Attachment avoidance and health-related quality of life: Mediating effects of avoidant coping and health self-efficacy in a rehabilitation sample.

Abstract

Purpose/Objective: The onset of chronic illness or disability (CID) can be conceptualized as a threat that activates the attachment system. Moreover, the waxing-and-waning nature of CIDrelated symptoms and management of acute and chronic illness stressors means that the attachment system may be repeatedly activated. Contending with repeated threats to health (i.e., security) can complicate psychosocial adjustment to CID and can negatively impact health-related quality of life (HRQoL). Adjustment to CID requires intrapersonal resources, such as adaptive coping and self-efficacy. In spite of attachment theory's relevance to conceptualizing adaptation to CID, no models of psychosocial adaptation to CID account for individual differences in coping behaviors and health self-efficacy through an attachment lens. This limits future theory-driven research. Thus, the present study proposes and tests an integrated model of psychosocial adaptation to CID using an attachment framework. Research Method/Design: Participants in this study included adults referred for psychological services at a tertiary care physical rehabilitation center between 2016 and 2020. Ninety adults completed measures of attachment anxiety and attachment avoidance, coping, health self-efficacy, and HRQoL at one time point. Results: Path analysis indicated that the proposed model fits the data well. Higher attachment avoidance was significantly related to lower HRQoL, as mediated by higher avoidant coping and lower health self-efficacy. Conclusions/Implications: Results suggest that individuals high on attachment avoidance may require additional support to move toward psychosocial adaptation. Further research examining the role of attachment insecurity dimensions in adaptation to CID is warranted and should include longitudinal designs to replicate these findings. Impact and ImplicationsThis study is the first to propose and test a comprehensive model of psychosocial adaptation to chronic illness and disability in a clinical physical rehabilitation sample using an attachment theory framework. Results suggest that individual differences in attachment insecurity dimensions (i.e., attachment anxiety and attachment avoidance) may shape psychosocial adaptation to chronic illness or disability (operationalized as health-related quality of life). More specifically, individuals higher on attachment avoidance have significantly lower health-related quality of life, and this cross-sectional relationship is mediated by higher avoidant coping and lower health self-efficacy. Consideration of the differential relationships among attachment insecurity dimensions, coping, and health self-efficacy may help clinicians determine overall treatment fit, better tailor treatments to meet the individual needs of the patient, and help inform future theory-driven research.

Cross-Sectional and Longitudinal Associations Between Romantic Attachment, Health Satisfaction, and Health Goal Importance in Partnered and Single Individuals

“…Together, these factors might contribute to lower health satisfaction among insecurely-and particularly anxiously-attached individuals. Regarding more avoidantly-attached people, health satisfaction might be less negatively colored by their attachment because of their deactivating regulation processes (Mikulincer & Shaver, 2007) and avoidant coping style (Maras et al, 2021). Specifically, it was found in previous research that more avoidantly attached individuals close off the experience of negative emotions and emotionally disengage and cognitively distance themselves from threatening events (Mikulincer & Shaver, 2019).…”

“…Conversely, attachment insecurity-represented by both the avoidance and anxiety dimensions-has been associated with adverse health in previous studies (Brazeau & Chopik, 2020). For instance, research has found that more avoidant individuals tend to report lower health-related quality of life (Maras et al, 2021) and that more anxious individuals tend to report more cardiovascular conditions .…”

“…Regarding attachment avoidance in specific, previous research suggests that attachment avoidance is linked to lower treatment adherence in individuals diagnosed with lupus disease (Bennett et al, 2011) and to higher inflammatory responses to marital conflict signified by a higher inter-leukin-6 production (Gouin et al, 2009). More avoidantly attached individuals were also more likely to report lower health-related quality of life (Maras et al, 2021) and had lower levels of immunity, indicated by lower NK cell cytotoxicity (Picardi et al, 2013).…”

Attachment style and post-bariatric surgery health behaviours: the mediating role of self-esteem and health self-efficacy

“…In contrast, highly avoidant individuals with their positive self-image avoid seeing personal weaknesses, and may thus present higher self-efficacy [ 48 , 49 ]. However, the empirical evidence for this relationship is inconclusive as attachment anxiety and avoidance were found to predict poorer self-efficacy among some populations [ 50 – 53 ] yet not among others [ 54 ].…”

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre

“…Some researchers have demonstrated that attachment insecurity relates to poorer rehabilitation outcomes in chronic pain (Kowal et al, 2015), cancer (Adellund Holt, Jensen, Gilsa Hansen, Elklit, & Mogensen, 2016), and cardiac patients (Heenan, Greenman, Tassé, Zachariades, & Tulloch, 2020). There is also some evidence suggesting that higher attachment avoidance is related to poorer HRQoL in a mixed-CID rehabilitation sample (Maras, Balfour, Lefebvre, & Tasca, 2021).…”