The Mediating Role of Mentalization in the Relationship between Attachment and Emotioal Dysregulation with Social Anxiety:

Subject Areas : Clinical psychology

Elahe Drogar ¹ (PhD Candidate University of Science and Culture)
Ali Fathi-Ashtiani ² (PhD University of , Baqiyatallah University of Medical Sciences University of Science and Culture,)
Emad Ashrafi ³ (PhD University of Science and Culture)

Received: 2021-02-08 Accepted : 2021-02-08 Published : 2020-12-21

Keywords: attachment, emotion regulation, Social anxiety, metallization,

Abstract :

This study aimed to investigate the mediating role of mentalization in the relationship between attachment styles and difficulty in emotion regulation with social anxiety. The research method was descriptive and correlational. The sample consisted of 706 students of Mashhad University who were selected by convenience sampling method and completed the Adult Attachment Scale (Besharat,2011), Reflective Functioning Scale (Fonaghi, Leighton, Molton & Lee, 2016), Social Phobia Inventory (Connor, Davidson, Churchill, Sherwood, & Whistler, 2000), and Difficulty in Emotion Regulation Scale (Gertz & Romer, 2004). Structural equation modeling analysis showed that mentalization can mediate the relationship between attachment styles and difficulty in regulating emotion with social anxiety symptoms. The direct effects of mentalization, attachment, and emotion regulation difficulty on symptoms of social anxiety were significant. The direct effects of attachment and difficulty in emotion regulation on mentalization were also negative and significant. The indirect effect of attachment styles and difficulty in emotion regulation through mentalization was also significant. Findings suggest that mentalization have a mediating role between attachment styles and difficulty in regulating emotion with symptoms of social anxiety.

References:

بشارت، م. ع. (1392). مقیاس دلبستگی بزرگسال: پرسشنامه، شیوه اجرا و کلید نمره‌گذاری. فصلنامه روان‌شناسی تحولی: روان‌شناسان ایرانی، 9(35)، 320 -317.

بشارت، م. ع. (1392). نقش واسطه‌ای راهبردهای نظم‌دهی شناختی هیجان در رابطه بین سبک‌های دلبستگی و ناگویی هیجانی. فصلنامه روان‎شناسی تحولی: روان‌شناسان ایرانی، 37(10)، 16 -5.

بشارت، م. و فرهمند، ه. (1396). نقش واسطه‌ای دشواری نظم‌جویی هیجان در رابطه بین آسیب‌های دلبستگی و نشانه‌های افسردگی و اضطراب. فصلنامه اندیشه و رفتار در روان‌شناسی بالینی، 11(44)، 16 -7.

بشارت، م.، اسدی، م. و تولائیان، ف. (1394). نقش واسطه‌ای استحکام در رابطه بین سبک‌های دلبستگی و راهبردهای نظم‌بخشی هیجان. فصلنامه روان‎شناسی تحولی: روان‌شناسان ایرانی، 46(12)، 119 -107.

بشارت، م.، خلیلی خضرآبادی، م. و رضازاده، م. (1395). نقش واسطه‌ای دشواری تنظیم هیجان در رابطه بین روان‌سازه‌های ناسازگار اولیه و مشکلات زناشویی. دو فصلنامه روان‌شناسی خانواده، 3(2)، 44 -27.

بشارت، م.، مدنی، م. و پورحسین، ر. (2014). بررسی نقش تعدیل‌کننده عواطف مثبت و منفی در حیطه سبک‌های دلبستگی و مشکلات زناشویی. مجله علوم روان‌شناختی، 13(49)، 18 -6.

حسنوندعموزاده، م.، باقری، ا. و شعیری، م. ر. (1389). بررسی روایی و اعتبار سیاهه ترس اجتماعی در نمونه‌های غیربالینی. مجموعه مقالات پنجمین سمینار سراسری بهداشت روانی دانشجویان، اردیبهشت 1389، دانشگاه شاهد.

دروگر، ا.، فتحی آشتیانی، ع. و اشرفی، ع. (۱۳۹۹). بررسی ویژگی‌های روان‌سنجی نسخه فارسی پرسشنامه ذهنی‌سازی. فصلنامه روان‌شناسی بالینی، ۱۲(۴۵)، 12 -1.

شمس، ع.، عزیزی، م. و میرزایی، ب. (۱۳۸۹). بررسی رابطه تحمل آشفتگی و نظم‌جویی هیجانی با میزان وابستگی دانشجویان به سیگار. مجله تحقیقات نظام سلامت حکیم، ۱۳(۱)، 18 -11.

فتحی‌ آشتیانی، ع. و داستانی، م. (1395). آزمون‌های روان‌شناختی. تهران: انتشارات بعثت.

مسگریان، ف.، آزادفلاح، پ.، فراهانی، ح. و قربانی، ن. (1396). روابط موضوعی و مکانیزم‌های دفاعی در اضطراب اجتماعی. فصلنامه روان‌شناسی تحولی: روان‎شناسان ایرانی، 14(53)، 14 -3.

 

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: Text Revision (DSM-V). Washington, DC: American Psychiatric Association.

Azoulay, R., Berger, U., Keshet, H., Niedenthal, P. M., & Gilboa-Schechtman, E. (2019). Social anxiety and the interpretation of morphed facial expressions following exclusion and inclusion. Journal of Behavior Therapy and Experimental Psychiatry, 66, 101-115

Ballespí, S., Vives, J., Sharp, C., Tobar, A., & Barrantes-Vidal, N. (2019). Hypermentalizing in Social Anxiety: Evidence for a Context-Dependent Relationship. Frontiers in psychology, 10, 150-161.

Barrett, P. (2007). Structural equation modelling: Adjudging model fit. Personality and Individual differences, 42(5), 815-824.

Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H. U. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903-912.

Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588-606.

Bosquet, M., & Egeland, B. (2006). The development and maintenance of anxiety symptoms from infancy through adolescence in a longitudinal sample. Development and psychopathology, 18(2), 517-550.

Cassidy, J., & Shaver, P. R. (2009).Handbook of attachment: Theory, research and clinical applications. New York: Guilford press.

Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165(9), 1127-1135.

Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., Kessler, J., Woike, J. K., Wolf, O. T., & Convit, A. (2006). Introducing MASC: a movie for the assessment of social cognition. Journal of Autism and Developmental Disorders, 36(5), 623-636.

Eng, W., Heimberg, R. G., Hart, T. A., Schneier, F. R., & Liebowitz, M. R. (2001). Attachment in individuals with social anxiety disorder: The relationship among adult attachment styles, social anxiety, and depression. Emotion, 1(4), 365-380.

Fischer-Kern, M., Fonagy, P., Kapusta, N. D., Luyten, P., Boss, S., Naderer, A., ... & Leithner, K. (2013). Mentalizing in female inpatients with major depressive disorder. The Journal of Nervous and Mental Disease, 201(3), 202-207.

Fonagy, P. & Ghinai, R.A. (2008). A self-report measure of mentalizing development and preliminary test of reliability and validity of the Reflective Function Questionnaire (RFQ). Unpublished manuscript. London: University College.

Fonagy, P. (2018). Affect regulation, mentalization and the development of the self. London: Routledge.

Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PloS One, 11(7), e0158678.

Fonagy, P., Moran, G. S., Edgcumbe, R., Kennedy, H., & Target, M. (1993). The roles of mental representations and mental processes in therapeutic action. The Psychoanalytic Study of the Child, 48, 9-48.

Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews. London: University College London.

Gabbard, G. O. (2017). Long-term psychodynamic psychotherapy: A basic text. American Psychiatric Pub.

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.

Gunnar, M. R., & Quevedo, K. M. (2007). Early care experiences and HPA axis regulation in children: A mechanism for later trauma vulnerability. Progress in Brain Research, 167, 137-149.

Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder: Update and extension. In Social anxiety (pp. 395-422). Waltham: Academic Press.

Henderson, L., Gilbert, P., & Zimbardo, P. (2014). Shyness, social anxiety, and social phobia. In Social Anxiety (Third Edition) (pp. 95-115). New York: Guilford Press.

Hesse, C., & Floyd, K. (2011). Affection mediates the impact of alexithymia on relationships. Personality and Individual Differences, 50, 451-456.

Hezel, D. M., & McNally, R. J. (2014). Theory of mind impairments in social anxiety disorder. Behavior Therapy, 45(4), 530-540.

Hooper, D., Coughlan, J., & Mullen, M. R. (2008). Structural equation modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6(1), 53-60.

Hu, L. T., Bentler, P. M., & Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychological Bulletin, 112(2), 351-362.

Jöreskog, K. G., & Sörbom, D. (1993). LISREL 8: Structural equation modeling with the SIMPLIS command language. Scientific Software International.

Kashdan, T. B., & Collins, R. L. (2010). Social anxiety and the experience of positive emotion and anger in everyday life: An ecological momentary assessment approach. Anxiety, Stress, & Coping, 23(3), 259-272.

Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review, 34(2), 107-117.

Kenny, D. A., & McCoach, D. B. (2003). Effect of the number of variables on measures of fit in structural equation modeling. Structural Equation Modeling, 10(3), 333-351.

Kessler, R. C., Avenevoli, S., McLaughlin, K. A., Green, J. G., Lakoma, M. D., Petukhova, M., ... & Merikangas, K. R. (2012). Lifetime co-morbidity of DSM-IV disorders in the US national comorbidity survey replication adolescent supplement (NCS-A). Psychological Medicine, 42(9), 1997-2010.

Kline, R. B. (2010). Principals and practice of structural equation modeling. New York: The Guilford Press.

Kullik, A., & Petermann, F. (2013). Attachment to parents and peers as a risk factor for adolescent depressive disorders: The mediating role of emotion regulation. Child Psychiatry & Human Development, 44(4), 537-548.

Lysaker, P. H., Olesek, K. L., Warman, D. M., Martin, J. M., Salzman, A. K., Nicolò, G., ... & Dimaggio, G. (2012). Metacognition in schizophrenia: Correlates and stability of deficits in theory of mind and self-reflectivity. Psychiatry Research, 190(1), 18-22.

Malda-Castillo, J., Browne, C., & Perez‐Algorta, G. (2019). Mentalization‐based treatment and its evidence‐base status: A systematic literature review. Psychology and Psychotherapy: Theory, Research and Practice, 92(4), 465-498.

Manning, R. P., Dickson, J. M., Palmier-Claus, J., Cunliffe, A., & Taylor, P. J. (2017). A systematic review of adult attachment and social anxiety. Journal of affective disorders, 211, 44-59.

Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Othoropsychiatry, 83, 131-141.

McIntosh, C. N. (2006). Rethinking fit assessment in structural equation modelling: A commentary and elaboration on Barrett (2007). Personality and Individual Differences, 42(5), 859-867.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.

Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25, 6-10.

Mineka, S., & Oehlberg, K. (2008). The relevance of recent developments in classical conditioning to understanding the etiology and maintenance of anxiety disorders. Acta Psychologica, 127(3), 567-580.

Nielsen, S. K. K., Lønfeldt, N., Wolitzky-Taylor, K. B., Hageman, I., Vangkilde, S., & Daniel, S. I. F. (2017). Adult attachment style and anxiety-The mediating role of emotion regulation. Journal of Affective Disorders, 218, 253-259.

Nolte, T., Guiney, J., Fonagy, P., Mayes, L. C., & Luyten, P. (2011). Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework. Frontiers in Behavioral Neuroscience, 5, 55-68.

Pedersen, S. H. Lunn, S. Katznelson,H. & Poulsen, S. (2012). Reflective functioning in 70 patients suffering from Bulimia nervosa. European Eating Disorders Review, 20(4), 303-310.

Plana, I., Lavoie, M.-A., Battaglia, M., & Achim, A. M. (2014). A meta-analysis an scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders. Journal of Anxiety Disorders, 28, 169-177.

Pollock, N. C., McCabe, G. A., Southard, A. C., & Zeigler-Hill, V. (2016). Pathological personality traits and emotion regulation difficulties. Personality and Individual Differences, 95, 168-177.

Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24(7), 737-767.

Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B., & Lancee, W. (2010). Adult attachment measures: A 25-year review. Journal of Psychosomatic Research, 69(4), 419-432.

Rudden, M., Milrod, B., Target, M., Ackerman, S., & Graf, E. (2006). Reflective functioning disorder patients: A pilot study. Journal of the American Psychoanalytic Association, 54, 1339-1343.

Samson, A. C., Lackner, H. K., Weiss, E. M., & Papousek, I. (2012). Perception of other people’s mental states affects humor in social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 625-631.

Sbarra, D. A., & Hazan, C. (2008). Coregulation, dysregulation, self-regulation: An integrative analysis and empirical agenda for understanding adult attachment, separation, loss, and recovery. Personality and Social Psychology Review, 12(2), 141-167.

Schimmenti, A., & Bifulco, A. (2015). Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles. Child and Adolescent Mental Health, 20, 41-48.

Schneider, R. L., Arch, J. J., Landy, L. N., & Hankin, B. L. (2016). The Longitudinal effect of emotion regulation strategies on anxiety levels in children and adolescents. Journal of Clinical Child &Adolescent Psychology, 45, 1-14.

Schumacker, R. E., & Lomax, R. G. (2004). A beginner's guide to structural equation modeling. London: Psychology Press.

Sripada, C. S., Angstadt, M., Banks, S., Nathan, P. J., Liberzon, I., & Phan, K. L. (2009). Functional neuroimaging of mentalizing during the trust game in social anxiety disorder. Neuroreport, 20(11), 984-989.

Sripada, C. S., Kessler, D., & Angstadt, M. (2014). Lag in maturation of the brain’s intrinsic functional architecture in attention-deficit/hyperactivity disorder. Proceedings of the National Academy of Sciences, 111(39), 14259-14264.

Toth, S. L., Rogosch, F. A., & Cicchetti, D. (2008). Attachment-theory-informed intervention and reflective functioning in depressed mothers. In H. Steele, & M. Steele (Eds.), Clinical applications of the adult attachment interview (pp. 154-172). New York, NY: Guilford Press.

Walter, H., & Mohnke, S. (2015). Mentalizing and psychopathology in schizophrenia, depression, and social anxiety disorders: The mediating role of emotion regulation. Child Psychiatry & Human Development, 44,537-548.

Washburn, D., Wilson, G., Roes, M., Rnic, K., & Harkness, K. L. (2016). Theory of mind in social anxiety disorder, depression, and comorbid conditions. Journal of Anxiety Disorders, 37, 71-77.

Zimmerman, P., & Becker-Stol, F. (2002). Stability of attachment representations during adolescence: The influence of ego-identity status. Journal of Adolescence, 25(1), 107-124.