Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation

Abstract

BackgroundA range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual‐sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma‐related voices (TRV) model was developed to generate novel research in this area.AimsThis study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model.MaterialsThe PTSD Diagnostic Scale for DSM‐5, State Adult Attachment Measure, Depression Anxiety and Stress Scales‐21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi‐modality Unusual Perceptual Experiences Questionnaire.MethodsWe used path analysis in a non‐clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi‐sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation.ResultsOur model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14–.61) and indirect pathways (βs = .01–.08) were significant (ps < .001).DiscussionOur findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation.ConclusionOur findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.

Voice hearers' explanations of trauma‐related voices and processes of change throughout imagery rescripting: A qualitative exploration

“…We found that relational safety was a key element of our themes, which may support attachment‐based perspectives of trauma‐related voices (Berry et al, 2017; Berry & Bucci, 2016; Strachan, Paulik, & McEvoy, 2023) and recent evidence that insecure attachment mediates the relationship between relational trauma and hallucinatory experiences (Strachan, Paulik, Preece et al, 2023). Participants described early experiences of being alone, lonely and unprotected, and voices that unpredictably soothe or distress.…”

“…This finding is consistent with those from a randomised controlled trial ( n = 40) of ImRs for post‐traumatic nightmares that found significant reductions in perceived incompetence, which compared to other trauma‐related beliefs, was most strongly associated with PTSD symptom reduction (Long et al, 2011). Furthermore, preliminary evidence suggests that negative affect, emotion regulation deficits and dissociative coping mediate the pathway from trauma to hallucinatory experiences (Strachan, Paulik, Preece et al, 2023), and past qualitative findings suggest trauma‐focussed treatments enhance skills to constructively cope with distress (Feary et al, 2022) and stand up for oneself (Bosch & Arntz, 2021). Bandura (1997) suggests that encouragement from credible others, experiences of successful performance and physiological feedback influence self‐efficacy.…”

Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature

“…The non-clinical studies found small positive correlations between voice predisposition and both anxious and avoidant attachment (Berry et al, 2018) and a similar pattern for paranoia (Mertens et al, 2021). Strachan et al (2023) also reported a small positive association between insecure attachment and unusual perceptual experiences, while Puckett et al (2023) found no associations between voice predisposition and anxious, avoidant or disorganised attachment. When assessed through interview (rather than self-report), the association between attachment with paranoia became moderate for anxious and non-significant for avoidant attachment (Mertens et al, 2021).…”

“…Of these, Mertens et al (2021) and Puckett et al (2023) ran non-clinical studies and all others recruited clinical participants with diagnosed or self-reported psychosis. One study measured 'unusual perceptual experiences' in a non-clinical group (Strachan et al, 2023), and four measured 'positive symptoms' in clinical samples, but did not distinguish hallucinations, paranoia or other symptoms in the analyses (Austin, 2011;de With et al, 2023;Degnan, 2020;Pollard et al, 2020). Degnan (2020) also measured negative symptoms.…”

“…These showed 1 small to moderate positive correlations between dissociation and both anxious (preoccupied) and disorganised (fearful) attachment (Berry et al, 2018;Mertens et al, 2021;Puckett et al, 2023;Strachan et al, 2023), and a small negative association with secure attachment (Mertens et al, 2021). There was inconsistent support for a small positive association between dissociation and avoidant (dismissive) attachment (Berry et al, 2018;Mertens et al, 2021).…”