• Alcohol Dependence and Avoidant Attachment – Implications for Therapy

      Cornwall, Jane (University of Wolverhampton, 2007-10)
      The literature review revealed co-morbidity between adverse childhood experiences, adult psychopathology and alcohol dependence, although causality was questionable due to multiple variables. The current study used 54 clients at the acute end of the spectrum of severe alcohol dependence from a specialist tertiary substance misuse service (clients) and a control group of 54 non-problematic drinkers from an NHS working population (controls) to examine possible differences in security of attachment and maladaptive schemas and investigated how early relational experiences influenced core beliefs regarding self, others and intimate relationships and therapeutic implications for severely alcohol dependent clients’ engagement in specialist services. The study was divided into two sections: (1) quantitative analysis using Feeney, Noller and Hanrahan’s (1994) Attachment Style Questionnaire to measure attachment style and Young’s Schema Questionnaire (Young & Brown, 2001) to measure maladaptive schemas in the domain of disconnection and rejection and (2) qualitative analysis, using Interpretational Phenomenological Analysis (IPA) to explore eight severely alcohol dependent clients’ subjective experiences of intimate relationships. Clients scored significantly lower in secure attachment style and significantly higher in both avoidant and ambivalent attachment style than controls and suggested overlapping between the two dimensions, known as ‘fearful avoidant’ attachment. Clients scored significantly higher than controls in all five sub-categories of maladaptive schemas in the domain of disconnection and rejection, namely mistrust/abuse, emotional deprivation, abandonment, social isolation/alienation and defectiveness/shame. IPA revealed common themes of negative parent-child interaction: physical and psychological abuse, neglect and explicit maternal rejection and emotional deprivation and hostile and abusive parent-parent interaction. These aetiological factors influenced fearful avoidant attachment and maladaptive core beliefs. Negation of children’s needs implicated an immaturely developed diffuseness of identity and defective self that inhibited formation of intimate adult relationships. A bio-psychosocial explanation suggested alcohol ameliorated hyper-vigilant anxiety and depression from adverse childhood experiences within a threatening family environment that implicated insecure attachment, maladaptive core beliefs and negative self-identity, inhibiting emotional intimacy. It advocated screening procedures and an integrated CBT and schema-based therapeutic approach for those at the more severe end of the spectrum of alcohol dependence deemed at risk of not engaging or disengaging prematurely from services.
    • Cognitive, Emotional and Environmental Mediators of Early Parenting in High Risk Families

      Adamson-Macedo, Elvidina N.; Redshaw, Maggie; Del Priore, Christina; Barnes, Christopher (University of Wolverhampton, 2008)
      The UK currently has the highest number of premature births (babies born before 37 weeks gestation age and below 2.5kg) in Europe affecting around 70,000 babies and their caregivers each year. Consequently many interventions have been created to support the development of the preterm newborn and minimise the complications of prematurity. Many of the interventions developed have been predominantly tactile and have almost exclusively focused upon their effect upon the baby and not, for example considered the effect that this type of intervention might have upon the parents; specifically the mother, when they are the ones who perform the therapy. In fact there is a severe lack of systematic studies investigating the latter. Hence, the aim of this thesis was to search for research-based evidence on the benefits of environmental support to both babies (e.g. increased weight gain or awake periods) and their mothers (e.g. higher perceptions of themselves as a mother) during hospital confinement and within the context of Neonatal Health Psychology (NNHP). For this reason, the main hypothesis investigated whether mothers’ cognitions and emotions; specifically Maternal Self-Efficacy, Self-Esteem and Attachment, would be affected by environmental mediators in the form of structured or non-structured tactile sensory nurturing interventions. The empirical work reported in this thesis is divided into 3 distinct phases. Firstly, as their was no appropriate measure of maternal Self-Efficacy for mothers of hospitalised preterm neonates the main aim of Phase-1 was to develop and validate an appropriate measure. Using a prospective survey method and a mixed design (between/within and correlational) a total of 160 mother-preterm dyads (pooled from 2 cohorts; cohort 1, N=100; cohort 2, N=60) were recruited. The results demonstrated that the Perceived Maternal Parenting Self-Efficacy (PMPS-E) tool had good initial psychometric properties (including internal/external reliability and construct validity) for its use with mothers of relatively healthy hospitalised preterm neonates. Secondly, in order to investigate mothers’ perceived maternal parenting self-efficacy beliefs further Phase-2 examined whether the type of feeding a mother chose to give to her baby mediated her self-efficacy beliefs. The results suggested that breastfeeding a preterm neonate during hospital confinement may adversely affect mothers’ perceptions of their efficacy in all aspects of parenting. Finally, using an experimental method Phase-3 tested the main hypothesis of this thesis and used a randomised cluster control trial (RCCT) design to allocate 60 mothers and their preterms equally to one of three cluster groups; consisting of either structured (e.g. TAC-TIC therapy or Using a Toy) or non-structured (Placebo/Control) tactile sensory nurturing interventions. The main findings illustrate that tactile sensory nurturing interventions do mediate maternal cognitions and emotions, preterm weight gain and behavioural state. In particular, mothers who performed TAC-TIC demonstrated significantly higher self-reported perceptions in their self-efficacy, self-esteem and attachment, which was attributed to the fact that these babies spent increased amounts of time in an alert and responsive behavioural state, and gained more weight throughout the study period. Thus, the work presented throughout this thesis has implications for Neonatal Health Psychologists and other Health Care professionals’ practice within neonatal units, the use of Neonatal Health Psychology as a framework to study the preterm neonate and their family, and also the way in which both mothers and their hospitalised preterm neonates are supported during hospital confinement.