Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
Psychooncology. 2021 Jul;30(7):1059-1067. doi: 10.1002/pon.5640. Epub 2021 Mar 1.
Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time.
We studied 206 patients with advanced cancer (mean age = 59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6-month follow-up (N = 125) as outcomes.
Attachment avoidance partially mediated the relationship between death anxiety and demoralization (β = 0.07, 95% CI 0.02-0.12) and anxiety (β = 0.05, 95% CI 0.001-0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: β = -0.07, 95% CI -0.13 to -0.02, anxiety: β = -0.05, 95% CI -0.11 to -0.003).
Due to its trait-like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change-sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.
尽管可靠的人际关系对存在困扰有保护作用，但依恋不安全感作为持续心理困扰的潜在因素的证据仍不明确。我们测试了一个纵向模型，假设回避型依恋作为长时间内高沮丧和焦虑的中介。
我们研究了 206 名患有晚期癌症的患者（平均年龄 59.6 岁，61%为女性），他们参加了一项干预试验。患者完成了关于沮丧、焦虑、感知相关性、依恋不安全感和死亡焦虑的自我报告测量。我们的中介路径模型包括基线时的感知相关性和死亡焦虑作为预测因素，基线时的回避型依恋作为中介，以及 6 个月随访时的沮丧和焦虑作为结果（N=125）。
回避型依恋部分中介了死亡焦虑与沮丧（β=0.07，95%置信区间 0.02-0.12）和焦虑（β=0.05，95%置信区间 0.001-0.10）之间的关系。感知相关性的间接效应通过回避型依恋对两个结果都有显著意义（沮丧：β=-0.07，95%置信区间-0.13 至-0.02，焦虑：β=-0.05，95%置信区间-0.11 至-0.003）。
由于其特质性，回避型依恋在解释存在困扰的过程中可能不如先前研究表明的那样起核心作用。在心理社会干预中解决敏感的关系问题可能更有效地缓解存在困扰。
