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ADULT ATTACHMENT AND POSTTRAUMATIC STRESS SYMPTOMS: LONGITUDINAL ANALYSIS AND THE ROLE OF COPING SELF-EFFICACY

by

MARGARET ANN MORISON B.S., George Mason University, 2018

A thesis submitted to the Graduate Faculty of the University of Colorado Colorado Springs

in partial fulfillment of the requirements for the degree of

Master of Arts Department of Psychology

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This thesis for the Master of Arts degree by

Margaret Ann Morison

has been approved for the

Department of Psychology

by

Charles C. Benight, Chair

Andrew Lac

Diana Selmeczy

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Morison, Margaret Ann (M.A., Psychology)

Adult Attachment and Posttraumatic Stress Symptoms: Longitudinal Analysis and the Role of Coping Self-Efficacy

Thesis directed by Professor Charles C. Benight. ABSTRACT

Attachment orientations reflect individuals’ expectations for interpersonal relationships and influence emotion regulation strategies and coping. A great deal of research has been conducted on the relationship between adult attachment and traumatic stress. Much of the previous research has documented that anxious and avoidant

attachment orientations have deleterious effects on the trauma recovery process, such that anxious and avoidant attachment may leave survivors vulnerable to PTSD symptoms. However, prior work as found those high in avoidant attachment and low in anxious attachment (e.g., dismissing) may not experience such vulnerabilities. Further, anxious and avoidant attachment orientations appear to differ in terms of self-efficacy appraisals, which represent a key aspect of self-regulation. Trauma coping self-efficacy (CSE-T) was examined as a previously unexamined mechanism of action between adult attachment and PTSD symptoms in a theoretically based structural equation model. Anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms via CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not

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significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of ones’ self as capable to cope with trauma recovery.

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ACKNOWLEDGEMENTS

I would like to acknowledge my parents, Samuel and Karen Morison, and my sister, Katherine Cecilio, who have been a source of unconditional support and

inspiration. I would also like to thank Alexander Ross, Jordan Orlow, and Julie Hurd for their endless encouragement and unwavering belief in my capabilities. Additionally, I owe many thanks to my graduate cohort and research lab, who have made Colorado Springs feel like home. Finally, I want to acknowledge Daisy, whose comfort,

companionship, and recommendations for edits have been essential in completing this work.

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TABLE OF CONTENTS CHAPTER

I. INTRODUCTION ...1

Attachment Theory ...2

Adult Attachment Orientations ...2

Adult Attachment and PTSD Symptoms ...7

Adult attachment associations with PTSD symptoms ...7

Influence of attachment orientations on PTSD symptoms ...9

Influence of trauma exposure on attachment orientations ...10

Longitudinal research ...12

Experimental and task-based research ...17

Adult Attachment, Coping Self-Efficacy, and PTSD Symptoms ...21

The Present Study ...26

Study Hypotheses ...28 II. METHOD ...30 Procedure ...30 Measures ...32 Demographics ...32 Trauma exposure ...32 Adult attachment ...33 PTSD symptoms ...34

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Trauma coping self-efficacy ...34

Data Analysis ...35

Model estimation and fit ...35

Missing data and attrition...37

III. RESULTS ...38

Preliminary Analyses ...38

Demographics ...38

Missing data and attrition...39

Normality and outliers ...41

Measurement Model ...41

Structural Model ...43

IV. DISCUSSION ...45

Anxious Attachment ...46

Avoidant Attachment ...47

Anxious and Avoidant Interaction ...49

Limitations ...51

Clinical Implications ...53

Conclusion ...54

REFERENCES ...56

APPENDIX: IRB Approval ...66

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LIST OF TABLES TABLE

1. Descriptives for Observed Variables for T1 (N = 380) and T2 (N = 227) ...36 2. Descriptives for Demographic Variables (N = 380) ...39

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LIST OF FIGURES FIGURE

1. Dimensional Model of Adult Attachment ...3

2. Conceptual Model Predicting PTSD Symptoms at Six Weeks ...29

3. Participant Flow Chart ...31

4. Measurement Model ...42

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CHAPTER I INTRODUCTION

Early caregiving relationships influence how individuals self-regulate in the face of potential threats and remain influential in adulthood (Mikulincer & Shaver, 2016). Given the relationship between attachment orientations and the regulation of distress, researchers have examined the association between adult attachment and trauma adaptation. The perceived (and often objectively real) threat faced by trauma survivors elicits the retrieval of pre-existing attachment representations that differ depending on previous experiences one has with close relationships (Mikulincer & Shaver, 2016). The current literature does not provide a clear understanding of how attachment styles

influence both initial reactions to trauma as well as posttraumatic adaptation over time. A key mechanism by which posttraumatic stress disorder (PTSD) symptoms alleviate or worsen throughout recovery is an individual’s self-appraisals regarding his or her ability to cope with symptoms (Benight & Bandura, 2004). However, different levels of coping self-efficacy perceptions across attachment orientations and the potential mediating role of coping self-efficacy have yet to be examined. This is the focus of the present thesis. In the following sections, attachment theory, the relationship between adult attachment and PTSD symptoms, and coping self-efficacy as a potential mediator in this relationship will be discussed.

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Attachment Theory

Attachment theory (Bowlby, 1982) has provided a crucial framework for

understanding how early life experiences with caregivers shape how individuals relate to others and what they expect of others. According to the original conceptualization of attachment by Bowlby (1982), when a person encounters a stressor, there is an innate desire to reach for support or attachment figures. This goal-oriented behavior observed in infancy is then influenced by caregivers’ responses (or lack of responses), which in turn, directs how infants respond to stress in the future. These interactions with caregivers in early life impact neurological development, either enhancing emotional regulatory capabilities or creating vulnerability to later distress (Schore, 2017). As individuals develop and attachments are formed to other important attachment figures, including romantic partners and close friends, attachment orientations continue to influence one’s perception of themselves and the relationships formed with others.

Adult attachment orientations. Attachment orientations influence how adults regulate distress (Mikulincer et al., 2006). A dominant model of adult attachment

describes attachment orientations along two continuous attachment dimensions – anxious and avoidant attachment (see Figure 1; Brennan et al., 1998; Fraley et al., 2015). Securely attached adults, who are low on both anxious and avoidant attachment, can maintain autonomy while also utilizing social support when needed (Mikulincer & Shaver, 2016). Insecurely attached adults, who rate high on anxious or avoidant attachment orientations, function differently in interpersonal relationships. Those who are anxiously attached are overwhelmed with concerns about being supported when in need, whereas avoidantly attached adults tend to distrust others and maintain distance in close relationships

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(Mikulincer et al., 2006). In the four-factor model of adult attachment, adults may instead be categorized based on the additive combination of scores along the two insecure

attachment orientations (Bartholomew & Horowitz, 1991). As shown in Figure 1, those high in anxious attachment but low in avoidant attachment are preoccupied, whereas those high in avoidant attachment and low in anxious attachment are dismissing. Finally, an individual scoring highly on both anxious and avoidant dimensions are characterized as fearful. These insecure attachment orientations may be further distinguished from one another by cognitive representations and behaviors during distress.

Figure 1. Dimensional Model of Adult Attachment. Note. Adapted from (Fraley, Hudson, Heffernan, & Segal, 2015).

Adult attachment may also be examined in relation to specific attachment figures or as a global construct. Although many studies of adult attachment utilize measurements of romantic attachment, such as the widely used Experiences in Close Relationships Scale Revised (ECR-R; Fraley, Waller, & Brennan, 2000), adults may vary in levels of attachment avoidance or attachment anxiety with respect to different close relationships. For example, one’s attachment to their romantic partner may be characterized as secure, whereas their attachment towards their father may be higher in avoidant attachment. Among the major close relationships individuals have with others, including close

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friends, romantic partners, and parents or parental figures, each relationship contributes to a latent global attachment orientation (Fraley, Vicary, et al., 2011; Fraley, Heffernan, et al., 2011; Fraley et al., 2015). Global attachment orientation has been shown to be

predictive of adjustment, suggesting that the culmination of attachment orientations from various close relationships plays an important role in functioning despite differences in attachment across relationships (Fraley, Heffernan, et al., 2011).

Unlike infants who are limited in their regulatory repertoire, adults draw upon internal cognitive representations of attachment figures when faced with stress or potential threat, also referred to as internal working models (Bowlby, 1982). Internal working models are cognitive representations of one’s self and of others that are influenced by one’s attachment orientation. For example, adults who are anxiously attached may generally see the world as unsafe, supports as unreliable, and themselves as unable to cope with potential threats or unworthy of support (Mikulincer & Shaver, 2016). The attachment orientation or style is reflective of the accessibility of these

attachment representations. For adults with high levels of anxious or avoidant attachment, there is a lack of secure representations of comforting or supportive attachment figures, thus leading to maladaptive behavioral strategies for regulating intense negative affect (e.g., avoidance or excessive self-criticism).

When faced with a perceived threat (including internal threats, such as intrusive thoughts), the attachment system will be activated. Adults’ internal representations will, in turn, influence how they respond or what behavioral coping strategies are utilized. Anxiously attached adults may utilize hyperactivating strategies, which consist of

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ones, or attempts to minimize distance from loved ones (Mikulincer & Shaver, 2016). This may strain close relationships, ultimately resulting in the abandonment that anxiously attached individuals fear most. Hyperactivating strategies used by anxiously attached adults are thought to be associated with greater vigilance for potential threat, exaggeration of the danger posed, and rumination about threats. Such hyperactivating strategies serve to exacerbate distress.

Prior research has provided support for the theoretical conceptualization of the role of anxious attachment on coping strategies and perceptions of one’s self and others. In the study by Sheinbaum and colleagues (2015) utilizing ecological momentary assessment (EMA) over the course of a week, anxiously attached adults reported greater negative affect, less positive affect, were more likely to view their current situation as stressful, were more suspicious of others, felt uncared for, and were more likely to perceive mistreatment (as compared to secure adults). When anxious adults were alone, they reported feeling that it was because others did not want to be with them.

Interestingly, when anxiously attached adults were around others, they felt less close to those individuals and preferred being alone. This hyperactivation of the attachment system is also reflected by greater physiological arousal (Silva et al., 2015; Taylor et al., 2017), increased accessibility of mental representations of attachment figures (Mikulincer et al., 2002), greater emotion-focused coping (Mikulincer & Florian, 1995; Mikulincer et al., 1993), and support-seeking (Mikulincer & Florian, 1995; Mikulincer et al., 1993; Vogel & Wei, 2005) when distressed or threatened.

Avoidantly attached individuals, in contrast, tend to utilize deactivating strategies (Mikulincer & Shaver, 2016). Driven by a desire to control or maximize distance from

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close relationship partners, avoidantly attached individuals attempt to evade intimacy or self-disclosure. The highly avoidantly attached individual makes a deliberate effort to disengage with the distressing context. Much like hyperactivating strategies, deactivating strategies are thought to exacerbate negative emotions, given that they are minimally (if ever) expressed. However, it is unclear as to whether such individuals are attempting to downplay distress they feel or there is simply less distress to report.

Previous literature has demonstrated that adults high in attachment avoidance tend to utilize deactivating strategies when encountering a stressor. Specifically, avoidantly attached adults were less likely to seek support (Vogel & Wei, 2005), engaged in more distancing coping strategies (Mikulincer & Florian, 1995; Mikulincer et al., 1993) and demonstrated less mental activation of attachment representations (Mikulincer et al., 2002). The findings regarding distress felt by avoidantly attached adults are less consistent. Some experimental studies find avoidantly attached adults exhibit no

significant increases in physiological arousal (Taylor et al., 2017) or self-reported distress (Maunder et al., 2006) across relaxation and stress tasks, whereas other studies find evidence of physiological reactivity (Maunder et al., 2006; Silva et al., 2015). Work by Fraley and Shaver (1997) suggest that those who exhibit a prototypically dismissing (high avoidant, low anxious) attachment orientation are skilled at suppressing attachment-related distressing thoughts, as exhibited by decreases in physiological arousal following instructions to suppress the thought of abandonment by a partner. In daily life, avoidantly attached adults report an overall preference for being alone, lower positive affect, more shame/guilt, fewer feelings of being cared for, and were less likely to appraise their current situation as positive when compared to securely attached adults (Sheinbaum et al.,

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2015). Overall, it is unclear as to whether the deactivating strategies employed by avoidantly attached individuals are effective methods of coping with stress.

Given the influence of adult attachment orientations on coping behaviors and responses to stress, a large body of literature has examined the relationship between adult attachment and recovery from trauma. One potential outcome of traumatic events is PTSD, a mental disorder following a traumatic event consisting of hyperarousal, negative cognitions and mood, avoidance of trauma reminders, and intrusive symptoms such as flashbacks (American Psychological Association [APA], 2013). Approximately 8.3% of adults in the United States meet Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria for PTSD (Kilpatrick et al., 2013). Although a range of posttraumatic negative mental health outcomes is not exclusively limited to PTSD (such as depression or anxiety; Breslau, 2009), the present study focuses on PTSD symptoms. Attachment and PTSD Symptoms

Adult attachment associations with PTSD symptoms. Several cross-sectional studies have found significant, modestly-sized positive associations between anxious or avoidant attachment and PTSD symptoms across several types of trauma, including intimate partner violence (Scott & Babcock, 2010; Woodward et al., 2013), exposure to war (Besser & Neria, 2012; Besser et al., 2009), and childhood physical abuse (Muller et al., 2008). In the meta-analytic review by Woodhouse, Ayers, and Field (2015), adult attachment orientations were found to be significantly associated with PTSD symptoms across 46 studies, with modest population effect size estimates (secure = -.27, anxious

= .26, and avoidant = .24). Interestingly, these findings were not moderated by study design, the quality of each study, or the attachment measurement used. However, one

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variable that did influence the relationship between attachment and PTSD symptoms was the measurement of PTSD symptoms, such that self-reported PTSD symptoms resulted in a stronger relationship with insecure attachment styles (e.g., anxious and avoidant

combined) than did clinician-administered interviews (Woodhouse et al., 2015). It has been previously hypothesized that those who are anxiously attached individuals may overreport symptoms, whereas avoidantly attached individuals may underreport

symptoms (Dozier & Lee, 1995). These differences in tendency to report distress may be one explanation for the deflated estimates of the relationship between insecure

attachment orientations and PTSD symptoms.

Alternatively, the varied findings surrounding avoidant attachment may be due to the potential overlap between avoidant and anxious attachment orientations. Woodhouse et al. (2015) found that a dismissing attachment orientation (high avoidant, low anxious) was not significantly associated with PTSD symptoms ( = .16). Preoccupied (high avoidant, high anxious) and fearful (low avoidant, high anxious) attachment orientations were significantly associated with greater PTSD symptoms (preoccupied = .31, fearful

= .44). This suggests that the relationship between an avoidant attachment orientation and PTSD symptoms may also depend on the same individual’s level of anxious

attachment. Adults who are prototypically dismissing in their attachment orientation may confer a benefit in terms of their coping self-efficacy to cope independently when

encountering stress, which has been found to facilitate recovery in trauma populations (Benight & Bandura, 2004). Examining the interaction between avoidant and anxious attachment may allow for more complex relationships between adult attachment and PTSD symptoms to be elucidated (Fraley & Bonnano, 2004; Fraley et al., 2006).

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The impact of an individuals’ attachment orientation on PTSD symptoms may partially depend on the type of traumatic event experienced. Indeed, one's views of others as trustworthy may be more strongly influenced by violence brought on by another individual (i.e., interpersonal trauma) than traumas such as natural disasters (Mikulincer et al., 2015). Although the meta-analytic review by Woodhouse and colleagues (2015) did not find any moderating effect of trauma type, a later work by Huang, Chen, Su, and Kung (2016) found a moderating effect of trauma type (interpersonal versus

non-interpersonal) on the relationship between insecure attachment and PTSD symptoms. Specifically, anxious attachment was only associated with PTSD symptoms in the interpersonal trauma group. Avoidant attachment was not predictive of PTSD symptoms in either trauma group. Thus, non-interpersonal traumatic events may not activate the attachment system and accompanying internal working models in the same manner an interpersonal traumatic event may. Further, the use of samples with homogenous types of traumatic event exposure may impact estimates of the relationship between adult

attachment and PTSD symptoms.

Influence of attachment orientations on PTSD symptoms. Given the less favorable view of self and others (Mikulincer & Shaver, 2016; Sheinbaum et al., 2015), as well as the maladaptive responses to stress exhibited by those high on anxious attachment (Maunder et al., 2006; Mikulincer et al., 2002; Mikulincer & Florian, 1995; Mikulincer et al., 1993; Silva et al., 2015; Taylor et al., 2017; Vogel & Wei, 2005), it follows that anxious attachment orientations may intensify difficulties encountered when one is recovering from a traumatic event, such as the development of PTSD symptoms. Unable to draw upon internal models of secure figures or effectively utilize external

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support systems, distress is maintained in those with an anxious attachment orientation (Mikulincer et al., 2015).

Avoidantly attached adults, who hold negative views of others (Mikulincer & Shaver, 2016; Sheinbaum et al., 2015) and utilize deactivating strategies for coping with stress (Mikulincer & Florian, 1995; Mikulincer et al., 1993; Mikulincer et al., 2002; Vogel & Wei, 2005), may have a complex relationship with PTSD symptoms. Secure internal representations are not drawn upon during times of stress (Mikulincer et al., 2002), as others have typically been unavailable or inconsistent in their support

(Mikulincer & Shaver, 2016). However, for those both high in avoidant attachment and low in anxious attachment (i.e., dismissing), internal working models of the self are positive, accompanied by positive perceptions of their ability to cope independently. Although an avoidant attachment orientation is often considered maladaptive due to the emotional suppression employed during times of distress (Mikulincer et al., 2015), these positive self-appraisals may facilitate recovery from traumatic events.

In contrast to those with insecure attachment orientations, securely attached adults may be more resilient to trauma, given their positive internal working models of

themselves and others (Mikulincer & Shaver, 2016). These internal working models allow for securely attached individuals to seek support when needed but can comfortably maintain autonomy.

Influence of trauma exposure on attachment orientations. Trauma exposure may also exert an influence on attachment orientations, both cognitively and

interpersonally. As noted by Ehlers and Clark (2000), trauma exposure is often followed by a series of negative appraisals regarding one’s self and the world. Survivors may

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appraise themselves as less able to prevent future disasters or unable to rely on others. Trauma symptoms may be appraised as signs they are “going crazy” or that they will be unable to connect with others because of overwhelming trauma symptoms. Indeed, traumatic events have the potential to alter one’s view of themselves, others, and the world negatively. Such negative trauma appraisals may be particularly salient for those who are anxiously or avoidantly attached, given the internal working models associated with such attachment orientations (Bowlby, 1982; Mikulincer & Shaver, 2016). Exposure to traumatic events (and subsequent intrusive reminders of such traumas) may serve as a confirmation of negative views of others as unsafe or unresponsive and one’s self as unable to handle distress, thus exacerbating insecure attachment orientations. For those survivors with persistent symptoms over time, feelings of weakness and vulnerability may also amplify attachment insecurities (Mikulincer et al., 2015). Symptoms of PTSD may also hinder close relationships. As demonstrated in a meta-analytic review (Taft et al., 2011), survivors with PTSD may experience greater difficulties in intimate

relationships (ρ = .38), which in turn would negatively influence attachment orientations. It has been previously argued that attachment orientations and PTSD symptoms are reciprocally related (Mikulincer et al., 2015). Whereas cross-sectional studies and the meta-analysis by Woodhouse and colleagues (2015) have laid a groundwork for

describing the directionality of the association between adult attachment styles and PTSD symptoms, it is crucial to examine this relationship over time. Longitudinal and

experimental research offers a greater understanding of the temporal and dynamic qualities of the relationship between these constructs.

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Longitudinal research. Several studies have longitudinally examined the influence of attachment orientations on posttraumatic stress symptoms. Shallcross, Frazier, and Anders (2014) evaluated the impact of pre-event attachment on PTSD symptoms after potentially traumatic events (PTEs) in 174 undergraduate students. Among those who experienced a PTE in the two months since baseline, pre-event attachment anxiety predicted greater PTSD symptoms and general distress four months later, whereas attachment avoidance only predicted greater PTSD symptoms four months later. In a sample of 36 community participants recruited from an emergency room for assault or injury, greater secure attachment 72 hours post-event was associated with fewer PTSD symptoms at 4- and 12- weeks post-event (Benoit et al., 2009). These studies (Benoit et al., 2009; Shallcross et al, 2014) support the conceptualization of attachment influencing the development of PTSD symptoms.

A study utilizing a cross-lagged panel design found that baseline attachment anxiety predicted higher PTSD symptoms and lowered perceived social support four months later in 135 undergraduates recently exposed to the Israel-Gaza war (Besser & Neria, 2010). However, PTSD symptoms and social support at baseline did not predict attachment anxiety at four months. Importantly, the study by Besser and Neria (2010) did not find a significant correlation between attachment avoidance and later PTSD

symptoms. This differential finding regarding insecure attachment orientations and PTSD symptoms may lend evidence to the conceptualization of avoidant attachment as

protective against distress.

In contrast, the cross-lagged study by Solomon, Dekel, and Mikulincer (2008) found for 209 veterans of the Yom Kippur war, PTSD symptoms at baseline predicted

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insecure attachment (i.e., anxious and avoidant) 12 years later. Although the same prospective relationship was found between baseline insecure attachment and PTSD symptoms 12 years later, the relationship of PTSD symptoms predicting later attachment (avoidant r = .24 and anxious r = .30) was stronger than the relationship of attachment predicting later PTSD symptoms (avoidant r = -.07 and anxious r = .07). Furthermore, a multiple regression demonstrated that attachment at baseline did not make a significant contribution to PTSD symptoms 12 years later beyond that of baseline PTSD symptoms. Unlike the conclusions of Benoit and colleagues (2009) or Besser and Neria (2010) – that attachment orientations influenced PTSD symptoms – these findings suggest that PTSD symptoms may negatively impact attachment orientations years after the trauma.

Further complicating this portion of the literature, two other studies found a bidirectional relationship between adult attachment orientations and PTSD symptoms over time (Murphy et al., 2016; Franz et al., 2014). Franz and colleagues (2014)

conducted a longitudinal analysis of 975 Vietnam veterans and found that the association between PTSD symptoms measured in veterans at 37 years old and again at 61 years old was mediated by anxious and avoidant attachment assessed at 55 years of age. These results suggest that the relationship between earlier PTSD symptoms and later PTSD symptoms is influenced through one’s attachment style.

Murphy and colleague’s (2016) study of 119 childhood sexual assault survivors found that baseline PTSD symptoms predicted attachment anxiety and avoidance six months later, whereas baseline attachment avoidance predicted PTSD symptoms at both six months and 12 months. In this study, PTSD symptoms and avoidant attachment exacerbated each other. These results partially complement the findings by Franz and

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colleagues (2014), such that both found a prospective bidirectional relationship between avoidant attachment and PTSD symptoms (Murphy et al., 2016). In contrast to Besser and Neria (2010) and Franz and colleagues (2014), attachment anxiety in this study was not related to later PTSD symptoms (Murphy et al., 2016). This study also stands out as the only longitudinal study of adult attachment and PTSD symptoms using a sample of childhood trauma survivors. Childhood sexual abuse may be distinct due to the

developmental timing of trauma exposure. However, no literature currently exists comparing these specific types of traumatic events in terms of attachment orientations. Importantly, internal consistencies for the attachment measure were not explicitly reported but ranged from a poor internal consistency of α = .62 to a good internal consistency of α = .87 (Murphy et al., 2016). Unreliability of measurement may limit what conclusions can be made from the study results.

Similar findings were observed in Fraley and colleagues’ (2006) investigation of 45 survivors of the September 11th terrorist attack who lived within four blocks of the World Trade Center attacks. Attachment anxiety and avoidance were significantly correlated with PTSD symptoms 11 months later (18 months post-event; anxiety r = .30, avoidance r = .26). Although securely attached individuals had lower PTSD symptoms than those who scored higher on attachment anxiety or avoidance at each time point, there was no main effect of attachment on the rate of change in PTSD symptoms over 11 months. Interestingly, the interaction between attachment anxiety and attachment

avoidance predicted initial PTSD symptoms, such that securely attached adults at baseline had fewer PTSD symptoms than preoccupied, dismissing, or fearful adults. Dismissing (high avoidance, low anxiety) adults’ level of PTSD symptoms was

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indistinguishable from preoccupied (high avoidance, high anxiety) adults. This contrasts with the meta-analytic findings by Woodhouse et al. (2015) and the conceptualization of dismissing attachment as protective against distress. Although these findings suggest that attachment style may influence individuals’ adaptation to traumatic events, attachment orientations may not be critical determinants of how PTSD symptoms change over time (and vice versa). This finding potentially highlights the need for examining mechanisms by which they are associated.

Fraley and Bonanno (2004) similarly examined the relationship between adult attachment and PTSD symptoms in a sample of 59 bereaved adults using both main effects of anxious and avoidant attachment, as well as an interaction term. It was found that anxious attachment predicted the initial PTSD symptoms, but not the rate of change in symptoms over 14 months. Avoidant attachment was not significantly associated with either initial symptoms or the rate of change. In examining the interaction between anxious and avoidant attachment, it was found that those fearfully attached had the highest PTSD symptoms, followed by those with a preoccupied attachment. Dismissing and securely attached adults had similarly low levels of PTSD symptoms and exhibited no increases in symptoms over time. Dismissing attachment in this study was indeed protective, unlike the study of 9/11 survivors (Fraley et al., 2006). Consistent is the benefit of secure attachment, such that those who are more prototypically securely attached experienced fewer PTSD symptoms than those who are preoccupied or fearful (Fraley & Bonanno, 2004; Fraley et al., 2006).

In sum, longitudinal studies examining adult attachment orientations and PTSD symptoms have resulted in discrepant findings regarding specific insecure orientations’

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(anxious, avoidant, or the interaction) relation to PTSD symptoms and the direction of influence between these constructs. Across studies, many types of trauma are examined, including childhood sexual abuse (Murphy et al., 2016), combat (Franz et al., 2014; Mikulincer et al., 2011; Solomon et al., 2008), war exposure (Besser & Neria, 2010), exposure to terror attacks (Fraley et al., 2006), injury or assault (Benoit et al., 2009), and bereavement (Fraley & Bonanno, 2004). Several types of attachment measures were utilized, with most measures focused on attachment in romantic relationships (Besser & Neria, 2010; Fraley et al., 2006; Fraley & Bonanno, 2004; Franz et al., 2014; Murphy et al., 2016; Solomon et al., 2008). However, none of the present studies elaborated on the type of attachment (e.g., romantic) under investigation. In the early aftermath of trauma, attachment orientations may influence the likelihood of developing PTSD, with insecure attachments resulting in higher PTSD symptoms (Besser & Neria, 2010; Fraley et al., 2006; Fraley & Bonanno, 2004; Shallcross et al., 2014) and secure attachments resulting in less PTSD symptoms (Benoit et al., 2009; Fraley et al., 2006; Fraley & Bonanno, 2004). Among those survivors with an insecure attachment orientation, negative views of self and others may exacerbate negative cognitions involved in PTSD. For those more securely attached, positive internal working models (Mikulincer & Shaver, 2016) and greater self-regulation (Benoit et al., 2009) may act as protective factors against PTSD.

However, the directional influence within the relationship between insecure attachment and PTSD has been a point of contention in the literature. Whereas Besser and Neria (2010) found attachment prospectively predicted PTSD only, the study by Solomon and colleagues (2008) argues in contrast that PTSD symptoms predict attachment, but not the other way around. Among the longitudinal studies utilizing

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participants with more distal trauma histories, including adult survivors of child sexual abuse (Murphy et al., 2016) and veterans (Franz et al., 2014), a bidirectional relationship between attachment and PTSD symptoms was observed. Thus, the length of time relative to trauma exposure may play a role in determining the direction of this relationship. For instance, symptoms that persist beyond the first year of trauma recovery may prove to be detrimental for attachment representations, thus leading to the observed bidirectional relationship. Indeed, the severity of PTSD symptoms has been observed to vary

throughout recovery (both between- and within-individuals), ultimately highlighting the importance of timing in measuring PTSD symptoms (Galatzer-Levy et al., 2018).

Within the types of insecure attachment, longitudinal results on the association between insecure attachment styles and PTSD symptoms are largely consistent, such that anxious and avoidant attachment are positively associated with PTSD symptoms (Fraley et al., 2006; Franz et al., 2014; Murphy et al., 2016; Solomon et al., 2008; Shallcross et al., 2014; see also Besser & Neria, 2010). However, among the two longitudinal studies to examine the interaction between anxious and avoidant attachment (Fraley & Bonanno, 2004; Fraley et al., 2006), findings regarding the potential benefits of a dismissing attachment orientation (high avoidant, low anxious) are mixed. More research on this interaction between avoidant and anxious attachment orientations and its influence on PTSD symptoms, as well as potential mechanisms of action, is needed. Our

understanding of the relationship between adult attachment and PTSD symptoms may be aided by experimental research.

Experimental and task-based research. Experimental work on adult attachment and PTSD symptoms has sought to clarify how the two interact, primarily with

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manipulations regarding attachment figures. Bryant and Chan (2017) examined healthy participants’ attachment orientations and their relation to memories and intrusive

experiences for negative pictures (i.e., an analog for trauma exposure). Participants were randomized to receive an attachment prime or a control prime. In the attachment prime condition, participants were instructed to think about a supportive person in his or her life that was dependable and elicited feelings of safety. In each group, these healthy adults viewed a series of pictures (negative or neutral) and were prompted every 30 seconds to engage in either the attachment or control priming task, depending on their assigned group. Two days later, participants freely recalled the images that had been presented and rated how distressing the recall task was. Finally, after an additional two days,

participants self-reported any intrusive memories of negative pictures shown. Highly avoidantly attached participants did not experience decreases in distress after the

attachment prime compared to those who were low on avoidant attachment. Furthermore, there were no significant difference in distress between priming conditions for highly avoidantly attached individuals. Highly anxiously attached participants, on the other hand, did experience decreased distress after the attachment prime, whereas those low on anxious attachment (i.e., securely attached participants) did not. For highly anxiously attached participants’ ratings of distress during recall, there was no significant difference in distress ratings between priming conditions. Although anxiously attached adults benefited from cognitive representations of secure attachment figures, this benefit did not carry over into negative memory recall. Finally, both anxiously attached and avoidantly attached participants reported greater intrusions regardless of priming condition relative to those who were low on anxious or avoidant attachment orientations. Attachment

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orientations, therefore, acted as a risk factor for intrusions and distress. Further, the soothing effects of attachment representations were ineffective in reducing distress for avoidantly attached, and, for those who were anxiously attached, any soothing benefit was not maintained when asked to recall negative memories.

Mikulincer and colleagues (2014) used PTSD trajectories amongst a random sub-set of ex-prisoners of war from their previous work (ex-POWs; Mikulincer et al., 2011) to understand the differential impact of attachment orientations responses to a Stroop color-naming task. From the original investigation, three different courses of PTSD were found. These included a stable PTSD trajectory (ex-POWs with persistently high PTSD symptoms), a worsening PTSD trajectory (ex-POWs with a late onset of PTSD

symptoms), and a stable resilience trajectory (ex-POWs with consistently lower levels of PTSD symptoms). Ex-POWs from each group provided names of secure attachment figures, which were then used to prime participants (via rapid subliminal presentation) prior to a Stroop color-naming task. This Stroop task utilized trauma-related words to assess the cognitive accessibility of secure attachment representations and their soothing qualities when distressed. The regulatory, soothing function of secure attachment

representations did help those in the worsening PTSD trajectory, as they exhibited greater access to trauma-related words (evidenced by latency in color-naming), but this latency was reduced by priming for secure attachment. Thus, the soothing function of secure attachment representations remained intact for those with worsening PTSD. For those with a stable PTSD trajectory, on the other hand, having been primed with a secure attachment representation did not offset heightened accessibility of trauma-related words. This suggests that chronic PTSD symptoms interfere with secure attachment

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representations, which may serve to maintain or induce an overall insecure attachment orientation.

A similar subliminal attachment prime and Stroop color-naming task was used by Andersen and colleagues (2015) with Israeli combat veterans. Additionally, participants engaged in a pain task – wherein the threshold for pain was assessed using a heated forearm strap – and pain rating scale. Among those randomly assigned to the attachment prime condition, names of secure attachment figures (as provided by participants) were primed by rapid presentation, followed by the Stroop task involving war-related words. Among participants with low levels of PTSD symptoms, the attachment prime was significantly associated with lower pain thresholds and shorter reaction times for war-related words. Thus, the priming of secure attachment figures had a soothing effect on combat veterans. However, among veterans with high levels of PTSD symptoms, the effect of the attachment prime on pain thresholds and reaction times to war-related words was non-significant. Comparable to the study by Mikulincer and colleagues (2014), PTSD symptoms appeared to interfere with the comforting benefits of secure attachment figures.

Adult attachment orientations may serve to exacerbate distress and intrusive symptoms in the face of exposure to adverse events (Bryant & Chan, 2017). Over long periods, for those with persistent PTSD symptoms, PTSD symptoms may maintain attachment insecurities by interfering with representations of others as secure and responsive (Mikulincer et al., 2014; Andersen et al., 2015). Mental reactivation of the traumatic event, resulting from prolonged PTSD, may serve to increase a sense of helplessness and negatively influence the belief that supports are available or will

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alleviate distress (Mikulincer & Shaver, 2016). Overall, experimental research supports the relationship between attachment and PTSD symptoms. Furthermore, the extant literature on adult attachment and PTSD symptoms has focused minimally on the mechanism by which attachment orientations influence self-regulation and distress in trauma survivors. The role of coping self-efficacy in this self-regulation process may be a pivotal mechanism.

Attachment, Coping Self-Efficacy, and PTSD

An important aspect not examined in the attachment literature are individuals’ perceptions of their capabilities in the face of external and internal threat. The perceived ability to cope in the face of environmental demands and self-regulate after experiencing a traumatic event, or perceived coping self-efficacy (CSE), is a crucial determinant of recovery (Benight & Bandura, 2004). Indeed, the predictive utility of CSE was

demonstrated by Luszczynska, Benight, and Cieslak (2009) in their meta-analytic review. It was found that, among longitudinal studies, CSE predicted PTSD symptoms and general distress (distress, depression, and anxiety) up to 8 months post-event with a medium to large effect sizes (PTSD r = -.62, general distress r = -.50). Amongst cross-sectional studies, greater CSE predicted lower PTSD symptom severity (r = -.36), frequency (r = -.77), and lower general distress (r = -.50). These effect sizes outweigh those observed by other predictors of PTSD, such as perceived social support (r = -.28; Ozer et al., 2003) and emotion dysregulation (r = .53; Seligowski et al., 2014).

From a Social Cognitive Theory (SCT; Bandura, 1997) perspective, trauma-exposed individuals self-evaluate their own emotions, behaviors, and reactions to both the traumatic event itself, as well as their posttraumatic stress reactions (Benight &

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Bandura, 2004). This self-evaluation encourages decisions made on the part of the individual and thus is a part of agentic individuals’ self-regulation. Specifically, appraisals of one’s capabilities help to self-regulate by guiding behaviors in order to reach specific goals. In this sense, individuals are not only influenced by the environment but also may exert influence onto his or her environment.

If a person believes that they are not handling the adaptation process as well as they anticipated they would, or if their attempts to cope failed to alleviate symptoms, self-efficacy to cope would diminish. On the other hand, if a survivor experiences a successful coping effort, this mastery experience may serve to boost CSE and improve posttraumatic outcomes. Further, the belief that one can exercise control over their life regulates how they perceive potential threats, the choices they make, and how resilient they are to stressors (Benight & Bandura, 2004). Those with higher CSE are more likely to utilize adaptive coping strategies and maintain an active role in shaping their environment to facilitate recovery (for example, seeking supportive others), thus resulting in alleviated stress or anxiety. However, if one has a low sense of CSE, he or she may be more alert to perceived threats in the environment and feel that they are unable to manage these

threats, ultimately impairing functioning and resulting in greater PTSD symptom severity. If a trauma survivor feels powerless to control their intrusive thoughts, for example, this may exacerbate re-experiencing symptoms.

Negative appraisals seen in trauma survivors specifically related to the self as incompetent and the world as a dangerous place plays a critical role in PTSD (Ehlers & Clark, 2000) and are associated with insecure attachment orientations (Arikan et al., 2016). Insecure attachment orientations are defined in part by the negative internal

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working models of self or others, which in turn drives different strategies for responding to stress (Mikulincer & Shaver, 2016). CSE perceptions may be a driving mechanism by which trauma exposure exacerbates negative perceptions of ones’ self as capable and others as caring or responsive. Further, the perception of ones’ self as incapable of managing their symptoms and demands of recovery has direct implications for coping behaviors (Benight & Bandura, 2004). Differences in CSE across attachment orientations therefore may be directly influencing the different ways in which individuals

self-regulate based on their attachment orientation (i.e., hyperactivating or deactivating strategies; Mikulincer & Shaver, 2016; Mikulincer et al., 2006). Previous research on attachment has alluded to potential relationships between attachment orientations and CSE.

Mikulincer and Florian (1995) examined attachment and cognitive appraisals of stress, including primary appraisals (i.e., stress either perceived as a threat or a challenge) and secondary appraisals (i.e., one’s perceived ability to handle stress). Using male recruits in training for the Israeli Defense Forces, they found that anxious and avoidant men appraised training as more threatening, whereas secure men appraised training as more of a challenge (Mikulincer & Florian, 1995). Additionally, secure and avoidant men appraised themselves as more able to cope (i.e., CSE) with training than anxiously

attached men.

Sheinbaum and colleagues (2015) similarly demonstrated that anxiously attached, non-traumatized adults had a greater fear of losing control in daily life and appraised themselves as less confident than securely attached adults in coping capabilities. In contrast to the study by Mikulincer and Florian (1995) indicating that avoidantly attached

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adults had greater CSE, avoidantly attached adults expressed less confidence in their coping capabilities, although this relationship was weaker than that of anxious attachment and coping capabilities (β = -.37 vs. β = -.59, respectively; Sheinbaum et al., 2015).

In a series of experimental studies, Mikulincer (1998) found in his sample of non-traumatized adults that those highly anxiously attached endorsed more negative

descriptions of themselves, exhibited high accessibility to negative self-attributes, and had faster reaction times for endorsing imperfections when distressed. Avoidantly attached adults described themselves in more favorable terms, exhibited high

accessibility to positive self-appraisals, and had faster reaction times when endorsing positive traits when distressed. Whereas anxiously attached individuals became hyper-focused on their perceived imperfections, avoidantly attached individuals tended to self-enhance. Similarly, in a study examining responses to emotional pictures, the more anxiously attached adults were, the less able they were to control their emotional responses to socially negative pictures (Vrticˇka et al., 2012). There were no significant findings for control perceptions among avoidantly attached adults.

It is possible that among trauma survivors, an anxious attachment may result in low CSE, which in turn, results in higher PTSD symptoms. As mentioned previously, anxiously attached adults utilize hyperactivating strategies to cope with distress due to negative internal working models, resulting in a heightened emotional response and concern for potential threats (Mikulincer et al., 2006). These negative self-appraisals are reflected in both self-report (Mikulincer & Florian, 1995; Sheinbaum et al., 2015) and experimental (Mikulincer, 1998; Vritcka et al., 2012) studies. When managing

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capable and, in turn, have difficulties self-regulating distress. Thus, it follows that anxiously attached individuals would have low CSE.

For avoidantly attached individuals, it has been previously theorized that they may possess greater self-efficacy regarding their ability to maintain distance and have experienced success in coping independently (i.e., mastery experiences; Mikulincer & Florian, 1998; Mikulincer et al., 1999). If one has internal working models of others as typically unavailable to unhelpful when one is distressed, self-reliance may provide one with more positive appraisals of his or her ability to cope independently of others. Avoidantly attached adults have demonstrated both positive self-appraisals (Mikulincer, 1998; Mikulincer & Florian, 1995) as well as negative self-appraisals (Sheinbaum et al., 2015). Although avoidant attachment is sometimes found to be associated with adverse posttraumatic outcomes such as PTSD (Woodhouse et al., 2015), the mechanism by which avoidant attachment is related to PTSD may depend on an individuals’ level of anxious attachment. Specifically, those who are high on both avoidant attachment and anxious attachment may experience working models characterized by a distrust of others due to fears of rejection. This would contrast with the adult exclusively high on avoidant attachment who feels they are capable of handling distress independently. Thus, those high in avoidant attachment but low in anxious attachment may experience a benefit in terms of CSE, thus leading to lower PTSD symptoms.

In the trauma literature, CSE has been highlighted as a crucial determinant of posttraumatic outcomes, such that perceptions of one’s self as unable to cope with trauma symptoms leads to poor self-regulation and greater distress (Benight & Bandura, 2004). Although other mediators in the attachment-PTSD relationship have been identified, such

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as perceived social support (Besser & Neria, 2010; Besser & Neria, 2012), coping strategies (Mikulincer et al., 1993) and emotion regulation (Benoit et al., 2009), CSE plays a key role in explaining how these constructs exert an influence on individuals’ responses to stress. Perceived social support boosts CSE perceptions, thus reducing distress (Smith et al., 2013; Smith et al., 2017). A strong sense of CSE encourages

adaptive methods of coping and assists in regulating emotions by minimizing perceptions of threat (Benight & Bandura, 2004). However, the influence of attachment orientations on CSE perceptions and PTSD symptoms in trauma survivors has yet to be examined. These orientations, influenced by interactions with significant others throughout one’s life, may be important individual factors that impact the course of posttraumatic recovery through CSE.

The Present Study

For anxiously attached adults who experience negative self-evaluations (Mikulincer et al., 2006), persistent symptoms may result in greater decreases in CSE over time, given that the attempts at coping thus far have not alleviated symptoms. Low CSE would, in turn, serve to worsen PTSD symptoms (Luszczynska et al., 2009;

Bosmans & van der Velden, 2017; Benight & Bandura, 2004). Greater PTSD symptoms may then interfere with secure attachment cognitive representations and their potential for stress reduction (Mikulincer et al., 2014; Andersen et al., 2015), reinforcing an overall anxious attachment orientation.

Although some longitudinal studies have found a positive relationship between avoidant attachment and PTSD symptoms (Fraley et al., 2006; Franz et al., 2014; Murphy et al., 2016; Solomon et al., 2008), avoidantly attached adults have been found to

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self-evaluate their coping skills and expectations in a positive light (Mikulincer, 1998; Mikulincer & Florian, 1995). The discrepant meta-analytic findings on the association between avoidant attachment and PTSD (Woodhouse et al., 2015), in addition to the defensive self-enhancement seen when avoidantly attached adults encounter a stressor (Mikulincer, 1998; Mikulincer & Florian, 1995) may indicate that high avoidant

attachment in the absence of anxious attachment (e.g., dismissing) is a protective factor against distress. A fearful attachment (high anxious, high avoidant), characterized by both a fear of rejection and avoidance of others (Bartholomew & Horowitz, 1991), may lack the benefits of a boosted self-efficacy when faced with distress, thus leading to the observed relationship between avoidant attachment and PTSD elsewhere (Fraley et al., 2006; Franz et al., 2014; Murphy et al., 2016; Solomon et al., 2008). Thus, survivors whose attachment orientation is more prototypically dismissing may experiencing greater CSE and less PTSD symptoms, whereas those more prototypically fearful experiencing low CSE and high PTSD symptoms.

Research examining the longitudinal relationship between adult attachment orientations and PTSD symptoms have provided evidence for both a unidirectional relationship (Benoit et al., 2009; Besser & Neria, 2010; Fraley et al., 2006; Shallcross et al., 2014; Solomon et al., 2008) and a bidirectional relationship (Murphy et al., 2016; Franz et al., 2014; Mikulincer et al., 2011) utilizing samples with a substantial range in time since the traumatic event. Although the present study does not seek to clarify the issue of the direction of influence in the attachment-PTSD relationship, the extant literature appears to highlight the issue of timing in measuring these constructs.

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Study Hypotheses

The present study utilizes structural equation modeling to examine the direct and indirect effects of adult attachment orientations on PTSD symptoms. I hypothesize that CSE perceptions will mediate the relationship between anxious attachment and PTSD symptoms six weeks later (see Figure 2). For those high in avoidant attachment, I

hypothesize that those individuals will experience more positive CSE perceptions but will nonetheless experience worse PTSD symptoms six weeks later. Indeed, avoidantly

attached survivors may still evaluate their coping capabilities, but may not suffer from the same negative self-perceptions that are seen with anxiously attached adults. CSE is thus not anticipated to mediate the relationship between avoidant attachment and PTSD symptoms. To examine potential relationships between with CSE and PTSD for those high in avoidant attachment and low in anxious attachment (e.g., dismissive attachment), an interaction term will be included in the model. Specifically, I hypothesize that those high in avoidant and low in anxious attachment will experience lower CSE perceptions and higher PTSD symptoms. Given the importance of timing in examining recovery from traumatic events (Galatzer-Levy et al., 2018), the time since the traumatic event will be controlled for in two ways. Firstly, participants included will have been exposed to a traumatic event within the last year. Secondly, the time since the traumatic event will be included in the model.

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Figure 2. Conceptual Model Predicting PTSD Symptoms at Six Weeks. Note. CSE-T = Trauma Coping Self-Efficacy; PTSD = Posttraumatic stress disorder.

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CHAPTER II METHOD Procedure

Community participants were recruited through Amazon’s Mechanical Turk (MTurk), with data collection taking place between June and November 2020. Surveys were created through the Cloud Research website, which offers a user-friendly interface for creating longitudinal Mturk surveys (Litman, Robinson, & Abberbock, 2017). The inclusion criteria for the present study consisted of (a) having experienced at least one traumatic event based on the DSM-5 (APA, 2013) definition in the last year, (b) being at least 18 years old, and (c) fluency in English. Based on sample size recommendations by Weston and Gore (2006), I aimed to collect a minimum of 200 participants. In order to reach this minimum sample size, a substantially larger number of potential participants were screened for inclusion (see Figure 3). Participants were compensated for each survey, providing $0.02 for the screening survey, $1.00 for the baseline survey, and $2.00 for the follow-up survey.

Prior to informed consent and inclusion in the study, potential participants completed a brief screener survey with four yes or no questions to assess eligibility criteria. Those who self-identified as an adult (over 18 years), fluent in English, and having been trauma-exposed in the last year were invited to complete the baseline survey. Eligible participants completed self-report surveys on attachment, CSE, and PTSD

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in Figure 3, about one third of individuals who completed the baseline survey did not meet the trauma criteria (e.g., loss that was not violent or accidental) or did not experience a traumatic event in the timeframe specified. Other participants reported a traumatic event that was not within the last year. These participants were not invited to complete the follow-up survey and were not included in analyses.

Figure 3. Participant Flow Chart.

As careless responding and automated bots are of concern in Mturk studies, several checks were put in place to ensure the quality of the data collected. Duplicate IP addresses were blocked from completing any survey on multiple occasions through the Cloud Research service (Litman, Robinson, & Abberbock, 2017). However, three

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responses were discarded. Open-ended questions regarding trauma exposure were included to 1) assess the most distressing traumatic event meets DSM-5 criteria and falls within the last year, and 2) the participant was not a bot. One common example of a rejected response to the open-ended trauma exposure question was providing a copy-pasted definition of PTSD. Blank responses to open-ended questions were not rejected through Mturk but were not included in the present analyses as inclusion criteria could not be verified. Responses were considered careless if participants gave the same response to all survey questions (for example, “1” on each survey item) or a suspicious pattern across all survey questions (for example, “6” followed by “7” and repeating). These responses were rejected through Mturk.

Measures

Demographics. Participants reported on various demographic information, including age, gender, ethnicity, highest level of education, and annual household

income. Participants were also asked to indicate whether they had received a diagnosis of COVID-19 due to the ongoing SARS-CoV-2 pandemic and the potential contribution to missing data.

Trauma exposure. Exposure to a traumatic event in the last year was assessed using the extended version of the Life Events Checklist (LEC; Weathers et al., 2013). The LEC lists 17 different traumatic events, from which participants are asked to indicate if they had experienced it themselves, witnessed the event, heard about the event

occurring to a close friend or family member, was experienced through the course of a job (e.g., first responder), or was not experienced. The extended LEC also included open-ended questions regarding the worst event in the last year and how much time had

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elapsed since the traumatic event. These open-ended questions were carefully reviewed to ensure the event met DSM-5 criteria and the event fell within the last year.

Corresponding to the DSM-5 definition of a traumatic event, participants who indicate any degree of trauma exposure were considered eligible to participate.

Adult attachment. Anxious and avoidant attachment will be assessed using the Experiences in Close Relationships – Relationship Structures scale (ECR-RS; Fraley, Heffernan, et al., 2011). Participants are instructed to respond to the same nine statements regarding how they feel towards different attachment figures, including attachment with his or her romantic partner, close friend, mother figure, and father figure. For each attachment figure, the Anxious attachment subscale items emphasize concerns over abandonment (e.g., “I need a lot of reassurance that close relationship partners really care about me”), while the Avoidant attachment subscale items emphasize a desire to distance from close others (e.g., “I prefer not to be too close to others”). Items are rated from 1 (Disagree strongly) to 7 (Agree strongly) and summed on each subscale to create total scores for Anxious and Avoidant attachment. Mean composites, using averaged anxious or avoidant scores for each attachment figure, have exhibited good reliability (Anxious α = .80, Avoidant α = .88; Fraley, Heffernan, et al., 2011). Previous work by Fraley, Vicary, and colleagues (2011) demonstrated that attachment orientation to each

attachment figure (e.g., partner, friend, mother, and father) may be used as indicators for an overall latent construct representing one’s “global” or “prototypical” attachment orientation. This approach to estimating global attachment may result in less ambiguity as to whom the participant should be bearing in mind when responding to the self-report

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statements. Global scores for attachment anxiety and attachment avoidance in the present sample demonstrate good internal consistency (α = .91 and .90, respectively).

PTSD symptoms. The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) will be used to measure PTSD symptoms. Items on the PCL-5 correspond to PTSD symptom criteria from the DSM-5, including intrusive symptoms, avoidance, negative alterations in cognition or mood, and arousal symptoms (APA, 2013). Participants will be instructed to respond to the 20-item questionnaire regarding how bothered he or she is by symptoms in the past month concerning his or her experience in the past year (Weathers et al., 2013). Item responses range from 0 (Not at all) to 4 (Extremely). Items are summed to create a total PTSD symptom severity score. The PCL-5 has demonstrated good

internal consistency (α = .95) and test-retest reliability (r = .82) over one week (Belvins et al., 2015). The PCL-5 total score demonstrates good internal consistency in the present sample, α = .96.

Trauma coping self-efficacy. Trauma survivors’ CSE will be measured using the Trauma Coping Self-Efficacy (T) self-report scale (Benight et al., 2015). The CSE-T is a 9-item, context-specific measure of survivors’ perceptions of his or her coping capabilities surrounding trauma symptoms (e.g., “Control thoughts of the traumatic experience happening again”) and other posttraumatic demands (e.g., “Get my life back to normal”). Participants are instructed to indicate the extent to which they feel capable of coping with these various posttraumatic demands. Items are rated on a 7-point scale ranging from 1 (not at all capable) to 7 (totally capable). The CSE-T has demonstrated good internal consistency (α = .87 to .91), discriminant validity, and test-retest reliability

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(r = .57 to .81). In the present sample, total CSE-T score demonstrates good internal consistency, α = .92.

Data Analysis

Adult attachment variables were created by averaging avoidant and anxious scores across the different relational contexts (i.e., friend, mother, father, and partner; Fraley, Heffernan, et al., 2011). Additionally, an interaction term was formed using the product of mean-centered global avoidant attachment and global anxious attachment (Aiken & West, 1991). Latent variables were formed for CSE and PTSD symptoms, allowing for the removal of measurement error (Crano et al., 2015). Further, parceling was utilized to form latent variables, thereby minimizing the number of paths to be estimated in the measurement model in favor of parsimony (Matsunaga, 2008). To employ parceling for PTSD, symptom cluster mean composites were used as indicators for the PTSD symptom latent variable. Finally, the nine-item CSE-T was randomly parceled to form three mean composites with three items each. Details outlining the parcel items, internal consistency, means, and standard deviations of observed model variables are included in Table 1.

Model estimation and fit. A partially latent structural equation model (SEM) was estimated using Mplus software version 8.5 (Muthen & Muthen, 2017). A two-step process was utilized for estimating the proposed model (e.g., Mueller & Hancock, 2007). Prior to estimating the proposed structural model, the measurement portion of the model was estimated in order to address any model misspecification concerns. Several indices of model fit were used to determine how well the model structure fit the underlying data.

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Table 1

Descriptives for Observed Variables for T1 (N = 380) and T2 (N = 227)

Scale # of Items α T1 α T2 M SD ECR-RS Attachment Anxiety 12 .91 -- 0.00 1.43 Attachment Avoidance 24 .90 -- 0.00 0.98 CSE-T Parcel 1 (Items 1, 6, 9) 3 -- .76 4.61 1.40 Parcel 2 (Items 3, 5, 8) 3 -- .82 4.44 1.44 Parcel 3 (Items 2, 4, 7) 3 -- .75 4.93 1.32 PCL-5 Cluster B 5 -- .91 2.33 1.04 Cluster C 2 -- .87 2.74 1.21 Cluster D 7 -- .91 2.43 1.08 Cluster E 6 -- .87 2.31 1.02

Note. ECR-RS = Experiences in Close Relationships Scale – Relationship Structures; CSE-T = Trauma Coping Self-Efficacy Scale; PCL-5 = The PTSD Checklist for the DSM-5.

The model χ2 was examined, which assesses the discrepancy between the hypothesized model and underlying covariate structure of the data. Model χ2 uses

significance testing, wherein a significant χ2 indicates the model is significantly different from the underlying data. However, as a p-value test, model χ2 is sensitive to sample size (Kline, 2016). Thus, the adjusted model χ2/df was also examined, using a cutoff value of less than 3.00 (Kline, 1998). As indicators of goodness-of-fit, the Comparative Fit Index (CFI; Bentler, 1990) and Tucker-Lewis Index (TLI; Tucker & Lewis, 1973) were also examined. These indices compare the proposed model to the independence model (i.e., model with no estimated parameters). Values of CFI and TLI over .95 represent a good fitting model (Hu & Bentler, 1999). The Root Mean Square Error of Approximation (RMSEA; Macallum, Browne, & Sugawara, 1996) and Standardized Root Mean Square Residual (SRMR; Jöreskoh & Sörbom, 1981) were used as “badness-of-fit” indices, which compare the proposed model to a saturated model (i.e., all possible parameters

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estimated). RMSEA and the accompanying 90% confidence interval utilize a cutoff of less than .08 to identify a good fit, and between .08 and .10 indicate a mediocre fit (Macallum, Browne, & Sugawara, 1996). Similarly, SRMR uses a cutoff of .08 to indicate a good fitting model (Hu & Bentler, 1999).

Missing data and attrition. Item-level missing data and missing data due to dropout from the study (i.e., attrition) were examined to establish the degree of

missingness and potential mechanisms of missingness. To identify the proper procedure for handling this degree of missing data, I first sought to identify if the data was Missing Completely At Random (MCAR), Missing At Random (MAR), or Not Missing At Random (NMAR; Rubin, 1976; Little & Rubin, 2002). MCAR is the most restrictive, describing a pattern of missing data that is unrelated to measured variables and unrelated to the values of the outcome itself. In contrast, MAR describes missing due to measured variables. Patterns of missingness due to attrition were assessed using a series of t-tests and chi-square analyses examining differences between those who completed both timepoints and those who only completed T1.

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CHAPTER III RESULTS Preliminary Analyses

Demographics. Participants were primarily female (67.3%), White (72.5%), and married (38%; see Table 2). The present sample is well-educated, with the majority holding a college degree. Trauma exposure as measured by the LEC revealed the most common traumatic events (either experienced, witnessed, learned of, or as part of job) were transportation accidents (70.7%), followed by life-threatening illness or injury (62.8%), other (62%), natural disasters (59.2%), physical assaults (57.3%), unwanted sexual experiences (55.8%). The least common traumatic events were causing harm or death to someone else (15.4%) and captivity (13.9%). A small percentage of participants reported receiving a COVID-19 diagnosis at any time during the pandemic (NT1 = 15, NT2 = 9). Six individuals reported receiving a COVID-19 diagnosis at T2 that was not reported at T1, which may indicate they became ill during the study. Time since the most currently distressing traumatic event ranged from zero to 365 days, with the average amount of time passed being 197.73 days (SD = 107.48). Three participants (two healthcare workers, one exposed to domestic violence) were experiencing ongoing trauma exposure and were thus coded as “0” for the number of days since the traumatic event. Average T2 PTSD symptom severity exceeded the cut-off value of 33.0

recommended by the National Center for PTSD (M = 47.93, SD = 19.74), suggesting that the present sample was highly distressed.

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Table 2

Descriptives for Demographic Variables (N =380)

Measures n % Gender Male 116 30.4 Female 257 67.3 Non-binary 7 1.8 Other 2 0.5 Ethnicity White/Caucasian 277 72.5 Black/African American 30 7.9 Hispanic/Latinx 23 6.0 Indigenous American/Native American/Alaskan Native 3 0.8

Asian American/Pacific Islander 32 8.4

Multi-racial 15 3.9

Other 2 0.5

Annual Household Income

Less than $15,000 49 12.9 $15,000 to $35,000 80 21.0 $35,000 to $50,000 84 22.0 $50,000 to $75,000 70 18.4 $75,000 to $100,000 50 13.1 $100,000 or greater 48 12.6 Education High school 40 10.5 Some college 88 23.0 Associate’s degree 41 10.7 Bachelor’s degree 148 38.7 Master’s degree 55 14.4

Doctoral or professional degree 10 2.6 Relationship Status

Single (never married) 125 32.7

Committed partnership 86 22.5 Married 145 38.0 Separated 6 1.6 Divorced 15 3.9 Widowed 4 1.0 Other 1 0.3

Missing data and attrition. There was no item-level missing data for T1 or T2 on any model variables. However, there was 40% attrition. There were no significant

Figure

Figure 1. Dimensional Model of Adult Attachment. Note. Adapted from (Fraley, Hudson,  Heffernan, & Segal, 2015)
Figure 2. Conceptual Model Predicting PTSD Symptoms at Six Weeks. Note. CSE-T =  Trauma Coping Self-Efficacy; PTSD = Posttraumatic stress disorder
Figure 3. Participant Flow Chart.
Figure 4. Measurement Model. Note. Standardized factor loadings and covariances are  presented
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