Key Points
Rationale
Prior research has established robust links between attachment insecurity and PTSD symptoms following trauma (Woodhouse et al., 2015).
This study provides proof of concept for a recently proposed trauma and attachment model (Marshall & Frazier, 2019). This model argues that those high inattachment anxietyengage in hyperactivating strategies designed to intensify distress and draw attention/comfort from others.
Those high inattachment avoidanceengage in deactivating strategies designed to suppress distressing emotions and maintain independence. While intended to achieve proximity or distance, these secondary strategies foster PTSD symptoms.
The model also proposes that trauma severity moderates this process, such that secondary strategies are even more problematic when trauma severity is high, as approach coping is critical for processing trauma emotions to prevent PTSD. When trauma severity is lower, secondary strategies are less problematic as approach coping is less critical.
Method
Sample
The 302 participants were adults (>18 years) from the U.S. (91.4%) and Australia (8%) who had experienced a traumatic event at some point across their lifespan.
The sample was mostly female (74.5%) with a mean age of 35 years. Most were married/in a committed relationship (62.2%). Participants reported a diverse range of trauma experiences.
Statistical Measures
Results
As hypothesized, attachment anxiety and avoidance both indirectly predicted greater PTSD symptoms through their positive associations with maladaptive coping strategies.
Specifically, attachment anxiety predicted greater use of both hyperactivating strategies (b = .28,p< .001) and deactivating strategies (b = .16, p = .005). Hyperactivating (b = 13.57,p< .001) and deactivating (b = 7.27,p< .001) strategies in turn predicted more PTSD symptoms.
Similarly, attachment avoidance predicted greater use of deactivating strategies (b = .27, p < .001), which predicted more PTSD symptoms.
Insight
A key insight from this study is that attachment anxiety may lead individuals to rely not only on hyperactivating strategies designed to maximize proximity, but also deactivating strategies to modulate distress when hyperactivation becomes too overwhelming.
The findings also provide the first empirical support for the proposition that secondary attachment strategies are more problematic for PTSD symptoms when trauma severity is high.
This corroboratesattachment theory’spremise that the greater the distress, the more critical primary coping and social support is for adaptive functioning post-trauma.
Together, the results lend credence to calls for attachment-informed psychotherapy that helps minimize reliance on maladaptive secondary strategies in a manner tailored to clients’ attachment tendencies. Fostering felt security is paramount.
Strengths
Limitations
Implications
The findings underscore the value of attachment-based case conceptualization to identify PTSD risk and inform treatment planning.
Clinicians should assess attachment orientations to identify those at risk for more severe PTSD symptoms after trauma, especially individuals with insecure attachments
For clients high in attachment anxiety, the results suggest assisting emotion regulation skills and distress tolerance alongside validating coping attempts to meet unmet attachment needs.
For clients high in attachment avoidance, maintaining autonomy while gently processing avoided trauma emotions may prevent excessive deactivating strategies.
The moderating effect of trauma severity also highlights the need for early intervention post-trauma when distress is most acute. Later intervention risks entrenchment of maladaptive secondary strategies.
Overall, an attachment-informed approach can enhance trauma processing to prevent PTSD development.
References
Primary reference
Marshall, E. M., Karantzas, G. C., Chesterman, S., & Kambouropoulos, N. (2024). Unpacking the association between attachment insecurity and PTSD symptoms: The mediating role of coping strategies.Psychological Trauma: Theory, Research, Practice, and Policy, 16(1), 86–91.https://doi.org/10.1037/tra0001270
Other references
Briere, J. (2011).Trauma Symptom Inventory-2(TSI-2): Professional manual. PAR.
Karantzas, G. C., McCabe, M. P., & Cole, S. (2012). Chronic illness and relationships. In P. Noller & G. C. Karantzas (Eds.),The Wiley-Blackwell handbook of couples and family relationships(pp. 406–419). Wiley.https://doi.org/10.1002/9781444354119.ch28
Marshall, E. M., & Frazier, P. A. (2019). Understanding posttrauma reactions within an attachment theory framework.Current Opinion in Psychology, 25, 167-171.https://doi.org/10.1016/j.copsyc.2018.08.001
Simpson, J. A., Rholes, W. S., & Phillips, D. (1996). Conflict in close relationships: An attachment perspective.Journal of Personality and Social Psychology, 71(5), 899–914.https://doi.org/10.1037/0022-3514.71.5.899
Woodhouse, S., Ayers, S., & Field, A. P. (2015). The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis.Journal of Anxiety Disorders, 35,103–117.https://doi.org/10.1016/j.janxdis.2015.07.002
Keep Learning
Here are some suggested discussion questions for a college class based on this research:
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
