Katherine Newman-Taylor

What is the role of attachment style in paranoia and psychosis?

Our attachment (relationship) style describes how we see ourselves and others, how we cope when feeling threatened, and how we manage strong and difficult emotions. If we are ‘securely attached’ we cope reasonably well when distressed and seek help when needed. If we are ‘insecurely attached’ we struggle to cope with difficult feelings and find it hard to seek help even when this would be useful.

There is good evidence linking attachment style to paranoia and psychosis. People who report paranoia or have psychosis are more likely to have an insecure attachment style. In our research, we are trying to understand how insecure attachment leads to paranoia and psychosis. This in turn is helping us work out how to improve psychological therapies and mental health services. For more detail see: 10.1111/bjc.12361 and 10.1111/papt.12371.

We have found that people who are insecurely attached are more likely to hold critical beliefs about themselves and others, find it hard to ‘step back’ from streams of thinking, and either suppress or escalate their emotions. These processes then contribute to paranoia and psychosis. We have also found that helping people develop a sense of ‘felt security’ (akin to a secure attachment style) reduces paranoia – for people in the general population and people with psychosis. For examples see: 10.1111/papt.12398 and 10.1017/S1352465820000351.

What do our studies involve?

We have run several studies using ‘attachment priming.’ This involves temporarily inducing a sense of secure or insecure attachment to examine the impact on people’s beliefs, feelings and willingness to seek help. These studies have shown us that attachment style has a causal impact on these processes and paranoia. This means that if we can improve people’s sense of security, this is likely to reduce their paranoia. Other examples are here: 10.3390/brainsci11101257 and 10.1111/papt.12354.

How can this help us improve psychological therapies?

Our work suggests that psychological therapies should include ways to help people learn to feel secure and learn to manage very strong feelings (e.g., 10.1017/S1754470X20000288). This is likely to be particularly helpful to people who are both insecurely attached and have psychosis. Further research is now needed to test the impact of these interventions in busy mental health services.

How can this help us improve mental health services?

If we know how to support people with psychosis to feel more secure, we can use these approaches to improve mental health services. For example, we are currently developing a training programme for inpatient wards designed to help staff understand the impact of attachment, and how best to support people with an insecure attachment style. Our initial study in this area is here: 10.1017/S1754470X22000526.