Emotion Regulation in Association of Adult Attachment

The role of emotion regulation in the association of adult attachment and mental health: A systematic review

1. Introduction
   Mental health in adulthood might be affected by several causes such as genetics (Button et al. 2008; Lau and Eley 2008), drugs and alcohol (Newton-Howes and Boden, 2015), physical and sexual abuse (Cutajar et al., 2010; Mueser et al., 1998; Mueser, Salyers, et al., 2004), exposure to disasters such as flood or earthquake (Norris et al., 2002) and violence (Follingstad 2009; Golding 1999). Although mental illness has been linked with abundant risk factors, attachment and emotion regulation seem to be very important components in the development of mental disorders (Ponizovsky et al., 2007; Nolen-Hoeksema & Aldao 2011). Given the importance of attachment and its trace during life period, many studies have investigated the relationship between attachment and mental health and detected a strong association between those (Banford et al., 2015; Gajwani et al., 2013; Roberts et al., 1996; Wei et al., 2003, 2004, 2006., Kobak, Sudler, and Gamble, 1991). Strong evidence shows that individuals with anxious or avoidant attachments face a higher risk of mental health problems (Besser & Neria, 2010, 2012; Elwood & Williams, 2007).
   In a different thread of research, there is growing evidence that emotion dysregulation such as anger and sadness to emotional and behavioral problems are linked to increased vulnerability to developing mental disorders (Gilbert, et al., 2011; Gilbert et al., 2012; Eisenberg, Cumberland, et al., 2001; Storch et al., 2011; Silk, Steinberg, & Morris, 2003; Clyne et al., 2010). Also emotion regulation showed a substantial association with attachment as plenty of studies have demonstrated (Bost et al,. 2014; Van der Meer et al., 2015; Mikulincer & Florian, 1998; Shakory et al., 2015).
   Several studies investigate the hypothesis that emotion regulation is at least partly responsible for the link between adult attachment style and mental health. However, there is so far no literature review available on this association. Therefore, this comprehensive review provides an overview of the literature of the relationship between attachment and mental health in adulthood, considering the role of emotion regulation to supply a wide range of suggestions for future research. This review begins with a description of theory of attachment and explanation of its categories. Then, a concept of the relationship between emotion regulation, attachment and mental health will be examined. Subsequently, this paper reviews the empirical papers to examine the relation between attachment, emotion regulation and mental disorder in adulthood. At the end, we provide a conclusion of the reviewed papers.
   1.1. Adult attachment and dimensions
   Attachment theory (Bowlby, 1969; Ainsworth and Bowlby, 1991), which started with a focus on infant-mother attachment, has developed about 20 years since its beginnings to also focusing on adult functioning (Hazen and Shaver, 1987). Bowlby explained attachment theory as ‗a way of conceptualizing the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality disturbance, including anxiety, anger, depression, and emotional detachment, to which unwilling separation and loss give rise‘ (Bowlby, 1979, p. 127).
   Mortazavizadeh Z. et al. Archives of Psychology, vol. 2, issue 9, September 2018 Page 3 of 25
   Copyright © 2018, Archives of Psychology. All rights reserved. http://www.archivesofpsychology.org
   Studies have shown that the type of attachment style during childhood becomes relatively stable in adulthood (Hazen and Shaver, 1990; Fraley, 2002). The dimensions of attachment style are described by using three terms: secure, anxious and avoidant attachments (George, Kaplan, and Main, 1987; Hazan and Shaver 1987; Brennan, Clark, & Shaver, 1998). These dimensions are also suggested in a four-category model of adult attachments (Bartholomew and Horowitz, 1991). Generally speaking, anxious attachment is characterized by worriedness of availability of people and motivates to achieve attention and love from a partner or close person to overcome distress. A person with avoidant attachment strives to rely on himself and would not inquire help even though he needed. Securely attached adults, however, demonstrate low anxiety and low avoidance and are comfortable to trust other people, thereby developing an intimate long-term relationship. (Bowlby, 1969; Shaver and Fraley, 2008; Mikulincer and Shaver, 2003). Meanwhile, Bartholomew and Horowitz (1991) illuminated four aspects of attachment as: preoccupied, dismissing-avoidant, fearful-avoidant and secure attachment which have been used in various researches. Preoccupied attachment is specified by high anxiety and low avoidance, dismissing-avoidant attachment with high avoidance and low anxiety, and fearful-avoidant attachment by high anxiety and high avoidance. However, securely attached individuals show both low anxiety and low avoidance.
   1.2. Attachment and mental health
   The explanation of attachment theory will provide a path to understanding the development of secure attachment, that it may assist people to overcome distress and restore confidence and emotional balance (Cassidy & Shaver, 2016). Bowlby (1973, 1980) explained that individuals with different attachment orientations have different internal working models of the self and of others. Interaction with the caregivers who are supportive in times of demand, bring up the development of attachment security (Sroufe and Waters, 1997). As a result, positive internal working models build a foundation for proper mental health (Mikulincer & Shaver, 2003). Nevertheless, when individuals develop negative representations of themselves or others through uncertain parental support, they become more vulnerable to psychopathology. A negative internal working model of self derives from inconsistent care and attention from caregivers, and leads to attachment anxiety. Individuals with avoidant attachment have a negative internal working model of others, because they did not receive sufficient response from their caregiver (Mikulincer et al., 2003; Pietromonaco and Feldman Barrett, 2000). Therefore, anxiously attached individuals seek proximity to an excessive extent, they experience distress when they find people unavailable and they encounter with fear of abandonment. While avoidantly attached individuals feel uneasy being close to others, they attempt to become self-reliant and they minimize emotional displays (Brennan et al., 1998). A growing body of research investigating the association of attachment and mental disorder (Ponizovsky et al., 2007; West & George, 2002; Bartholomew and Horowitz, 1991; Brennan, et al., 1998; Hazan and Shaver, 1987; Allen et al., 2001; Bifulco et al., 2002) found that individuals with secure attachment represented higher psychological functioning, while individuals with insecure patterns of attachment style experience more mental illness symptoms.
   1.3. Attachment and emotion regulation
   Attachment theory (Bowlby, 1973, 1980, 1982) is a useful and influential framework
   Mortazavizadeh Z. et al. Archives of Psychology, vol. 2, issue 9, September 2018 Page 4 of 25
   Copyright © 2018, Archives of Psychology. All rights reserved. http://www.archivesofpsychology.org
   for understanding emotion regulation across the lifespan (Mikulincer, Shaver & Pereg, 2003). Following Bowlby (1980), modern attachment theorists (Cassidy & Berlin, 1994; Thompson, 2013; Cassidy & Kobak, 1988) recently discovered the maintaining role of emotion regulation in relationship with attachment figures. Also, Sroufe (1996) expressed that attachment can be described in terms of dyadic regulation of emotion regulation.
   The development of attachment style in individuals derives from the basic attachment experience with their caregiver. Two dimensions of insecure attachment (Brennan et al., 1998) will appear across childhood and adulthood as attachment avoidance and attachment anxiety. High attachment anxiety will lead to desperateness and make individuals uncertain about their ability to handle distress without the attachment figure‘s assistance (Mikulincer et al., 2003). Anxious attachment would be associated with a heightening of negative emotions whereas these individuals learned that a heightening of negative emotions would be essential to draw attention from others (Cassidy, 1994). Nonetheless, individuals with an avoidant attachment style prefer to have emotional distance; therefore, they rarely possess comfortable feelings about others. Also, avoidant individuals rely upon deactivating strategies which lead to suppression of negative emotions and cognitions and distance from the attachment context. Subsequently, a long term of hyper-activation and deactivation may make individuals vulnerable to pervasive emotional problems (Mikulincer et al., 2003). In contrast, a secure attachment individual facing threat engages in proximity-seeking behaviors in order to be close to an attachment figure. Hence, a raised adaptive mechanism of emotion regulation relieves distress and continues to support security (Mikulincer & Shaver, 2008).
   1.4. Emotion regulation and mental disorder
   Emotion regulation (ER) develops throughout the lifespan (Cole, 2014). The impact of emotion regulation on mental health has recently become a substantial theme in many investigations (Aldao et al., 2010; Gross & Thompson, 2007; Koole, 2009; Kring & Sloan, 2009). Yet, the concept of emotion regulation has been found in several definitions and there is a lack of universal definition for emotion regulation (Cole et al., 2004). According to Gross (1998) emotion regulation is ―the process by which individuals influence which emotions they have, when they have them and how they experience and express these emotions‖ (p. 275). However, Campos et al. (2004) suggested that emotions can simultaneously occur with the regulation of the same emotion. Therefore, several definitions became apparent for emotion regulation. With regards to regulation of emotion, two categories of ER can be distinguished, adaptive and maladaptive emotion regulation. Problem solving and reappraisal of positive or neutral interpretations of events are examples of adaptive emotion regulation (Aldao et al., 2010). Suppression and avoidance are examples of maladaptive emotion regulation (Gross, 1998; Hayes et al., 2004). Gross and John (2003) categorized ER into two categories of strategies: antecedent-focused strategy and response-focused strategy. According to this model, an antecedent-focused strategy occurs early and thereby intervenes before the emotional response tendencies have been fully generated. Maladaptive emotion regulation, which is described as response-focused strategy (Gross and John, 2003), would reduce the behavioral expression of negative emotion, and occur after the
   Mortazavizadeh Z. et al. Archives of Psychology, vol. 2, issue 9, September 2018 Page 5 of 25
   Copyright © 2018, Archives of Psychology. All rights reserved. http://www.archivesofpsychology.org
   generation of the emotional responses. Although both emotion regulation strategies could have positive and negative consequences, maladaptive ER is suggested as being associated with a wide range of mental disorders (Gross & Munoz, 1995; Moore et al., 2008; Aldao et al., 2010). Additionally, Baradly (2000) has noted that maladaptive ER may precede the development of psychopathology. Indeed, a deficit of emotion regulation is a common problem in abundant psychiatric disorders (Berking and Wupperman 2012). Therefore, emotion regulation has been proposed as a robust predictor of mental health functioning (Nolen-Hoeksema and Aldao 2011). Additionally, as Gross and Levenson (1997) explained, psychiatric disorders might be conceptualized as difficulties with emotion regulation.
2. Method of the review
   To find pertinent publications on the topic of attachment and mental health in adulthood which includes emotion regulation as a mechanism, a database search has been conducted. The search was conducted in the electronic databases Psych INFO, Elsevier and Google Scholar by combining the key terms: ‗adult attachment‘, ‗mental health, diseases or illnesses‘ and ‗emotion regulation‘. Further criteria of eligible papers were English language, adulthood and published in peer reviewed journals. Subsequently, the reference lists of relevant papers were examined to identify additional suitable papers. The term ―emotional disclosure‖ as an aspect of emotion regulation was also used in the search to bring up more study results.

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