Ringer Jamie M, Buchanan Erin E, Olesek Kyle, Lysaker Paul H
Roudebush VA Medical Center, Indianapolis, Indiana, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Psychol Psychother. 2014 Jun;87(2):209-21. doi: 10.1111/papt.12012. Epub 2013 Aug 5.
Having an insecure attachment style in schizophrenia has been linked to treatment response and symptom severity in schizophrenia. This study sought to further examine whether attachment style is related to subjective indicators of recovery including hope and self-esteem, independent of symptom level and secondly, whether attachment style in schizophrenia differs from attachment style of persons facing adversity in the form of a prolonged non-psychiatric medical illness.
Participants were 52 men with schizophrenia, and 26 with HIV/AIDS who had no history of experiencing severe mental illness. These groups were compared in terms of their endorsement of attachment style.
All participants were administered the Experiences in Close Relationships measure of adult attachment style. The schizophrenia group was also given the Rosenberg Self-Esteem Scale to assess self-esteem, the Beck Hopelessness Scale as a measure of hope, and the Positive and Negative Syndrome Scale, as an assessment of symptoms.
Avoidant attachment in the schizophrenia group was linked with higher levels of hopelessness while anxious attachment was linked to lower levels of self-esteem. The association between anxious attachment and self-esteem persisted after controlling for severity of positive, negative, and depressive symptoms in a stepwise multiple regression analyses. Compared to the HIV/AIDS group, participants with schizophrenia had significantly higher levels of anxious attachment but not avoidant attachment style.
Attachment style may impact attainment of key subjective domains of recovery in schizophrenia such as self-esteem, independent of symptom severity.
If self-esteem and/or hopelessness are identified as a focus of treatment, focusing on attachment style may be an important treatment component. Therapist understanding of patients' attachment style may allow for a better understanding of resistance in the therapeutic relationship. Helping persons with schizophrenia to recognize and change how they tend to relate to others may promote gains in subjective elements of recovery.
精神分裂症患者具有不安全的依恋风格与精神分裂症的治疗反应和症状严重程度有关。本研究旨在进一步探讨依恋风格是否与康复的主观指标（包括希望和自尊）相关，而不受症状水平的影响；其次，精神分裂症患者的依恋风格是否与面临长期非精神科疾病形式逆境的人的依恋风格不同。
参与者为52名患有精神分裂症的男性和26名感染艾滋病毒/艾滋病且无严重精神疾病史的男性。对这些组在依恋风格的认可方面进行比较。
所有参与者都接受了成人依恋风格的亲密关系经历测量。精神分裂症组还接受了罗森伯格自尊量表以评估自尊，贝克绝望量表以测量希望，以及阳性和阴性症状量表以评估症状。
精神分裂症组中的回避型依恋与更高水平的绝望感相关，而焦虑型依恋与更低水平的自尊相关。在逐步多元回归分析中控制阳性、阴性和抑郁症状的严重程度后，焦虑型依恋与自尊之间的关联仍然存在。与艾滋病毒/艾滋病组相比，精神分裂症患者的焦虑型依恋水平显著更高，但回避型依恋风格并非如此。
依恋风格可能会影响精神分裂症康复的关键主观领域的实现，如自尊，而不受症状严重程度的影响。
如果将自尊和/或绝望感确定为治疗重点，关注依恋风格可能是一个重要的治疗组成部分。治疗师对患者依恋风格的理解可能有助于更好地理解治疗关系中的阻抗。帮助精神分裂症患者认识并改变他们与他人相处的方式，可能会促进康复主观因素的改善。
