys and girls it is the predominant cause of illness

and disability (World Health Organization [WHO], 2014). Depression substantially increases the risk of suicide

(Wulsin, Vaillant, & Wells, 1999), which is the third cause of death in adolescents (WHO, 2014). Moreover,

even subclinical depressive symptoms are associated with impaired functioning (Cuijpers & Smit, 2002;

Lewinsohn, Solomon, Seeley, & Zeiss, 2000). Therefore, research has focused on identifying vulnerability

factors that contribute to the development of depressive symptoms.

Empirical studies with children and adolescents suggest that insecure attachment is one vulnerability

factor in the development of depressive symptoms (Armsden, McCauley, Greenberg, Burke, & Mitchell, 1990;

Brumariu & Kerns, 2010). According to Bowlby (1969, 1973), early experiences in interactions with the

caregiver are stored in Internal Working Models (IWM). An IWM is a cognitive structure consisting of

representations of the self, of the attachment figure and of the environment that generate expectations about an

attachment figure’s availability and support in times of distress (Bowlby, 1969/1982, 1973; Cassidy, 2008).

Individual differences in quality of interactions with the caregiver are reflected in different contents of the IWM.

Recurrent experiences with an attachment figure who is available, sensitive and responsive in times of distress,

lead to the expectation that an attachment figure will be available to provide support when needed in the future,

and thus, secure attachment (Bowlby, 1969/1982, 1973). Instead, when children repeatedly experience that an

attachment figure is unavailable, insensitive or unresponsive, they become uncertain about that attachment

figure’s support in times of distress, and, as a result, develop insecure attachment (Bowlby, 1969/1982).

In line with the finding that individual differences in attachment are continuously distributed, rather

than categorically, insecure attachment, has been represented along two dimensions in middle childhood:

attachment avoidance and attachment anxiety (Brennan, Clark, & Shaver, 1998; Fraley & Spieker, 2003).

Attachment avoidance involves self-reliance and discomfort with closeness, dependence, and intimate self-

disclosure. Instead, attachment anxiety involves preoccupation with social support, jealousy, a strong desire for

interpersonal merger, and fear of and vigilance for rejection and abandonment by an attachment figure (Brennan

et al., 1998; Brenning, Soenens, Braet, & Bosmans, 2011; Cassidy & Berlin, 1994). Although two meta-analyses

(Groh, Roisman, van Ijzendoorn, Bakermans-Kranenburg, & Fearon, 2012; Madigan, Atkinson, Laurin, &

Benoit, 2013) find that internalizing symptoms are more strongly related to attachment avoidance and less to

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, 25/02/16,

Referenties checken.


attachment anxiety, these meta-analyses’ results generalize less to middle childhood depressive symptoms for

different reasons. The age of the samples when internalizing symptoms were assessed, was age 9 or above for

only eight of 42 (Groh et al., 2012) and six of 61 (Madigan et al., 2013) independent samples, while the

prevalence of depressive symptoms is rather low under age 10 (Hammen & Rudolph, 2003; Weller & Weller,

2000). Moreover, the outcomes included more anxiety-related symptoms that typically covary with other

avoidance behavior (Bosmans, Dujardin, Field, Salemink, & Vasey, 2015). According to a narrative review

(Brumariu & Kerns, 2010) and a recent meta-analysis (Madigan, Brumariu, Villani, Atkinson, & Lyons-Ruth,

n.d.), in late middle childhood (age 10-12), the association between attachment anxiety and depressive symptoms

tends to be more consistently found than between attachment avoidance and depressive symptoms. This suggests

that there may be specific maladaptive mechanisms underlying the association between attachment anxiety and

depressive symptoms in middle childhood. However, surprisingly little is known about which mechanisms

explain these associations (Brumariu & Kerns, 2010; Kerns, 2008). Therefore, the current study aimed to better

understand the specific vulnerabilities that can explain depressive symptoms in anxiously attached children.

Middle childhood (age 8-12) has been proposed as a crucial developmental period to investigate the

mechanisms in this association for various reasons. First, precursors of depressive symptoms, such as

maladaptive cognitive strategies, start developing in middle childhood (Hampel & Petermann, 2005; Mezulis,

Hyde, & Abramson, 2006). Second, prevalence and incidence rates for depressive symptoms increase from

childhood to adolescence, with a peak between ages 15 and 18 (Hammen & Rudolph, 2003; Hankin et al., 1998;

Weller & Weller, 2000). For these reasons, the association between insecure attachment and depressive

symptoms can be observed more easily from late middle childhood onwards (Brumariu & Kerns, 2010), making

it possible to study mechanisms in this relationship while they are developing. These mechanisms could shed

light on the high recurrence of depressive symptoms as childhood depressive symptoms increase the risk for the

onset of a long-term trajectory of depressive symptoms continuing far into adulthood (Weller & Weller, 2000).

Moreover, therapies for depression are generally less effective than therapies for other disorders (Weisz,

McCarty, & Valeri, 2006), so a better understanding of depressogenic mechanisms and antecedents in middle

childhood could mean a step forward for clinical practice.

Traditionally, the association between attachment anxiety and depressive symptoms has been explained

as resulting from maladaptive emotion regulation (ER) strategies. ER models of attachment (Cassidy, 1994;

Shaver & Mikulincer, 2002) describe that anxiously attached individuals adopt a heightening strategy to attain

and maintain sufficient proximity and support from their inconsistently available attachment figure. This

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heightening strategy is supposed to consist of two components, namely heightening negative affect and

heightening the importance of the attachment relationship (Cassidy, 1994; Shaver & Mikulincer, 2002).

Theoretically, it seems reasonable to assume that children’s strategy to heighten their focus on a potentially

rejecting attachment figure could also be a mechanism explaining attachment anxiety’s association with

depressive symptoms. However, until now, research merely focused on the role of heightening negative affect in

this association.

Heightening negative affect can be defined as chronically exaggerating negative affect, even in response

to relatively benign stimuli (Cassidy, 1994; Mikulincer & Florian, 1998; Shaver & Mikulincer, 2002). Evidence

suggests that heightening negative affect mediates the link between attachment anxiety and depressive symptoms

in middle childhood. In a cross-sectional study with a middle childhood and early adolescence sample, Brenning,

Soenens, Braet, and Bosmans (2012) operationalized this component as dysregulation. There was a unique and

positive association between attachment anxiety and dysregulation, and dysregulation mediated the relationship

between attachment anxiety and depressive symptoms (Brenning et al., 2012). However, a closer inspection of

the items assessing dysregulation (see Roth, Assor, Niemiec, Deci, & Ryan, 2009) revealed that dysregulation

might not have been an adequate operationalization of strategically heightening negative affect. Instead, these

items assessed children as “experiencing emotions but not having the capacity to regulate those emotions”

(Brenning et al., 2012, p. 448). More specifically, the dysregulation items seem to measure the extent to which

children have the impression that their ER strategy is not successful. Consequently, based on Brenning et al.

(2012) one cannot confidently conclude that the association between attachment anxiety and depressive

symptoms specifically reflects heightening of negative affect.

Instead, the definition of heightening negative affect seems conceptually closely linked to different

types of repetitive thinking (e.g. depressive rumination, brooding, or emotion-focused rumination). Segerstrom,

Stanton, Alden, and Shortridge (2003) defined repetitive thought as the “process of thinking attentively,

repetitively or frequently about one’s self and one’s world” (p. 909). Repetitive thinking characterized by

negatively valenced and abstract thought content is a vulnerability factor for different disorders, with each

disorder being characterized by a specific thought content (Ehring & Watkins, 2008; Watkins, 2008). In

depression, this repetitive thinking is passive, comparative, self-critical and focused on the depressed feelings

and on the reasons of their occurrence (Nolen-Hoeksema, 1991; Treynor, Gonzalez, & Nolen-hoeksema, 2003;

Watkins, 2008). In children, adolescents, as well as adults, this repetitive thinking about negative affect (RTna)

contributes to the onset, duration and severity of depressive symptoms (Abela & Hankin, 2011; Nolen-

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Hoeksema, 1991; Rood, Roelofs, Bögels, Nolen-Hoeksema, & Schouten, 2009) and is related to concurrent

depressive symptoms and increases in depressive symptoms over time (Burwell & Shirk, 2007; Lopez, Driscoll,

& Kistner, 2009; Treynor et al., 2003; Verstraeten, Vasey, Raes, & Bijttebier, 2010). This seems similar to the

description of Shaver and Mikulincer (2002) that, when anxiously attached individuals heighten negative affect,

“ they focus on their own distress, ruminate on negative thoughts, and adopt emotion-focused coping strategies

which exacerbate rather than diminish distress” (p. 141). Therefore, it seems a plausible hypothesis that RTna is

one specific, well defined and clearly operationalizable mechanism through which attachment anxiety is linked

with depressive symptoms.

This hypothesis has never been directly tested, but several studies have focused on the role of parenting

in the development of RTna. For example, Manfredi et al. (2011) found that adults who retrospectively reported

more parental overprotection in the first 16 years of life, reported more RTna. Also, overcontrolling parenting

and family expressions of sadness and guilt in the preschool years were associated with more RTna in early

adolescence (Hilt, Armstrong, & Essex, 2012). Moreover, in girls, the link between low levels of positive

maternal behavior at age 12 and increases in depressive symptoms at age 17 was mediated by increases in RTna

at age 15 (Gaté et al., 2013). Although similar parenting practices have often been linked with attachment

anxiety (Brenning et al., 2012; Karavasilis, Doyle, & Markiewicz, 2003), only one study has investigated the

links between attachment-related expectations, RTna, and depressive symptoms. Ruijten, Roelofs, and Rood

(2011) found in an adolescent sample that the negative association between self-reported trust in parental support

and depressive symptoms was mediated by higher levels of RTna. However, because a general measure for

insecure attachment was used, namely the amount of trust in the parent’s support when needed, it remains to be

seen whether RTna is the dominant ER strategy for attachment anxiety and not attachment avoidance. In

summary, based on theory and on the mentioned studies, it seems reasonable to assume that RTna may account

for at least part of the association between attachment anxiety and depressive symptoms in middle childhood.

Therefore, the current study aimed to provide a better understanding of the heightening strategy and its

role in the association between attachment anxiety and depressive symptoms in middle childhood. We focused

on the mother-child relationship as she remains the primary attachment figure for most children in middle

childhood (Cassidy, 2008; Kerns, Tomich, & Kim, 2006) and as there is no difference in the impact of

attachment to mother or father on the development of depressive symptoms. The following hypotheses were

tested: We tested the hypotheses that (1) higher levels of attachment anxiety are uniquely associated with higher

levels of RTna, (2) higher levels of RTna are associated with higher levels of depressive symptoms, and (3)

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higher levels of RTna mediate the positive relationship between attachment anxiety and depressive symptoms.

To test whether this mediation by RTna is specific for the relationship between attachment anxiety and

depressive symptoms, the latter mediation analysis will be repeated with attachment avoidance as

predictorindependent variable. In all analyses, the other attachment dimension will be added as a control

variable.

Study 1

Method

Participants. In this study, 390 children (53% girls) of the 5th and 6th grade of nine Belgian primary

schools participated. The age of the participants ranged between 9 to 13 years (M = 11.25, SD = 0.65).

Procedure. Letters with information about the aim and procedure of the study were distributed in the

classrooms. In these letters, children were invited to participate and parents were asked for permission through

passive informed consent. This way, the study achieved a 99% response rate. Children collectively filled out the

questionnaires in a fixed order during school hours under supervision of a psychology master’s student.

Measures.

Attachment anxiety and attachment avoidance. The child version of the Experiences in Close

Relationships Scale-Revised (ECR-RC; Brenning et al., 2011) about mother was completed by the participants to

assess attachment anxiety and attachment avoidance. This self-report questionnaire consists of 18 items for the

Attachment Anxiety scale (e.g. “I’m worried that my mother might want to leave me.”) and of 18 items for the

Attachment Avoidance scale (e.g. “I prefer not to get too close to my mother.”). The items are scored on a 7-

point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). A mean score for attachment anxiety

and for attachment avoidance was computed across each scale’s 18 items. The ECR-RC has been proven to

explicitly distinguish between attachment anxiety and attachment avoidance and both scales have strong internal

consistency, construct validity and predictive validity (Brenning et al., 2011). In the current sample, internal

consistencies of attachment anxiety (α = .87) and attachment avoidance (α = .90) were very good according to

the criteria of DeVellis (2003).

Repetitive thinking about negative affect (RTna). RTna was assessed using the Brooding subscale of

the Children’s Response Styles Questionnaire-Extended (CRSQ-ext; Verstraeten et al., 2010; adaptation of the

CRSQ; Abela, Vanderbilt, & Rochon, 2004). This self-report questionnaire consists of 5 items (e.g. “When I am

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sad, I think about a recent situation wishing it had gone better.” “When I am sad, I think: ‘‘Why do I always

react this way?”), which are scored on a 4-point Likert scale ranging from 1 (almost never) to 4 (almost always).

A mean score for RTna was calculated across the 5 items. In the current sample, internal consistency of RTna (α

= .77) was respectable according to the criteria of DeVellis (2003).

Depressive symptoms. To assess depressive symptoms, the Children’s Depression Inventory (CDI;

Kovacs, 2003; Dutch translation by Timbremont & Braet, 2002) was administered. The 27 items of this self-

report questionnaire involve cognitive, affective and behavioral symptoms of depression over the past two

weeks. The participants are asked for each item to choose the description that fits best from three descriptions

(e.g. “I feel like crying every day/many days/sometimes.”). The items are scored on a 3-point rating scale

ranging from 0 to 2, with higher scores reflecting more severe depressive symptoms. A mean score was

calculated across all 27 items. The CDI is reliable and valid (Kovacs, 2003; Saylor, Finch, Spirito, & Bennett,

1984) and discriminates children with major depressive disorders from non-depressed children (Kovacs, 2003).

For the Dutch version of the CDI, a cut-off score of 0.59 maximized its specificity and sensitivity (Theuwis,

Braet, Roelofs, Stark & Vandevivere,2013). In the current sample, internal consistency of depressive symptoms

(α = .87) was very good.

Results

Preliminary Analyses. Due to missing values, data for seven children were listwise deleted from the

data analyses, resulting in data for 381 children. There were no significant gender or age effects. Therefore, there

will not be controlled for these variables in subsequent analyses. In the sample of Study 1, 18.6% of the children

scored equal to or above the cut-off score on self-reported depressive symptoms. In Table 1, descriptive statistics

for all the variables are presented.

Associations between attachment anxiety, attachment avoidance, RTna, and depressive

symptoms. In Table 1, zero-order correlations between all the variables are presented. Both attachment anxiety

and attachment avoidance correlated positively with RTna. Because attachment anxiety and attachment

avoidance were positively correlated, hierarchical multiple regression analyses were conducted in SPSS to

investigate whether RTna was uniquely linked with attachment anxiety and not with attachment avoidance.

Attachment anxiety remained significantly related to RTna after controlling for attachment avoidance ( = .31,

t(378) = 5.21, p < .001), whereas there was no unique association of attachment avoidance with RTna when

controlling for attachment anxiety ( = .01, t(378) = 0.24, p = .810) (R² = .10, F(2,378) = 20.91, p < .001).

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Attachment anxiety was positively related to depressive symptoms, also after controlling for attachment

avoidance ( = .35, t(378) = 6.73, p < .001). Attachment avoidance was positively related to depressive

symptoms, also after controlling for attachment anxiety ( = .26, t(378) = 4.94, p < .001) (R² = .29, F(2,378) =

78.06, p < 001). RTna had a significantly positive correlation with depressive symptoms.

Mediation analyses. These analyses were conducted with the macro ‘PROCESS’ (Hayes, 2013) in

SPSS, which calculates unstandardized regression coefficients, standard errors, and effect sizes for indirect

effects of an independent variable (IV) on a dependent variable (DV) through one or multiple simultaneous

mediators (M). A bootstrap with N = 10,000 resamples was used. A point estimate of an indirect effect was

considered significant in the case zero was not contained in the 95%- or 99%- bias corrected confidence interval

(BC CI). When this point estimate is significant, mediation occurs. In the analyses with attachment anxiety as

independent variable, attachment avoidance was added as a covariate, and vice versa.

The indirect effect of attachment anxiety on depressive symptoms through RTna was significant (B =

0.03, SE = 0.01, 99%-BC CI [0.016, 0.061]; completely standardized B = .11). There was no significant indirect

effect of attachment avoidance on depressive symptoms through RTna (B = 0.00, SE = 0.01, 90%-BC CI [-

0.009, 0.011]; completely standardized B = .01, SE = .02, 90%-BC CI [-.035, .045]). This model explained 44%

of the variance in depressive symptoms (F(3,377) = 97.71, p < .001). 1 As a final test of whether RTna uniquely

mediates the link between attachment anxiety and depressive symptoms we performed a path analysis with both

attachment anxiety and avoidance as IV’s, RTna as M, and depressive symptoms as DV. Again, there was a

significant indirect effect of attachment anxiety on self-reported depressive symptoms through RTna (B = 0.04,

SE = 0.01, p < .001, 99%-BC CI [0.017, 0.061]), but not of attachment avoidance.

Discussion

Study 1 investigated whether RTna could be one mechanism explaining the association between

attachment anxiety and depressive symptoms in middle childhood. Results showed that (a1) higher levels of

attachment anxiety were associated with higher levels of RTna was more strongly linked with attachment anxiety

than attachment avoidance, (2) higher levels of RTna arewere associated with higher levels of depressive

symptoms, and (b3) RTna more stronglyonly mediated the association between attachment anxiety and

depressive symptoms, even when controlling for and lessnot the association between attachment avoidance and

1 A hierarchical multiple regression analysis was conducted to obtain the effect size for the addition of RTna to attachment avoidance and attachment anxiety in the prediction of depressive symptoms. A medium-high effect size was obtained (Cohen’s f² = .26).

9

, 25/02/16,

Nee, maar analogie met studie 2? A en b nodig om a*b te kunnen interpreteren ook?

, 25/02/16,

Is dat de vraag van een reviewer om dat expliciet te lijsten als hypothese?


depressive symptoms. .Moreover, when the same mediation analysis was tested with attachment avoidance as

independent variable while controlling for attachment anxiety, RTna did not mediate the association between

attachment avoidance and depressive symptoms. This was also supported by a path analysis with both

attachment anxiety and avoidance as IV’s. These findings suggest that RTna can be considered as a risk

mechanism accounting that is specific for the specific association between attachment anxiety and depressive

symptoms.

These results are in line with the finding of Ruijten et al. (2011) that adolescents who have less trust in

maternal support report more RTna, which in turn, predicts higher levels of depressive symptoms. The current

study extended their finding by replicating this effect in middle childhood and by assessing specific insecure

attachment dimensions instead of insecure attachment in general. This way, the current study provided further

support for the hypothesis that RTna is an ER strategy that is typical for attachment anxiety and not for

attachment avoidance and, thus, can help explain why and how attachment anxiety is related with depressive

symptoms.

A limitation of Study 1 was that it solely relied on self-report. By not considering multiple informants,

results could have been inflated by reporter bias due to emotion-related memory biases or self-representational

biases (Bosmans, Braet, Beyers, Van Leeuwen, & Van Vlierberghe, 2011; Timbremont, Braet, Bosmans, & Van

Vlierberghe, 2008). Moreover, attachment, RTna, and depressive symptoms are all related to temperamental

negative affectivity (e.g. Goldsmith & Alansky, 1987; Verstraeten, Vasey, Raes, & Bijttebier, 2009). As this

confound might have inflated the results, it seems necessary to control for this variable. Finally, this study only

focused on heightening of negative affect, and not on the second component of the heightening strategy,

heightening of the importance of the attachment relationship. We conducted a second study to address these

limitations.

Study 2

With regard to the second component of anxiously attached children’s heightening ER strategy,

heightening the importance of the attachment relationship, little research has been conducted in middle

childhood. In infancy, heightening the importance of the attachment relationship has been observed in anxiously

attached infants’ overdependence on their attachment figure, in their enhanced attentional focus on and increased

monitoring of their attachment figure, and in their elevated behavioral efforts aimed at minimizing distance from

their attachment figure (Cassidy, 1994; Cassidy & Berlin, 1994). In middle childhood, attachment behavior

10

, 25/02/16,

Ben toch nog niet helemaal overtuigd van de term confound in deze context

, 25/02/16,

Je hebt deze discussie nu ingekort, terwijl er een opm was dat het te kort was . Vind het zo ook wel beter, maar weet niet wat dan nog te doen om te verlengen (wel opm van NA verwerkt wat het langer maakt)


becomes less intense and observable (Mayseless, 2005). Instead, less explicit cognitive and affective aspects of

IWM’s attachment-related expectationsabout the availability of an attachment figures become more important in

alleviating distress (Armsden & Greenberg, 1987; Cassidy, 2008; Kerns et al., 2006).

Given the increased importance of cognitive processes in attachment as children grow older (Main,

Kaplan, & Cassidy, 1988), one could argue that heightening the importance of the attachment relationship might

also be reflected at a cognitive level in middle childhood. This argument is preliminary supported by anxiously

attached children’s narratives about attachment-related events reflecting repetitive, absorbing, and often negative

thoughts about the attachment figure (Venta, Shmueli-Goetz, & Sharp, 2014). Therefore, we propose that

repetitive thinking about mother (RTm) might reflect a strategic enhanced cognitive focus on motherstrategy that

expresses anxiously attached children’s heightened importance of the attachment relationship (Mikulincer,

Shaver, & Pereg, 2003; Shaver & Mikulincer, 2002). In middle childhoodnormative development, thisthe focus

on mother should declinedecrease throughout middle childhood in order to promote autonomy and other

developmental tasks inthat promoteskills in service of adaptive adolescent developmentce (Koehn & Kerns,

2015; Mayseless, 2005). InsteadConsequently, theory suggests that maintaining a heightened focus on mother

may be at the expense of experiences in which a child can learn adaptive coping strategies to handle distress

autonomouslyhas a maladaptive effect on children’s further development: it impairs their autonomy to freely

explore information and learn age-appropriate strategies to deal with distress. Instead, focusing on a mother that

elicits fears for rejection and absent care interferes with using strategies that help reducing distress (Mikulincer

& Shaver, 2007 (Bosmans, Dujardin, et al., 2015; Dujardin, Bosmans, De Raedt, & Braet, 2015). Consequently,

RTm could be an unstudied cognitive mechanism that might be considered in addition to RTna to explain the

link between attachment anxiety and depressive symptoms in middle childhood.

To investigate this proposition, in Study 2 a self-report questionnaire of RTm was developed because

self-report questionnaires are proposed to be the most adequate method to measure RT(m), as it allows tapping

into an unobservable , internal, and cognitive processes such as repetitive thinking (De Los Reyes & Kazdin,

2005).

Additionally, to overcome Study 1’s limitation that all variables were measured using self-report,

depressive symptoms were assessed using self- and mother-report. We tested the hypotheses that (1) higher

levels of attachment anxiety are associated with higher levels of RTna and RTm, (2) higher levels of RTna and

RTm are associated with higher levels of depressive symptoms, (3) RTna and RTm mediate the association

between attachment anxiety and depressive symptoms, with RTm mediating this relationship over and above

11

, 25/02/16,

Staat nu in discussie, misschien dan dat naar hier verplaatsen?

, 25/02/16,

Je zegt eigenlijk nergens iets over de compound score. is dat hier niet een goed moment om bv te zeggen dat Moeder report dikwijls inadequaat is (met ref). enm dat in dit veld het vaak gebeurt om een compound te berekeken waarin beide perspectieven ssamen genomen worden zodat je correlaties doet met studk depressieve symtpomen waar beide informatnen het erover eers zijn?

, 25/02/16,

Je moet dit nog opkuisen he!!!

, 25/02/16,

Zouden we hier geen mooie referentie voor kunnen vinden?

, 25/02/16,

Twee keer promote en development(al)

, 25/02/16,

Ben nog een beetje aan het twijfelen of het niet te vaag is.


RTna. To test whether this mediation by RTna and/or RTm is specific for the relationship between attachment

anxiety and depressive symptoms, the latter mediation analysis will be repeated with attachment avoidance as

predictorindependent variable. In all analyses, the other attachment dimension will be added as a control

variable. Moreover, we will control for temperamental negative affectivity to ensure that the results not simply

reflect the overlap between the variables’ association with negative affectivity.

Method

Participants. In this study, 157 children (52% girls) from 16 Belgian primary schools aged 9 to 12

years old (M = 10.91, SD = 0.87) and their mothers participated in the study. Most of the children lived with both

parents (76%). Mother was a primary caregiver in the first three years of life for 97% of the participating

children. With regard to education, 21% of the mothers had an elementary school or high school degree, 36% did

specialization studies after high school, and 43% had a university degree, whereas of the fathers, 31% had an

elementary school or high school degree, 24% did specialization studies after high school, and 46% had a

university degree.

Procedure. To invite children and their mothers to our study, we distributed flyers with information

about the study in the classrooms of the 4th, 5th and 6th grade. Because both mother and child had to come to

either of two research locations for an assessment that was part of a broader study on attachment, attachment-

related information processing biases and depression, letters were only distributed in schools in the vicinity of

these locations. Free parking and a reward for participating (two movie theatre tickets and the chance of getting

an mp3-player) were promised to each mother-child dyad. Children and their mothers who wished to participate

were contacted by the researcher or a master student. Upon arrival, active informed consent was obtained from

both the child and the mother. The questionnaires were administered in a fixed order among the other measures

of the broader assessment.

Measures. The measures in this second study were largely the same as in Study 1. RTna was assessed

with the 5 item Brooding subscale of the CRSQ-ext. Attachment anxiety and attachment avoidance were

assessed with a shortened version of the ECR-RC (Brenning, Van Petegem, Vanhalst, & Soenens, 2014),

consisting of 6 items for the Attachment Anxiety scale and 6 items for the Attachment Avoidance scale. This

version also showed excellent reliability and validity (Brenning et al., 2014). In the current sample, the internal

consistencies of attachment anxiety (α = .79), attachment avoidance (α = .74), and RTna (α = .76) were

respectable.

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Negative affectivity. The parent report form of The Early Adolescent Temperament Questionnaire-

Revised (EATQ-R; Ellis & Rothbart, 2001; revision of the EATQ; Capaldi & Rothbart, 1992; Dutch translation

by Rothbart & Hartman, 2001) was filled out by the mother. It consists of 62 items that are answered on a 5-

point Likert scale ranging from 1 (almost never true) to 5 (almost always true). In the current study, only the

items of the subscales Fear and Frustration were used. These subscales reflect the factor Negative Affectivity and

measure negative affect related to anticipation of distress (e.g. “My child worries about getting into trouble.”)

and to the interruption of ongoing tasks or goal blocking (e.g., “My child is annoyed by little things other kids

do.”) (Oldehinkel, Hartman, De Winter, Veenstra, & Ormel, 2004). The internal consistency, construct validity

and predictive validity of negative affectivity have been demonstrated in several studies (Ellis, 2002; Oldehinkel

et al., 2004). In the current sample, the internal consistency of negative affectivity (α = .77) was respectable.

Repetitive thinking about mother (RTm). The Perseverative Thinking about Mother Questionnaire

(PTMQ) is a self-report questionnaire that was designed for the current study to measure RTm. The

Perseverative Thinking Questionnaire Child Version (PTQ-C; Bijttebier, Raes, Vasey, Bastin, & Ehring, 2014)

inspired the formulation of the 15 PTMQ items that are scored on a 5-point Likert scale ranging from 0 (almost

never) to 4 (almost always). By not phrasing the items in accordance with scales for rumination, RTna, worry,

anxiety or attachment anxiety, an attempt was made to avoid item overlap with the Brooding subscale of the

CRSQ-ext and with the Attachment Anxiety scale of the ECR-RC-short. Moreover, the content-independent

items of the PTQ-C purely capture the thinking process and the dysfunctional effects of repetitive thinking, and

therefore provide a good base to formulate items about RTm without distinguishing between specific proximity-

related thoughts or worries.

PTMQ items were subjected to exploratory factor analysis. A principal components analysis was used

to extract factors. There were two factors with an initial eigenvalue greater than 1. The first factor had an

eigenvalue of 6.39 and accounted for approximately 42.6% of the common variance, while retaining a second

factor (with an eigenvalue of 1.19) only increased the explained common variance with 8.0% and made

interpretation of the factors difficult. Based on these eigenvalues and their explained variance, the scree plot and

the interpretability of the solution, one factor was retained. The loadings of the 15 items on this factor (shown in

Appendix A) seem satisfactory, as Stevens (2002) recommends interpreting factor loadings with an absolute

value greater than .40. Confirmatory factor analysis (CFA) revealed that the fit of the one-factor solution to the

PTMQ data was acceptable (Maximum Likelihood Ratio ² (C1) = 175.91, df for (C1) – (C2) = 90, ²/df = 1.95,

13


RMSEA = .08, SRMR = .06, CFI = 0.97). A mean score for RTm was calculated across the 15 items. In the

current sample, the internal consistency of the PTMQ (α = .90) was very good.

Self-reported and mother-reported depressive symptoms. The CDI was administered again to estimate

self-reported depressive symptoms. The internal consistency of self-reported depressive symptoms (α = .81) was

very good. The Withdrawn-Depressed subscale of the Child Behavior Checklist (CBCL; Achenbach & Rescorla,

2001) was used to assess mother-reported depressive symptoms of the child. This subscale consists of 6 items

(e.g., “There is little that he/she likes.”), which are rated on a 3-point scale (0 = not true, 1 = somewhat or

sometimes true, 2 = very true or often true). A mean score was calculated for these 6 items. The CBCL is a valid

and reliable questionnaire (Achenbach & Rescorla, 2001) and the Withdrawn-Depressed subscale discriminates

youths with major depression disorder or dysthymic disorder from youths without these diagnoses (Ebesutani et

al., 2010). In the current sample, the internal consistency of mother-reported depressive symptoms (α = .73) was

respectable.

Multi-informant compound score of depressive symptoms. Using principal component analysis in

SPSS, a common factor score was calculated based on the mean scores of the two measures for depressive

symptoms (CDI and the Withdrawn-Depressed scale of the CBCL) (see for example, Braet, Van Vlierberghe,

Vandevivere, Theuwis, & Bosmans, 2013). This multi-informant compound score reflects the common variance

between self-reported and mother-reported depressive symptoms, or in other words, the extent to which children

and their mothers agree upon child depressive symptoms. One factor with an eigenvalue higher than 1 (1.31) was

extracted with both informants’ scores loading .81 on this factor.

Results

Preliminary analyses. Missing values were deleted for each analysis separately. There were no

significant gender effects, but RTna correlated significantly with age (r(154) = .22, p = .007), and therefore, age

will be used as control variable in subsequent analyses. Negative affectivity correlated positively with RTm

(r(145) = .17, p = .040) and depressive symptoms (self-report: r(140) = .23, p = .007; mother-report: r(152)

= .33, p < .001; and multi-informant compound score: r(140) = .38, p < .001). In this sample, 6.2% of the

children scored equal to or above the cut-off score for self-reported depressive symptoms. For mother-reported

depressive symptoms, 7.6% of the children scored in the subclinical range, and 4.5% scored in the clinical

range. In Table 1, descriptive statistics for all the variables are presented.

14

, 25/02/16,

Omdat age ook niet in tabel voor beide omdat het een covariaat is.

, 25/02/16,

Waarom steek je NA niet in tabel 2?

, 25/02/16,

Maar het is toch echt een variabele?

, 25/02/16,

%?

, 25/02/16,

Wat dan nog? Aantallen waarmee in tabellen?

, 25/02/16,

Moet je niet meer details geven over MV?


Associations between attachment anxiety, attachment avoidance, RTna, RTm and depressive

symptoms. In Table 2, zero-order correlations between the variables are presented. Firstly, attachment anxiety

correlated positively with RTna and RTm. Because attachment anxiety and attachment avoidance were

positively correlated, multiple hierarchical regression analyses were conducted to investigate whether RTna and

RTm were uniquely linked with attachment anxiety and not with attachment avoidance (Table 3). Attachment

anxiety remained significantly related to RTna and RTm after controlling for attachment avoidance, whereas

there was no unique association of attachment avoidance with RTna and RTm when controlling for attachment

anxiety. Furthermore, attachment anxiety was positively related to depressive symptoms, also after controlling

for attachment avoidance. Attachment avoidance was positively correlated with depressive symptoms, however,

the correlation with mother-reported depressive symptoms became only marginally significant after controlling

for attachment anxiety. Finally, RTna and RTm correlated positively with self-reported depressive symptoms,

but no associations were found with mother-reported depressive symptoms. However, the correlations between

on the one hand RTna and RTm and on the other hand the multi-informant compound score were significant.

Mediation analyses. These analyses were conducted with the macro ‘PROCESS’ (Hayes, 2013) in

SPSS. Three separate analyses were conducted for each attachment dimension (while controlling for the other

dimension), testing whether attachment is indirectly linked to depressive symptoms through (1) RTna as single

mediator (2) RTm as single mediator and (3) RTna and RTm as multiple mediators. Because there was no

association between RTna/RTm and mother-reported depressive symptoms, these mediation analyses only were

conducted for self-reported depressive symptoms and the multi-informant compound score as dependent

variables (Tables 4 and 5, respectively).

Analyses with the self-reported depressive symptoms score as DV, Replicating replicated the effects

found in Study 1., Again, the association between the indirect effect of attachment anxiety on and self-reported

depressive symptoms through was significantly mediated by RTna was significant (Table 4, row 1). Next, there

was a significant indirect effect of attachment anxiety on self-reported depressive symptoms through RTm

(Table 4, row 2). Finally, in multiple mediation analyses with RTna and RTm as mediators, there was a

significant, unique indirect effect of attachment anxiety on self-reported depressive symptoms through RTna as

well as RTm (Table 4, row 3).

When using the multi-informant compound score as DV, there was a marginally significant indirect

effect of attachment anxiety on depressive symptoms through RTna (Table 5, row 1). Next, there was a

significant indirect effect of attachment anxiety on the multi-informant compound score through RTm (Table 5,

15

, 25/02/16,

Ik laat de keuze aan u.

, 25/02/16,

Kan ik er nog dingen uithalen die er al in stonden en waar geen commentaar is op gekomen? Ze verwijzen er wel naar in hun comment als ze hun kritiek geven van ‘attachment avoidance is toch gecorreleerd met depressie, ook al zei je van niet’

, 25/02/16,

Is dat nodig? Idem voor studie 1? Als dat de expliciete vraag is van de reviewers en/of editors houden, maar anders is dit toch echt niet de focus van je onderzoek?


row 2). Finally, in multiple mediation analyses with RTna and RTm as mediators, the indirect effect of

attachment anxiety on the multi-informant compound score through RTna disappeared whereas there was a

significant, unique indirect effect through RTm (Table 4, row 3).2

In addition, negative affectivity was added as a covariate in these mediation analyses with attachment

anxiety as IV. Only one of the eight indirect effects changed, namely the significant indirect effect through

RTna for self-reported depressive symptoms, in the analyses with both RTna and RTm as mediators (Table 4,

row 3). This indirect effect became marginally significant (B = 0.01, SE = 0.01, 90%-BC CI [0.001, 0.026];

completely standardized B = .04), whereas the indirect effect through RTm remained significant.

In all the mediation analyses with attachment avoidance as independent variable, the indirect effects

through RTna and RTm were not significant (Table 4 and 5, rows 4, 5, and 6). Path analyses with both

attachment anxiety and avoidance as IV’s, RTna and RTm as M’s, and depressive symptoms as DV were also

conducted. There was a marginally significant indirect effect of attachment anxiety on self-reported depressive

symptoms through RTna (B = 0.01, SE = 0.01, p = .09, 95%-BC CI [0.001, 0.027]) and a significant indirect

effect through RTm (B = 0.02, SE = 0.01, p = .04, 99%-BC CI [0.002, 0.037]). There was no significant indirect

effect of attachment anxiety on the multi-informant compound score through RTna (B = 0.03, SE = 0.03, p = .35,

90%-BC CI [-0.003, 0.098]), but a marginally significant indirect effect through RTm (B = 0.09, SE = 0.05, p

= .07, 99%-BC CI [0.004, 0.250]). However, there were no significant indirect effects of attachment avoidance

on depressive symptoms, through RTna or RTm.

Discussion

Discussion

Study 2 was carried out to investigate whether the association between attachment anxiety and

depressive symptoms could be explained by children’s RTna and RTm. The effects depended on who reported

on the presence of depressive symptoms. This study replicated the findings of Study 1 and extended these

findings by revealing that the association between attachment anxiety and depressive symptoms not only reflects

children’s RTna, but also children’s RTm

The association between attachment anxiety and RTna found in Study 1 was replicated in Study 2.

Higher levels of attachment anxiety were associated with higher levels of RTna. In addition, higher levels of

2 Hierarchical multiple regression analyses were conducted to obtain the effect sizes for the addition of RTna and RTm to age, attachment avoidance and attachment anxiety in the prediction of self-reported depressive symptoms and the multi-informant compound score. A medium (Cohen’s f² = .19) and medium-low (Cohen’s f² = .08) effect size were obtained, respectively.

16

, 25/02/16,

, 25/02/16,

Magali, ik zou consequent de Dvs uit elkaar halen. Dus ook voor deze stukken…

, 25/02/16,

Beter nu?

, 25/02/16,

Hier moeten we nog eens zoeken naar overzichtelijke manier van presenteren

, 25/02/16,

Alle statistische symbolen moeten in Italic

, 25/02/16,

Het blijft verwarrend. Je verwijst nu naar Table 4 Row 3 alsof daar de resultaten staan na controle voor NA. Dat is toch niet het geval? Ik denk dat je voor analyses die je niet in detail beschrijft zoals de 7 mediatie analyses (intussen gezien dat het eigenlijk 5/6 mediatie analyses zijn. Zeggen dat detailed results can be obtained from the authors. Dan is het duidelijkd at dat afzonderlijke analyses zijn. Dan neits zeggen over T4R3, maar gewoon zegen in welke analyse er een verandering maar zonder data.

, 25/02/16,

Het is wat verwarrend dat je maar 6 analyses gedaan hebt, maar wel spreekt over 8 resultaten. Is niet 5/6 de van da analyses onveranderd? Ook de row is wat verwarrend trouwens: een rij gaat over een lijn in een kolom: de nummer 3 in de kolom verwijst eigenlijk (als ik het goed snap) naar analyse 3. Je meot zorgen dat mesnen niet in de war geraken. Dus toch een andere formulering zoeken


attachment anxiety were associated with higher levels of RTm and higher levels of RTm were associated with

higher levels of both self-reported depressive symptoms and depressive symptoms agreed upon by mother and

child. However, neither RTna, nor RTm, were associated with mother-reported depressive symptoms. This

finding is in line with other studies that show that there is a small agreement between mothers and children on

children’s unobservable, internal cognitions and feelings, like depressive symptoms (Angold et al., 1987; De Los

Reyes & Kazdin, 2005). Nevertheless, the fact that the effects were found again when using a multi-informant

compound score, which reflects depressive symptoms agreed upon by mother and child, does reflect that the

correlations between RTna/RTm and self-reported symptoms are not merely the result of reporter bias.

Regarding the mediation analyses, Study 2 replicated the results of Study 1 for self-reported depressive

symptoms. More specifically, RTna mediated the association between attachment anxiety and self-reported

depressive symptoms. These findings suggested that children who reported being more anxiously attached, also

reported more repetitive thoughts about negative affect, which in turn, was related to increased self-reported

depressive symptoms. Adding to Study 1, there was a trend for mediation by RTna in the association between

attachment anxiety and depressive symptoms agreed upon by mother and child. This finding suggests that the

effect might not be merely the result of reporter bias or shared method variance because the multi-informant

compound score theoretically reflects the variance in depressive symptoms that is shared or agreed upon by the

two informants. Further adding to Study 1, RTm mediated the relationship between attachment anxiety and

depressive symptoms, over and above RTna. When children reported being more anxiously attached, they also

reported more RTm, which in turn, was related to their self-reported depressive symptoms. Interestingly, for the

depressive symptoms agreed upon by mother and child, adding RTm reduced the mediation by RTna to non-

significance while the mediation by RTm remained significant. Importantly, these effects could not be explained

by negative affectivity. This further supports the hypothesis that the current studies identified attachment

anxiety-specific depressogenic mechanisms. Additionally supporting that this mechanism is specific for

attachment anxiety, there was no mediation by RTna or RTm in the association between attachment avoidance

and depressive symptoms. Finally, both the multiple mediation and the path analyses suggested that the

mediation by RTm had a larger effect size than the mediation of RTna. Although more research is needed to

investigate whether this finding replicates, this could indicate that RTna might be a part or a consequence of

RTm instead of an unique, equally important mechanism in the association between attachment anxiety and

depressive symptoms as suggested by the two components of the heightening strategy.

17


General Discussion

The aim of the current studies was to examine the mechanisms explaining the link between attachment

anxiety and depressive symptoms in middle childhood. In two studies, we investigated age-appropriate indicators

of two components of the heightening ER strategy observed in insecure-anxiously attached individuals, namely

heightening negative affect and heightening the importance of the attachment relationship. More specifically, it

was proposed that these heightening strategies might be reflected in increased repetitive thinking about negative

affect (RTna) and increased repetitive thinking about mother (RTm) respectively. Two studies provided first

evidence for the claim that the association between attachment anxiety and depressive symptoms is mediated by

repetivitive thoughs about negative affect and mother, although the strength of the effects depended on who

reported on children’s depressive symptoms.

Indicating that the current sample and data can be used to test these mediation hypotheses, in both

samples, the means of depressive symptoms and the percentage of children displaying (sub)clinical levels of

depressive symptoms are in line with the prevalence rates that are on average found in samples of this age-group

(Roelofs et al., 2010; Twenge & Nolen-Hoeksema, 2002). Moreover, as in previous research (see for example

the review by Brumariu & Kerns, 2010; Madigan et al., n.d.), insecure attachment was linked to depressive

symptoms. Although often stronger links with depressive symptoms are found for attachment anxiety compared

to avoidance (Brumariu & Kerns, 2010; Madigan et al., n.d.), in the current samples, both insecure attachment

dimensions were linked with depressive symptoms. However, similar patterns of results were found in several

other studies (Brenning et al., 2012; Groh et al., 2012; Madigan et al., 2013). This is not surprising as also

avoidantly attached children are less likely to seek maternal support during distress making them more

vulnerable to the detrimental effects of prolonged exposure to stress and stressful situations (Dujardin et al.,

n.d.). Nevertheless, several studies also suggested that, even though both insecure attachment dimensions can be

equally strong related to depressive symptoms, the underlying mechanisms differ (Brenning et al., 2012).

The current findings are in line with that suggestion, showing that RTna and RTm mediate the

association between attachment anxiety and depressive symptoms, but not the association between attachment

avoidance and depressive symptoms. These effects were predicted by Cassidy (1994), and the current study

provides first convincing evidence for these attachment-anxiety specific depressogenic mechanisms. Hereby, the

mediating effect of RTna appears to be highly robust, as it was replicated in both studies for self-reported

18


depressive symptoms and as there was a trend of replication for depressive symptoms agreed upon by mother

and child. Additionally, RTm mediated the relationship between attachment anxiety and both depressive

symptoms scores . There was no mediation by RTna and RTm in the relationship between attachment avoidance

and depressive symptoms. However, thisTheoretically it has been proposed that attachment dimension

avoidance can might influence depressive symptoms indirectly through other maladaptive emotion regulation

strategies such as a suppressing strategysupression (Brenning et al., 2012; Wei, Vogel, Ku, & Zakalik, 2005), a.

lthough However, a systematic review indicates that alsosuggests that evidence for such a mechanism is less

robustly this is less consistently found than the mediation by heightening strategies in the association between

attachment anxiety and depressive symptoms (Malik, Wells, & Wittkowski, 2015) suggesting that mre research

is needed to explain the maladaptive effects of attachment avoidance. This literature and the findings of the

current study support the relevance of investigating heightening strategies like RTm and RTna as specific

mechanisms in the relationship between attachment anxiety and depressive symptoms in middle childhood.

Interestingly, visual inspection of the effect sizes in the singleand multiple mediation analyses of Study

2 (in row 1, 2, and 3 in Table 4 and 5) suggests that the indirect effect through RTm has a larger effect size than

the indirect effect through RTna, and that adding RTm to the mediation model reduces the indirect effect of

RTna. More research is needed to test whether this means that RTna might be a part or a consequence of RTm

instead of an unique, equally important mechanism in the association between attachment anxiety and depressive

symptoms as suggested by the two components of the heightening strategy.

Furthermore, research is needed to further identify which are the maladaptive effects mechanisms

behind of repetitive thinking about mother specifically. The current study was based on hypotheses about the

maladaptive nature of repetitive thoughts in general. According to attachment literature, the focus on the

attachment figure should decline in this age period. Instead, in normal developing childrennormative

development, theory assumes that children’s focus shifts away from mother peers function more as attachment

figures to foster autonomous explorationand autonomy increases (Koehn & Kerns, 2015; Mayseless, 2005).

MoreoverIn support of this assumption that a reduced focus on mother is beneficial for explarotaiton, attentional

processing research shows that children with more trust are better able to ignore mother and to explore

potentially challenging stimuli, children heighten their focus on mother at the expense of openness to only mildly

threatening environments (Dujardin et al., 2015)(Bosmans field etc, 2015). and challenging tasks (Bosmans,

Dujardin, et al., 2015). ThereforeInstead, a heightened focus on mother might impede interfere with children’s

engagement in important adolescent developmental tasks, like learning to autonomously cope with mild distress.

19

, 25/02/16,

Waarom switch je nu ineens naar maladaptive attachment patroon zonder enige aankondiging? Zou je het niet in het normatieve houden? Je kan de studie van adinda toch ook omgekeerd beschrijven? Dat ze het juist beter kunnen.

, 25/02/16,

Guy: misschien moeten we het argument dat mother-report niet linkt aan RTna en RTm eigenlijk alleen maar hier maken en niet in de tussentijdse discussies


AdditionallyFor example, children with a heightened focus on mother wait longer to seek support in more

serious stressful eventsseek maternal support more quickly when feeling mildly distressed (Bosmans, Braet,

Heylen, & De Raedt, 2015). However, once they become highly distressed, the latter study showed that children

with an heightened focus on mother actually waited longer to seek her support, further suggesting that an

increased attentional focus on mother interferes with actual support seeking behavior at times when this support

is most needed (Bosmans, 2015). Finally, a heightened focus on mother might draw attention to an inconsistently

available and supportive caregiver, which could intensify feelings of loneliness and abandonment (Brenning et

al., 2012; Cassidy, 1994; Shaver & Mikulincer, 2002). These hypotheses about the maladaptive nature of

repetitive thoughts in general, are in line with the finding that shifting focus to certain thoughts is adaptive as

long as this occurs flexibly in function of personal goals. Instead, when this occurs inflexibly and thoughts

become intrusive and perseverative, it impedes goal attainment andbecomes maladaptive (Ottaviani, Shapiro, &

Couyoumdjian, 2013). Following this reasoning, it would be the repetitive instead of flexible nature of thinking

about mother, that would play a role in anxiously attached children’s vulnerability to depressive symptoms.

NeverthelessAlthough the current findings are in line with the repetitive thinking literature that shows that

repetitive thinking in general is a maladaptive cognitive process as it interferes with individual’s healthy ability

to flexibily shift their focus between different stimuli and thoughts, the current study’s operationalization of

RTm, did not allow testing the possibility that some repetitive thoughts about mother are more maladaptive then

others, depending on the content of the thoughts. based on the current studies, we cannot exclude that anxiously

attached children may also think in a more negative manner about their mother, whereas securely attached

children may have more protective thoughts. Consistent with this hypothesis and the current findingsIn support

of the possibility that the current effect might be explained by the content of anxiously attached children’s

repetitive thoughts about mother, Mikulincer et al. (2000, 2002) found indeed that negatively valenced

proximity-related worries are chronically accessible in anxiously attached individuals, whereas in securely

attached individuals only thoughts about love and support are accessible. This might mean that, in a short-term

perspective, a focus on mother might be beneficial, as it might lower distress by creating a sense of connection

with an unavailable mother in times of need (Mayseless, 2005; Seltzer, Ziegler, & Pollak, 2010). So although the

maladaptive nature of RTm seems to be situated primarily in its repetitiveness instead of in its possible

negatively valenced content, in view of both possible explanations, it could be useful to examine the content of

repetitive thoughts in future research.

20

, 02/25/16,

Dat volgt daar toch niet logisch uit? Dat is gewoon nog een tweede hypothese. Dan moet het worden: additionally, it could be that, for anxiously attached children there are short-term benefits of this heightened focus on mother. For example, xxx suggested that XXXX. If that were the case, the current data suggest that this short-term benefit might be limited because…

, 02/25/16,

Magali, ofwel moet je het herwerken (shifting focus to thoughts springt helemaal weg van shifting focus on mother. Dus je moet een goede brug maken, ofwel moet je uit die thoughts taal uitblijven (zou ik zelf doen als ik zou kiezen het te houden). Ofwel moet je het eruit laten. het voelt wat als een goed argument dat toch lichtjes uit context is geplaatst waardoor het niet helemaal fit met de argumenten die je eerder probeerde te geven

, 02/25/16,

Heb ik het nu niet beter samen gevat?


Limitations

Although the findings of both current studies seem to increase our understanding of the mechanisms

explaining the association between attachment anxiety and depressive symptoms, some limitations should be

taken into account while drawing conclusions. Firstly, the design of both studies was cross-sectional. Although

mediation analyses at first glance seem to suggest causal and temporal relationships, no conclusions can be made

about the causality or the direction of the effects. Nevertheless, regarding RTna, the current findings are in line

with previous studies suggesting longitudinal associations between parenting (e.g., psychological control), RTna

and depressive symptoms (Gaté et al., 2013; Hilt et al., 2012). As Pparenting is closely related to attachment

development (Ainsworth, Blehar, Waters, & Wall, 1978), and controlling parenting behavior mediates the

association between attachment and psychopathology (Bosmans et al., 2011; Bosmans, Braet, Van Leeuwen, &

Beyers, 2006), and between attachment anxiety and depressive symptoms in particular (Brenning et al., 2012).

Although one could assume that similar longitudinal associations might be found between attachment anxiety,

RTna, and depressive symptoms, this has not been investigated so far. Regarding RTm, the second study served

as a first test of a novel hypothesis. Consequently, future research with experimental and longitudinal designs

could should further investigateinvest in experimental and longitudinal designs (using cross-lagged analyses) to

overcome the current studies’ limitation and to determine the direction of the effects between attachment

anxiety, RTna, and RTm, and depressive symptoms as causal or developmental mechanisms in the association

between attachment anxiety and depressive symptoms.

Furthermore, in the current studies only questionnaires were administered and no other methods were

used to measure attachment anxiety, RTna, RTm and depressive symptoms. Consequently, it is possible that

thce current effects reflected shared method variance effects instead of a mechanism explaining the link between

anxious attachment and depressive symptoms. In an attempt to test whether the effects are indeed only the result

of shared method variance or, instead, reflect a specific mechanism, we performed Although additional path

analyses indicatedduring which the order of the predictor and mediator variabels was reversed. Comparing the

fits between models can give some indication that XXX. In the current studies, we could only perform such an

analysis for the data fo study 2 because the mdoel of study 1 was saturated. For Study 2, fit indices suggested

that the attachment –RTm/RTna – depressive symptoms model fitted the data better (RMSEA = , CFI =, ) better

than the reversed model (RMSEA =, CFI = ). Consequently, this seems to suggest that the findings might reflect

more than just shared-method variance. Nevertheless, it would be more appropriate to test the current studies’

hypotheses using different methods for the different variables. With regard to attachment, it could be important

21

Van de Walle Magali, 02/24/16,

In inleiding?


to include interviews such as CAI? or prompt-word methods such as the SBS test. With regard to depressive

symptns, it oculd be interesting to use interviews such as…. that a model with attachment anxiety and avoidance

as mediators in the relationship between RTna and RTm and depressive symptoms was worse than the fit of our

hypothesized model, the design of the studies does not allow to exclude thatTherefore, our results were

inflatedion of the results by shared-method variance is possible. Future research could use multi-method designs

combining different measurement methods for the quality of attachment relationships, RTna and RTm, and

depressive symptoms. Based on the In literature, about RTna, self-report questionnaires seemare the most

common and adequate method to assess this unobservable, internal, cognitive processes like RTna and RTm

(Abela, Vanderbilt, & Rochon, 2004; De Los Reyes & Kazdin, 2005; Treynor et al., 2003; Verstraeten et al.,

2010). However, there has been more discussion about measurement methods for the quality of attachment

relationships. According to social psychologists, attachment-related expectations can be reported directly in

questionnaires (Hazan & Shaver, 1987). Instead, developmental psychologists have argued that attachment-

related expectations cannot be accessed consciously, and therefore, should be inferred from the quality and

coherence of narratives elicited by attachment-system activating interview questions (Main, Kaplan, & Cassidy,

1985). To make it even more complex, recently, both developmental and social psychologists have investigated

the secure base script underlying attachment-related expectations with word prompt outlines (Waters & Waters,

2006). With regard to measures for depressive symptoms, questionnaires as well as interviews are used, but self-

report seems to be preferred above parent- or teacher-report (Angold et al 1987). Thus, a multi-method design

combining different measurement methods for the quality of attachment relationships might benefit future

research. In the current study, the multi-informant compound score, which reflects depressive symptoms mother

and child agree upon, was a compromise between reducing inflation of the results by methodological biases and

having the most reliable measures.

Finally, the interpretation of the findisngs regarding RTm should take into account that the way we

operationalized the heightened focus on mother in middle childhood is innovative and consequently, this has as

disadvantage that much more research is needed to evaluate tAs RTm is a novel construct, there are still many

gaps to fill by additional research that were not addressed in the current study. The PTMQ’s has not been

subject to elaborate validity and reliability testing. In the current study, RTm mediated the relationship between

attachment anxiety (but not attachment avoidance) and depressive symptoms over and above, and sometimes

even beyond RTna, and these constructs were moderately but not highly correlated (r = .30). This suggests that

RTm might be a different form of repetitive thinking that explains unique variation in depressive symptoms, and

22


thus, is a first indication for divergent and predictive validity for the PTMQ. However, future research is needed

to ensure this is really the case.

Clinical implications

Despite some these limitations, both current studies demonstrate the role of repetitive thinking about

negative affect and about mother in the association between attachment anxiety and depressive symptoms. These

findings may have some clinical implications. Treatment methods for depression are generally less effective than

treatment methods for other disorders (Weisz et al., 2006). As the current study highlights that RTna as well as

RTm contribute to depressive symptoms, it seems important to target both components to reduce current

depressive symptoms and further relapse. By reducing RTm, more cognitive capacity might become available to

learn from new experiences. Therefore, on the one hand, it could be useful to combine interventions targeting

RTm with existing interventions that have been proven successful in reducing RTna, like Cognitive behavioral

therapy (CBT), and rumination-focused CBT (RFCBT) (Watkins et al., 2007; Wilkinson & Goodyer, 2008).

These interventions try to switch individuals from less helpful to more helpful thoughts (Watkins et al., 2007;

Wilkinson & Goodyer, 2008). As RTm is a novel construct, interventions focusing specifically on reducing RTm

could be developed by analogy WITH? Beter ANALOGUOUS TO (what?). On the other hand, as RTm and

RTna are both types of repetitive thinking, it could be more efficient to target the repetitive and intrusive

thinking process, instead of the content of the thoughts, like in CBT. To this end, Mindfulness Based Cognitive

Therapy (MBCT; Teasdale et al., 2000) focuses on increasing awareness of thoughts and on relating to them in a

detached and decentered perspective, and seems a promising intervention to target RTna and RTm

simultaneously. Further research could disentangle active components of (RF)CBT and MBCT and investigate

effectiveness of combinations of these components in preventing different types of repetitive thinking in middle

childhood and thus, the onset and relapse of depression. WAAROM NIET DE RELATIE HERSTELLEN

ZOALS IN ABFT?

Conclusion

In sum, the current studies provided insight in the mechanisms explaining the relationship between

attachment anxiety and depressive symptoms in middle childhood. The two studies extended the findings of

Brenning et al. (2012) and Ruijten et al. (2011) in three ways: by focusing not only on heightening negative

affect, but also on heightening the importance of the attachment relationship, by investigating these mechanisms

23

, 02/25/16,

Hoe bedoel je switch individuals? Of bedoel je de individuals helpen om te switchen?

, 02/25/16,

Valt uit de lucht

, 02/25/16,

Waarom komt dat hier? Dat is toch al besproken bij de ES en toch ook geen limitaion. Ik zou nog wat verder uitweiden over de nood aan meer onderzoek en aan beter begrijpen wat RTm inhoudt e de PTMQ meet


in middle childhood, and by assessing specific insecure attachment dimensions instead of general insecure

attachment. Repetitive thinking about negative affect and about mother were found to play a significant role in

the association between attachment anxiety and depressive symptoms. Especially repetitive thinking about

mother seems a promising direction for future research as it could fill the gap on the role of attachment in the

development of depressive symptoms.

24

, 25/02/16,

Is dat nieuw tov Brenning?


References

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Appendix

Factor loadings of exploratory factor analysis on the PTMQ

Item

When I am going through an unpleasant time or am experiencing some problems… Factor 1

13. … I feel as if I must keep thinking about my mother. .76

11. …I keep thinking about my mother all the time. .76

6. …the same thoughts about my mother return into my mind. .75

7. …thoughts about my mother come into my mind without me wanting them to. .70

10. … my thoughts about my mother prevent me from focusing my attention on other things. .68

9. …I keep asking myself questions about my mother without finding an answer. .67

4. …I think about my mother without it helping me solve any of these problems. .67

8. …when I am thinking about my mother, I get stuck and I find it difficult to stop these

thoughts..67

15. …my thoughts about my mother take up all my attention. .64

2. …thoughts about my mother come on and I can’t do anything against it. .63

1. … the same thoughts about my mother keep going through my mind again and again. .61

3. … I can’t stop thinking about my mother. .60

12. …thoughts about my mother just pop into my mind. .57

5. …I can’t do anything else while thinking about my mother. .55

14. …my thoughts about my mother are not much help to me. .45

33


Table 1

Means, Standard Deviations, and Correlation Coefficients Among the Variables of Study 1 (N = 381)

1 2 3 4

1 Attachment anxiety -

2 Attachment avoidance .56*** -

3 RTna .32*** .19*** -

4 Depressive symptoms .50*** .46*** .52*** -

M 2.05 2.52 2.23 0.34

SD 0.90 1.08 0.73 0.25

Note. RTna = Repetitive thinking about negative affect; Depressive symptoms = Self-reported depressive

symptoms.

*** p < .001

34


Table 2

Means, Standard Deviations, and Correlation Coefficients Among the Variables in Study 2 (n=139-154)

1 2 3 4 5 6 7

1 Attachment anxiety -

2 Attachment avoidance .43*** -

3 RTna .23** .11 -

4 RTm .30*** .14 .30*** -

5 Depressive symptoms S .51*** .36*** .39*** .44*** -

6 Depressive symptoms M .25** .23** -.02 .12 .31*** -

7 Depressive symptoms C .45*** .34*** .26** .38*** .81*** .81*** -

M 1.49 2.81 2.04 1.08 0.24 0.22 0.00

SD 0.71 1.16 0.69 0.66 0.18 0.27 1.00

Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother; Depressive

symptoms S= Self-reported depressive symptoms; Depressive symptoms M = Mother-reported depressive

symptoms; Depressive symptoms C = compound score for self-reported and mother-reported depressive

symptoms.

** p < .01 *** p < .001

35


Table 3

Results of Hierarchical Multiple Regression Analyses at Step 2, Predicting RTna, RTm, and Depressive

Symptoms by Attachment Anxiety or Attachment Avoidance, Controlled for the Other Attachment Dimension.

R² R²-

change

F-

change

t df p

Prediction by attachment anxiety, controlled for attachment avoidance

RTna .05* .04 5.47 2.34 139 .22 .021

RTm .07** .05 7.60 2.76 135 .25 .007

Depressive symptoms S .34*** .20 39.27 6.27 132 .48 < .001

Depressive symptoms

M

.10*** .04 6.42 2.53 142 .22 .012

Depressive symptoms C .28*** .15 28.02 5.29 132 .43 < .001

Prediction by attachment avoidance, controlled for attachment anxiety

RTna .05* .00 0.05 0.22 139 .02 .826

RTm .07** .00 0.08 0.27 135 .03 .784

Depressive symptoms S .34*** .03 5.45 2.33 132 .18 .021

Depressive symptoms

M

.10*** .02 3.06 1.75 142 .15 .083

Depressive symptoms C .28*** .03 5.39 2.32 132 .19 .022

Note: RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother; Depressive

symptoms S= Self-reported depressive symptoms; Depressive symptoms M = Mother-reported depressive

symptoms; Depressive symptoms C = compound score for self-reported and mother-reported depressive

symptoms.

* p < .05 ** p < .01 *** p < .001

36


Table 4

Unstandardized Regression Coefficients With Standard Errors for the Different Effects, Point Estimate, Confidence Interval (CI), and Effect Size (Completely Standardized)

of Indirect Effects, and Proportion Explained Variance of the Mediation Analyses With Attachment Anxiety or Avoidance as Independent Variables (IV), RTna or/and RTm as

Mediators (M), and Self-reported Depressive Symptoms as Dependent Variable (DV)(10,000 bootstrap samples, n = 127-133)

M Effect of IV on

M

Effect of M on

DV

Total effect Direct effect Indirect effect Bias corrected CI of

indirect effect

Effect

size

R²

Attachment anxiety

1 RTna 0.26** (0.09) 0.06** (0.02) 0.13*** (0.02) 0.12*** (0.02) 0.02b (0.01) 0.002 < < 0.039 .06b .38***

2 RTm 0.28** (0.09) 0.08*** (0.02) 0.13*** (0.02) 0.11*** (0.02) 0.02a (0.01) 0.003 < < 0.056 .08a .41***

3 RTna

RTm

0.26** (0.10)

0.30** (0.09)

0.06** (0.02)

0.07** (0.02)

0.14*** (0.02) 0.10*** (0.02) 0.01b (0.01)

0.02a (0.01)

0.002 <

0.003 <

< 0.035

< 0.058

.05b

.07a

.45***

Attachment avoidance

4 RTna 0.05 (0.05) 0.06** (0.02) 0.03* (0.01) 0.02 (0.01) 0.00 (0.00) -0.003 < < 0.009 .02 .38***

5 RTm 0.05 (0.05) 0.08*** (0.02) 0.03* (0.01) 0.03* (0.01) 0.00 (0.00) -0.002 < < 0.013 .02 .41***

6 RTna

RTm

0.04 (0.05)

0.03 (0.05)

0.06** (0.02)

0.07** (0.02)

0.03* (0.01) 0.03* (0.01) 0.00 (0.00)

0.00 (0.00)

-0.003 <

-0.003 <

< 0.008

< 0.010

.01

.01

.45***

Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother. Age and the other attachment dimension were controlled for in all analyses.

z Completely standardized indirect effect and CI; a Significant point estimate of indirect effect at the 99% CI; b Significant point estimate of indirect effect at the 95% CI.

Otherwise, the point estimate of indirect effect lies not in the 90% CI.

37

, 02/25/16,

Volgens uw noot gaan die a en b etc over significantie van het indirect effect. Waarom zet je het dan ook bij de ES? Is dat niet verwarrend? Heb je de significanties van ES? Dat zijn toch meestal cut-offs? Volgens mij wordt dat niet in significantie uitgedrukt


p < .10 * p < .05 ** p < .01 *** p < .001

38


Table 5

Unstandardized Regression Coefficients With Standard Errors for the Different Effects, Point Estimate, Confidence Interval (CI), and Effect Size (Completely Standardized)

of Indirect Effects, and Proportion Explained Variance of the Mediation Analyses With Attachment Anxiety or Avoidance as Independent Variables (IV), RTna or/and RTm as

Mediators (M), and the Multi-informant Compound Score as Dependent Variable (DV)(10,000 bootstrap samples, n = 127-133)

M Effect of IV on

M

Effect of M on

DV

Total effect Direct effect Indirect effect Bias Corrected CI of

Indirect effect

Effect

size

R²

Attachment anxiety

1 RTna 0.26** (0.09) 0.19 (0.12) 0.68*** (0.13) 0.63*** (0.13) 0.05c (0.04) 0.003 < < 0.137 .03 .30***

2 RTm 0.28** (0.09) 0.35** (0.12) 0.65*** (0.13) 0.55*** (0.13) 0.10a (0.05) 0.005 < < 0.286 .06 .33***

3 RTna

RTm

0.26** (0.10)

0.30** (0.09)

0.15 (0.12)

0.31* (0.12)

0.69*** (0.13) 0.56*** (0.14) 0.04 (0.04)

0.10a (0.06)

-0.002<

0.002 <

< 0.124

< 0.292

.02

.06

.34***

Attachment avoidance

4 RTna 0.05 (0.05) 0.19 (0.12) 0.14* (0.07) 0.13 (0.07) 0.01 (0.01) -0.006 < < 0.040 .01 .30***

5 RTm 0.05 (0.05) 0.35** (0.12) 0.18* (0.07) 0.16* (0.07) 0.02 (0.02) -0.009 < < 0.064 .02 .33***

6 RTna

RTm

0.04 (0.05)

0.03 (0.05)

0.15 (0.12)

0.31* (0.12)

0.16* (0.07) 0.15* (0.07) 0.01 (0.01)

0.01 (0.02)

-0.006 <

-0.014 <

< 0.035

< 0.050

.01

.01

.34***

Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother. Age and the other attachment dimension were controlled for in all analyses.

z Completely standardized indirect effect and CI; a Significant point estimate of indirect effect at the 99% CI; c Marginally significant point estimate of indirect effect at the

90% CI. Otherwise, the point estimate of indirect effect lies not in the 90% CI.

39


p < .10 * p < .05 ** p < .01 *** p < .001

40

Documents

Web viewAttachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking About Negative Affect and About Mother. Abstract