Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking
About Negative Affect and About Mother
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Abstract
Two studies aimed to investigate whether repetitive thinking about negative affect (RTna) and repetitive thinking
about mother (RTm) can be mechanisms in the association between attachment anxiety and depressive
symptoms in middle childhood. In Study 1 (N = 381) and Study 2 (N = 157) 9- to 12-year-olds completed selfreport questionnaires measuring attachment, RTna and depressive symptoms. In Study 2, additionally, a
questionnaire was developed to measure RTm, and a compound score for self- and mother-reported depressive
symptoms was calculated. Results showed positive associations between attachment anxiety, RTna and RTm,
and self-reported depressive symptoms and depressive symptoms agreed upon by mother and child. RTna and
RTm mediated the relationship between attachment anxiety and these depressive symptoms. RTm mediated this
relationship even beyond RTna for the multi-informant compound score. Thus, RTna and RTm seem
independent mechanisms explaining the association between attachment anxiety and depressive symptoms in
middle childhood.
Key words: attachment anxiety; depressive symptoms; heightening strategy; repetitive thinking about negative
affect; repetitive thinking about mother
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking
About Negative Affect and About Mother
Depression is a frequent problem in adolescence and adulthood with a great impact on development
(Hankin et al., 1998; Weller & Weller, 2000). For adolescent boys and girls it is the predominant cause of illness
and disability (World Health Organization [WHO], 2014). Depression substantially increases the risk of suicide
(Wulsin, Vaillant, & Wells, 1999), which is the third cause of death in adolescents (WHO, 2014). Moreover,
even subclinical depressive symptoms are associated with impaired functioning (Cuijpers & Smit, 2002;
Lewinsohn, Solomon, Seeley, & Zeiss, 2000). Therefore, research has focused on identifying vulnerability
factors that contribute to the development of depressive symptoms.
Empirical studies with children and adolescents suggest that insecure attachment is one vulnerability
factor in the development of depressive symptoms (Armsden, McCauley, Greenberg, Burke, & Mitchell, 1990;
Brumariu & Kerns, 2010). According to Bowlby (1969, 1973), early experiences in interactions with the
caregiver are stored in Internal Working Models (IWM). An IWM is a cognitive structure consisting of
representations of the self, of the attachment figure and of the environment that generate expectations about an
attachment figure’s availability and support in times of distress (Bowlby, 1969/1982, 1973; Cassidy, 2008).
Individual differences in quality of interactions with the caregiver are reflected in different contents of the IWM.
Recurrent experiences with an attachment figure who is available, sensitive and responsive in times of distress,
lead to the expectation that an attachment figure will be available to provide support when needed in the future,
and thus, secure attachment (Bowlby, 1969/1982, 1973). Instead, when children repeatedly experience that an
attachment figure is unavailable, insensitive or unresponsive, they become uncertain about that attachment
figure’s support in times of distress, and, as a result, develop insecure attachment (Bowlby, 1969/1982).
In line with the finding that individual differences in attachment are continuously distributed, rather
than categorically, insecure attachment, has been represented along two dimensions in middle childhood:
attachment avoidance and attachment anxiety (Brennan, Clark, & Shaver, 1998; Fraley & Spieker, 2003).
Attachment avoidance involves self-reliance and discomfort with closeness, dependence, and intimate selfdisclosure. Instead, attachment anxiety involves preoccupation with social support, jealousy, a strong desire for
interpersonal merger, and fear of and vigilance for rejection and abandonment by an attachment figure (Brennan
et al., 1998; Brenning, Soenens, Braet, & Bosmans, 2011; Cassidy & Berlin, 1994). Although two meta-analyses
(Groh, Roisman, van Ijzendoorn, Bakermans-Kranenburg, & Fearon, 2012; Madigan, Atkinson, Laurin, &
Benoit, 2013) find that internalizing symptoms are more strongly related to attachment avoidance and less to
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
attachment anxiety, these meta-analyses’ results generalize less to middle childhood depressive symptoms for
different reasons. The age of the samples when internalizing symptoms were assessed, was age 9 or above for
only eight of 42 (Groh et al., 2012) and six of 61 (Madigan et al., 2013) independent samples, while the
prevalence of depressive symptoms is rather low under age 10 (Hammen & Rudolph, 2003; Weller & Weller,
2000). Moreover, the outcomes included more anxiety-related symptoms that typically covary with other
avoidance behavior (Bosmans, Dujardin, Field, Salemink, & Vasey, 2015). According to a narrative review
(Brumariu & Kerns, 2010) and a recent meta-analysis (Madigan, Brumariu, Villani, Atkinson, & Lyons-Ruth,
n.d.), in late middle childhood (age 10-12), the association between attachment anxiety and depressive symptoms
tends to be more consistently found than between attachment avoidance and depressive symptoms. This suggests
that there may be specific maladaptive mechanisms underlying the association between attachment anxiety and
depressive symptoms in middle childhood. However, surprisingly little is known about which mechanisms
explain these associations (Brumariu & Kerns, 2010; Kerns, 2008). Therefore, the current study aimed to better
understand the specific vulnerabilities that can explain depressive symptoms in anxiously attached children.
Middle childhood (age 8-12) has been proposed as a crucial developmental period to investigate the
mechanisms in this association for various reasons. First, precursors of depressive symptoms, such as
maladaptive cognitive strategies, start developing in middle childhood (Hampel & Petermann, 2005; Mezulis,
Hyde, & Abramson, 2006). Second, prevalence and incidence rates for depressive symptoms increase from
childhood to adolescence, with a peak between ages 15 and 18 (Hammen & Rudolph, 2003; Hankin et al., 1998;
Weller & Weller, 2000). For these reasons, the association between insecure attachment and depressive
symptoms can be observed more easily from late middle childhood onwards (Brumariu & Kerns, 2010), making
it possible to study mechanisms in this relationship while they are developing. These mechanisms could shed
light on the high recurrence of depressive symptoms as childhood depressive symptoms increase the risk for the
onset of a long-term trajectory of depressive symptoms continuing far into adulthood (Weller & Weller, 2000).
Moreover, therapies for depression are generally less effective than therapies for other disorders (Weisz,
McCarty, & Valeri, 2006), so a better understanding of depressogenic mechanisms and antecedents in middle
childhood could mean a step forward for clinical practice.
Traditionally, the association between attachment anxiety and depressive symptoms has been explained
as resulting from maladaptive emotion regulation (ER) strategies. ER models of attachment (Cassidy, 1994;
Shaver & Mikulincer, 2002) describe that anxiously attached individuals adopt a heightening strategy to attain
and maintain sufficient proximity and support from their inconsistently available attachment figure. This
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
heightening strategy is supposed to consist of two components, namely heightening negative affect and
heightening the importance of the attachment relationship (Cassidy, 1994; Shaver & Mikulincer, 2002).
Theoretically, it seems reasonable to assume that children’s strategy to heighten their focus on a potentially
rejecting attachment figure could also be a mechanism explaining attachment anxiety’s association with
depressive symptoms. However, until now, research merely focused on the role of heightening negative affect in
this association.
Heightening negative affect can be defined as chronically exaggerating negative affect, even in response
to relatively benign stimuli (Cassidy, 1994; Mikulincer & Florian, 1998; Shaver & Mikulincer, 2002). Evidence
suggests that heightening negative affect mediates the link between attachment anxiety and depressive symptoms
in middle childhood. In a cross-sectional study with a middle childhood and early adolescence sample, Brenning,
Soenens, Braet, and Bosmans (2012) operationalized this component as dysregulation. There was a unique and
positive association between attachment anxiety and dysregulation, and dysregulation mediated the relationship
between attachment anxiety and depressive symptoms (Brenning et al., 2012). However, a closer inspection of
the items assessing dysregulation (see Roth, Assor, Niemiec, Deci, & Ryan, 2009) revealed that dysregulation
might not have been an adequate operationalization of strategically heightening negative affect. Instead, these
items assessed children as “experiencing emotions but not having the capacity to regulate those emotions”
(Brenning et al., 2012, p. 448). More specifically, the dysregulation items seem to measure the extent to which
children have the impression that their ER strategy is not successful. Consequently, based on Brenning et al.
(2012) one cannot confidently conclude that the association between attachment anxiety and depressive
symptoms specifically reflects heightening of negative affect.
Instead, the definition of heightening negative affect seems conceptually closely linked to different
types of repetitive thinking (e.g. depressive rumination, brooding, or emotion-focused rumination). Segerstrom,
Stanton, Alden, and Shortridge (2003) defined repetitive thought as the “process of thinking attentively,
repetitively or frequently about one’s self and one’s world” (p. 909). Repetitive thinking characterized by
negatively valenced and abstract thought content is a vulnerability factor for different disorders, with each
disorder being characterized by a specific thought content (Ehring & Watkins, 2008; Watkins, 2008). In
depression, this repetitive thinking is passive, comparative, self-critical and focused on the depressed feelings
and on the reasons of their occurrence (Nolen-Hoeksema, 1991; Treynor, Gonzalez, & Nolen-hoeksema, 2003;
Watkins, 2008). In children, adolescents, as well as adults, this repetitive thinking about negative affect (RTna)
contributes to the onset, duration and severity of depressive symptoms (Abela & Hankin, 2011; Nolen-
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Hoeksema, 1991; Rood, Roelofs, Bögels, Nolen-Hoeksema, & Schouten, 2009) and is related to concurrent
depressive symptoms and increases in depressive symptoms over time (Burwell & Shirk, 2007; Lopez, Driscoll,
& Kistner, 2009; Treynor et al., 2003; Verstraeten, Vasey, Raes, & Bijttebier, 2010). This seems similar to the
description of Shaver and Mikulincer (2002) that, when anxiously attached individuals heighten negative affect,
“ they focus on their own distress, ruminate on negative thoughts, and adopt emotion-focused coping strategies
which exacerbate rather than diminish distress” (p. 141). Therefore, it seems a plausible hypothesis that RTna is
one specific, well defined and clearly operationalizable mechanism through which attachment anxiety is linked
with depressive symptoms.
This hypothesis has never been directly tested, but several studies have focused on the role of parenting
in the development of RTna. For example, Manfredi et al. (2011) found that adults who retrospectively reported
more parental overprotection in the first 16 years of life, reported more RTna. Also, overcontrolling parenting
and family expressions of sadness and guilt in the preschool years were associated with more RTna in early
adolescence (Hilt, Armstrong, & Essex, 2012). Moreover, in girls, the link between low levels of positive
maternal behavior at age 12 and increases in depressive symptoms at age 17 was mediated by increases in RTna
at age 15 (Gaté et al., 2013). Although similar parenting practices have often been linked with attachment
anxiety (Brenning et al., 2012; Karavasilis, Doyle, & Markiewicz, 2003), only one study has investigated the
links between attachment-related expectations, RTna, and depressive symptoms. Ruijten, Roelofs, and Rood
(2011) found in an adolescent sample that the negative association between self-reported trust in parental support
and depressive symptoms was mediated by higher levels of RTna. However, because a general measure for
insecure attachment was used, namely the amount of trust in the parent’s support when needed, it remains to be
seen whether RTna is the dominant ER strategy for attachment anxiety and not attachment avoidance. In
summary, based on theory and on the mentioned studies, it seems reasonable to assume that RTna may account
for at least part of the association between attachment anxiety and depressive symptoms in middle childhood.
Therefore, the current study aimed to provide a better understanding of the heightening strategy and its
role in the association between attachment anxiety and depressive symptoms in middle childhood. We focused
on the mother-child relationship as she remains the primary attachment figure for most children in middle
childhood (Cassidy, 2008; Kerns, Tomich, & Kim, 2006) and as there is no difference in the impact of
attachment to mother or father on the development of depressive symptoms. The following hypotheses were
tested: (1) higher levels of attachment anxiety are uniquely associated with higher levels of RTna, (2) higher
levels of RTna are associated with higher levels of depressive symptoms, and (3) higher levels of RTna mediate
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
the positive relationship between attachment anxiety and depressive symptoms. To test whether this mediation
by RTna is specific for the relationship between attachment anxiety and depressive symptoms, the latter
mediation analysis will be repeated with attachment avoidance as independent variable. In all analyses, the other
attachment dimension will be added as a control variable.
Study 1
Method
Participants. In this study, 390 children (53% girls) of the 5 th and 6th grade of nine Belgian primary
schools participated. The age of the participants ranged between 9 to 13 years (M = 11.25, SD = 0.65).
Procedure. Letters with information about the aim and procedure of the study were distributed in the
classrooms. In these letters, children were invited to participate and parents were asked for permission through
passive informed consent. This way, the study achieved a 99% response rate. Children collectively filled out the
questionnaires in a fixed order during school hours under supervision of a psychology master’s student.
Measures.
Attachment anxiety and attachment avoidance. The child version of the Experiences in Close
Relationships Scale-Revised (ECR-RC; Brenning et al., 2011) about mother was completed by the participants to
assess attachment anxiety and attachment avoidance. This self-report questionnaire consists of 18 items for the
Attachment Anxiety scale (e.g. “I’m worried that my mother might want to leave me.”) and of 18 items for the
Attachment Avoidance scale (e.g. “I prefer not to get too close to my mother.”). The items are scored on a 7point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). A mean score for attachment anxiety
and for attachment avoidance was computed across each scale’s 18 items. The ECR-RC has been proven to
explicitly distinguish between attachment anxiety and attachment avoidance and both scales have strong internal
consistency, construct validity and predictive validity (Brenning et al., 2011). In the current sample, internal
consistencies of attachment anxiety (α = .87) and attachment avoidance (α = .90) were very good according to
the criteria of DeVellis (2003).
Repetitive thinking about negative affect (RTna). RTna was assessed using the Brooding subscale of
the Children’s Response Styles Questionnaire-Extended (CRSQ-ext; Verstraeten et al., 2010; adaptation of the
CRSQ; Abela, Vanderbilt, & Rochon, 2004). This self-report questionnaire consists of 5 items (e.g. “When I am
sad, I think about a recent situation wishing it had gone better.” “When I am sad, I think: ‘‘Why do I always
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
react this way?”), which are scored on a 4-point Likert scale ranging from 1 (almost never) to 4 (almost always).
A mean score for RTna was calculated across the 5 items. In the current sample, internal consistency of RTna (α
= .77) was respectable according to the criteria of DeVellis (2003).
Depressive symptoms. To assess depressive symptoms, the Children’s Depression Inventory (CDI;
Kovacs, 2003; Dutch translation by Timbremont & Braet, 2002) was administered. The 27 items of this selfreport questionnaire involve cognitive, affective and behavioral symptoms of depression over the past two
weeks. The participants are asked for each item to choose the description that fits best from three descriptions
(e.g. “I feel like crying every day/many days/sometimes.”). The items are scored on a 3-point rating scale
ranging from 0 to 2, with higher scores reflecting more severe depressive symptoms. A mean score was
calculated across all 27 items. The CDI is reliable and valid (Kovacs, 2003; Saylor, Finch, Spirito, & Bennett,
1984) and discriminates children with major depressive disorders from non-depressed children (Kovacs, 2003).
For the Dutch version of the CDI, a cut-off score of 0.59 maximized its specificity and sensitivity (Theuwis,
Braet, Roelofs, Stark & Vandevivere,2013). In the current sample, internal consistency of depressive symptoms
(α = .87) was very good.
Results
Preliminary Analyses. Due to missing values, data for seven children were listwise deleted from the
data analyses, resulting in data for 381 children. There were no significant gender or age effects. Therefore, there
will not be controlled for these variables in subsequent analyses. In the sample of Study 1, 18.6% of the children
scored equal to or above the cut-off score on self-reported depressive symptoms. In Table 1, descriptive statistics
for all the variables are presented.
Associations between attachment anxiety, attachment avoidance, RTna, and depressive
symptoms. In Table 1, zero-order correlations between all the variables are presented. Both attachment anxiety
and attachment avoidance correlated positively with RTna. Because attachment anxiety and attachment
avoidance were positively correlated, hierarchical multiple regression analyses were conducted in SPSS to
investigate whether RTna was uniquely linked with attachment anxiety and not with attachment avoidance.
Attachment anxiety remained significantly related to RTna after controlling for attachment avoidance ( = .31,
t(378) = 5.21, p < .001), whereas there was no unique association of attachment avoidance with RTna when
controlling for attachment anxiety ( = .01, t(378) = 0.24, p = .810) (R² = .10, F(2,378) = 20.91, p < .001).
Attachment anxiety was positively related to depressive symptoms, also after controlling for attachment
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
avoidance ( = .35, t(378) = 6.73, p < .001). Attachment avoidance was positively related to depressive
symptoms, also after controlling for attachment anxiety ( = .26, t(378) = 4.94, p < .001) (R² = .29, F(2,378) =
78.06, p < 001). RTna had a significantly positive correlation with depressive symptoms.
Mediation analyses. These analyses were conducted with the macro ‘PROCESS’ (Hayes, 2013) in
SPSS, which calculates unstandardized regression coefficients, standard errors, and effect sizes for indirect
effects of an independent variable (IV) on a dependent variable (DV) through one or multiple simultaneous
mediators (M). A bootstrap with N = 10,000 resamples was used. A point estimate of an indirect effect was
considered significant in the case zero was not contained in the 95%- or 99%- bias corrected confidence interval
(BC CI). When this point estimate is significant, mediation occurs. In the analyses with attachment anxiety as
independent variable, attachment avoidance was added as a covariate, and vice versa.
The indirect effect of attachment anxiety on depressive symptoms through RTna was significant (B =
0.03, SE = 0.01, 99%-BC CI [0.016, 0.061]; completely standardized B = .11). There was no significant indirect
effect of attachment avoidance on depressive symptoms through RTna (B = 0.00, SE = 0.01, 90%-BC CI [0.009, 0.011]; completely standardized B = .01, SE = .02, 90%-BC CI [-.035, .045]). This model explained 44%
of the variance in depressive symptoms (F(3,377) = 97.71, p < .001). 1 As a final test of whether RTna uniquely
mediates the link between attachment anxiety and depressive symptoms we performed a path analysis with both
attachment anxiety and avoidance as IV’s, RTna as M, and depressive symptoms as DV. Again, there was a
significant indirect effect of attachment anxiety on self-reported depressive symptoms through RTna (B = 0.04,
SE = 0.01, p < .001, 99%-BC CI [0.017, 0.061]), but not of attachment avoidance.
Discussion
Study 1 investigated whether RTna could be one mechanism explaining the association between
attachment anxiety and depressive symptoms in middle childhood. Results showed that (1) RTna was more
strongly linked with attachment anxiety than attachment avoidance, (2) higher levels of RTna were associated
with higher levels of depressive symptoms, and (3) RTna only mediated the association between attachment
anxiety and depressive symptoms and not the association between attachment avoidance and depressive
symptoms. .These findings suggest that RTna can be considered as a risk mechanism that is specific for
association between attachment anxiety and depressive symptoms.
1
A hierarchical multiple regression analysis was conducted to obtain the effect size for the addition of RTna to
attachment avoidance and attachment anxiety in the prediction of depressive symptoms. A medium-high effect
size was obtained (Cohen’s f² = .26).
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
These results are in line with the finding of Ruijten et al. (2011) that adolescents who have less trust in
maternal support report more RTna, which in turn, predicts higher levels of depressive symptoms. The current
study extended their finding by replicating this effect in middle childhood and by assessing specific insecure
attachment dimensions instead of insecure attachment in general. This way, the current study provided further
support for the hypothesis that RTna is an ER strategy that is typical for attachment anxiety and not for
attachment avoidance and, thus, can help explain why and how attachment anxiety is related with depressive
symptoms.
A limitation of Study 1 was that it solely relied on self-report. By not considering multiple informants,
results could have been inflated by reporter bias due to emotion-related memory biases or self-representational
biases (Bosmans, Braet, Beyers, Van Leeuwen, & Van Vlierberghe, 2011; Timbremont, Braet, Bosmans, & Van
Vlierberghe, 2008). Moreover, attachment, RTna, and depressive symptoms are all related to temperamental
negative affectivity (e.g. Goldsmith & Alansky, 1987; Verstraeten, Vasey, Raes, & Bijttebier, 2009). As this
confound might have inflated the results, it seems necessary to control for this variable. Finally, this study only
focused on heightening of negative affect, and not on the second component of the heightening strategy,
heightening of the importance of the attachment relationship. We conducted a second study to address these
limitations.
Study 2
With regard to the second component of anxiously attached children’s heightening ER strategy,
heightening the importance of the attachment relationship, little research has been conducted in middle
childhood. In infancy, heightening the importance of the attachment relationship has been observed in anxiously
attached infants’ overdependence on their attachment figure, in their enhanced attentional focus on and increased
monitoring of their attachment figure, and in their elevated behavioral efforts aimed at minimizing distance from
their attachment figure (Cassidy, 1994; Cassidy & Berlin, 1994). In middle childhood, attachment behavior
becomes less intense and observable (Mayseless, 2005). Instead, less explicit cognitive and affective aspects of
IWM’s about attachment figures become more important in alleviating distress (Armsden & Greenberg, 1987;
Cassidy, 2008; Kerns et al., 2006).
Given the increased importance of cognitive processes in attachment as children grow older (Main,
Kaplan, & Cassidy, 1988), one could argue that heightening the importance of the attachment relationship might
also be reflected at a cognitive level in middle childhood. This argument is preliminary supported by anxiously
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
attached children’s narratives about attachment-related events reflecting repetitive, absorbing, and often negative
thoughts about the attachment figure (Venta, Shmueli-Goetz, & Sharp, 2014). Therefore, we propose that
repetitive thinking about mother (RTm) might reflect a strategy that expresses anxiously attached children’s
heightened importance of the attachment relationship (Mikulincer, Shaver, & Pereg, 2003; Shaver & Mikulincer,
2002). In normative development, the focus on mother should decrease throughout middle childhood in order to
promote autonomy and other skills in service of adaptive adolescent development (Koehn & Kerns, 2015;
Mayseless, 2005). Consequently, theory suggests that maintaining a heightened focus on mother has a
maladaptive effect on children’s further development: it impairs their autonomy to freely explore information
and learn age-appropriate strategies to deal with distress. Instead, focusing on a mother that elicits fears for
rejection and absent care interferes with using strategies that help reducing distress (Mikulincer & Shaver, 2007
(Bosmans, Dujardin, et al., 2015; Dujardin, Bosmans, De Raedt, & Braet, 2015). Consequently, RTm could be
an unstudied cognitive mechanism that might be considered in addition to RTna to explain the link between
attachment anxiety and depressive symptoms in middle childhood. To investigate this proposition, in Study 2 a
self-report questionnaire of RTm was developed because self-report questionnaires are proposed to be the most
adequate method to tap into unobservable processes such as repetitive thinking (De Los Reyes & Kazdin, 2005).
Additionally, to overcome Study 1’s limitation that all variables were measured using self-report,
depressive symptoms were assessed using self- and mother-report. We tested the hypotheses that (1) higher
levels of attachment anxiety are associated with higher levels of RTna and RTm, (2) higher levels of RTna and
RTm are associated with higher levels of depressive symptoms, (3) RTna and RTm mediate the association
between attachment anxiety and depressive symptoms, with RTm mediating this relationship over and above
RTna. To test whether this mediation by RTna and/or RTm is specific for the relationship between attachment
anxiety and depressive symptoms, the latter mediation analysis will be repeated with attachment avoidance as
independent variable. In all analyses, the other attachment dimension will be added as a control variable.
Moreover, we will control for temperamental negative affectivity to ensure that the results not simply reflect the
overlap between the variables’ association with negative affectivity.
Method
Participants. In this study, 157 children (52% girls) from 16 Belgian primary schools aged 9 to 12
years old (M = 10.91, SD = 0.87) and their mothers participated in the study. Most of the children lived with both
parents (76%). Mother was a primary caregiver in the first three years of life for 97% of the participating
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
children. With regard to education, 21% of the mothers had an elementary school or high school degree, 36% did
specialization studies after high school, and 43% had a university degree, whereas of the fathers, 31% had an
elementary school or high school degree, 24% did specialization studies after high school, and 46% had a
university degree.
Procedure. To invite children and their mothers to our study, we distributed flyers with information
about the study in the classrooms of the 4th, 5th and 6th grade. Because both mother and child had to come to
either of two research locations for an assessment that was part of a broader study on attachment, attachmentrelated information processing biases and depression, letters were only distributed in schools in the vicinity of
these locations. Free parking and a reward for participating (two movie theatre tickets and the chance of getting
an mp3-player) were promised to each mother-child dyad. Children and their mothers who wished to participate
were contacted by the researcher or a master student. Upon arrival, active informed consent was obtained from
both the child and the mother. The questionnaires were administered in a fixed order among the other measures
of the broader assessment.
Measures. The measures in this second study were largely the same as in Study 1. RTna was assessed
with the 5 item Brooding subscale of the CRSQ-ext. Attachment anxiety and attachment avoidance were
assessed with a shortened version of the ECR-RC (Brenning, Van Petegem, Vanhalst, & Soenens, 2014),
consisting of 6 items for the Attachment Anxiety scale and 6 items for the Attachment Avoidance scale. This
version also showed excellent reliability and validity (Brenning et al., 2014). In the current sample, the internal
consistencies of attachment anxiety (α = .79), attachment avoidance (α = .74), and RTna (α = .76) were
respectable.
Negative affectivity. The parent report form of The Early Adolescent Temperament QuestionnaireRevised (EATQ-R; Ellis & Rothbart, 2001; revision of the EATQ; Capaldi & Rothbart, 1992; Dutch translation
by Rothbart & Hartman, 2001) was filled out by the mother. It consists of 62 items that are answered on a 5point Likert scale ranging from 1 (almost never true) to 5 (almost always true). In the current study, only the
items of the subscales Fear and Frustration were used. These subscales reflect the factor Negative Affectivity and
measure negative affect related to anticipation of distress (e.g. “My child worries about getting into trouble.”)
and to the interruption of ongoing tasks or goal blocking (e.g., “My child is annoyed by little things other kids
do.”) (Oldehinkel, Hartman, De Winter, Veenstra, & Ormel, 2004). The internal consistency, construct validity
and predictive validity of negative affectivity have been demonstrated in several studies (Ellis, 2002; Oldehinkel
et al., 2004). In the current sample, the internal consistency of negative affectivity (α = .77) was respectable.
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Repetitive thinking about mother (RTm). The Perseverative Thinking about Mother Questionnaire
(PTMQ) is a self-report questionnaire that was designed for the current study to measure RTm. The
Perseverative Thinking Questionnaire Child Version (PTQ-C; Bijttebier, Raes, Vasey, Bastin, & Ehring, 2014)
inspired the formulation of the 15 PTMQ items that are scored on a 5-point Likert scale ranging from 0 (almost
never) to 4 (almost always). By not phrasing the items in accordance with scales for rumination, RTna, worry,
anxiety or attachment anxiety, an attempt was made to avoid item overlap with the Brooding subscale of the
CRSQ-ext and with the Attachment Anxiety scale of the ECR-RC-short. Moreover, the content-independent
items of the PTQ-C purely capture the thinking process and the dysfunctional effects of repetitive thinking, and
therefore provide a good base to formulate items about RTm without distinguishing between specific proximityrelated thoughts or worries.
PTMQ items were subjected to exploratory factor analysis. A principal components analysis was used
to extract factors. There were two factors with an initial eigenvalue greater than 1. The first factor had an
eigenvalue of 6.39 and accounted for approximately 42.6% of the common variance, while retaining a second
factor (with an eigenvalue of 1.19) only increased the explained common variance with 8.0% and made
interpretation of the factors difficult. Based on these eigenvalues and their explained variance, the scree plot and
the interpretability of the solution, one factor was retained. The loadings of the 15 items on this factor (shown in
Appendix A) seem satisfactory, as Stevens (2002) recommends interpreting factor loadings with an absolute
value greater than .40. Confirmatory factor analysis (CFA) revealed that the fit of the one-factor solution to the
PTMQ data was acceptable (Maximum Likelihood Ratio ² (C1) = 175.91, df for (C1) – (C2) = 90, ²/df = 1.95,
RMSEA = .08, SRMR = .06, CFI = 0.97). A mean score for RTm was calculated across the 15 items. In the
current sample, the internal consistency of the PTMQ (α = .90) was very good.
Self-reported and mother-reported depressive symptoms. The CDI was administered again to estimate
self-reported depressive symptoms. The internal consistency of self-reported depressive symptoms (α = .81) was
very good. The Withdrawn-Depressed subscale of the Child Behavior Checklist (CBCL; Achenbach & Rescorla,
2001) was used to assess mother-reported depressive symptoms of the child. This subscale consists of 6 items
(e.g., “There is little that he/she likes.”), which are rated on a 3-point scale (0 = not true, 1 = somewhat or
sometimes true, 2 = very true or often true). A mean score was calculated for these 6 items. The CBCL is a valid
and reliable questionnaire (Achenbach & Rescorla, 2001) and the Withdrawn-Depressed subscale discriminates
youths with major depression disorder or dysthymic disorder from youths without these diagnoses (Ebesutani et
13
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
al., 2010). In the current sample, the internal consistency of mother-reported depressive symptoms (α = .73) was
respectable.
Multi-informant compound score of depressive symptoms. Using principal component analysis in
SPSS, a common factor score was calculated based on the mean scores of the two measures for depressive
symptoms (CDI and the Withdrawn-Depressed scale of the CBCL) (see for example, Braet, Van Vlierberghe,
Vandevivere, Theuwis, & Bosmans, 2013). This multi-informant compound score reflects the common variance
between self-reported and mother-reported depressive symptoms, or in other words, the extent to which children
and their mothers agree upon child depressive symptoms. One factor with an eigenvalue higher than 1 (1.31) was
extracted with both informants’ scores loading .81 on this factor.
Results
Preliminary analyses. Missing values were deleted for each analysis separately. There were no
significant gender effects, but RTna correlated significantly with age (r(154) = .22, p = .007), and therefore, age
will be used as control variable in subsequent analyses. Negative affectivity correlated positively with RTm
(r(145) = .17, p = .040) and depressive symptoms (self-report: r(140) = .23, p = .007; mother-report: r(152) =
.33, p < .001; and multi-informant compound score: r(140) = .38, p < .001). In this sample, 6.2% of the children
scored equal to or above the cut-off score for self-reported depressive symptoms. For mother-reported depressive
symptoms, 7.6% of the children scored in the subclinical range, and 4.5% scored in the clinical range. In Table
1, descriptive statistics for all the variables are presented.
Associations between attachment anxiety, attachment avoidance, RTna, RTm and depressive
symptoms. In Table 2, zero-order correlations between the variables are presented. Firstly, attachment anxiety
correlated positively with RTna and RTm. Because attachment anxiety and attachment avoidance were
positively correlated, multiple hierarchical regression analyses were conducted to investigate whether RTna and
RTm were uniquely linked with attachment anxiety and not with attachment avoidance (Table 3). Attachment
anxiety remained significantly related to RTna and RTm after controlling for attachment avoidance, whereas
there was no unique association of attachment avoidance with RTna and RTm when controlling for attachment
anxiety. Furthermore, attachment anxiety was positively related to depressive symptoms, also after controlling
for attachment avoidance. Attachment avoidance was positively correlated with depressive symptoms, however,
the correlation with mother-reported depressive symptoms became only marginally significant after controlling
for attachment anxiety. Finally, RTna and RTm correlated positively with self-reported depressive symptoms,
14
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
but no associations were found with mother-reported depressive symptoms. However, the correlations between
on the one hand RTna and RTm and on the other hand the multi-informant compound score were significant.
Mediation analyses. These analyses were conducted with the macro ‘PROCESS’ (Hayes, 2013) in
SPSS. Three separate analyses were conducted for each attachment dimension (while controlling for the other
dimension), testing whether attachment is indirectly linked to depressive symptoms through (1) RTna as single
mediator (2) RTm as single mediator and (3) RTna and RTm as multiple mediators. Because there was no
association between RTna/RTm and mother-reported depressive symptoms, these mediation analyses only were
conducted for self-reported depressive symptoms and the multi-informant compound score as dependent
variables (Tables 4 and 5, respectively).
Analyses with the self-reported depressive symptoms score as DV, replicated the effect found in Study
1. Again, the association between attachment anxiety and depressive symptoms was significantly mediated by
RTna (Table 4, row 1). Next, there was a significant indirect effect of attachment anxiety on self-reported
depressive symptoms through RTm (Table 4, row 2). Finally, in multiple mediation analyses with RTna and
RTm as mediators, there was a significant, unique indirect effect of attachment anxiety on self-reported
depressive symptoms through RTna as well as RTm (Table 4, row 3).
When using the multi-informant compound score as DV, there was a marginally significant indirect
effect of attachment anxiety on depressive symptoms through RTna (Table 5, row 1). Next, there was a
significant indirect effect of attachment anxiety on the multi-informant compound score through RTm (Table 5,
row 2). Finally, in multiple mediation analyses with RTna and RTm as mediators, the indirect effect of
attachment anxiety on the multi-informant compound score through RTna disappeared whereas there was a
significant, unique indirect effect through RTm (Table 4, row 3).2
In addition, negative affectivity was added as a covariate in these mediation analyses with attachment
anxiety as IV. Only one of the eight indirect effects changed, namely the significant indirect effect through RTna
for self-reported depressive symptoms, in the analyses with both RTna and RTm as mediators (Table 4, row 3).
This indirect effect became marginally significant (B = 0.01, SE = 0.01, 90%-BC CI [0.001, 0.026]; completely
standardized B = .04), whereas the indirect effect through RTm remained significant.
In all the mediation analyses with attachment avoidance as independent variable, the indirect effects
through RTna and RTm were not significant (Table 4 and 5, rows 4, 5, and 6). Path analyses with both
2
Hierarchical multiple regression analyses were conducted to obtain the effect sizes for the addition of RTna and
RTm to age, attachment avoidance and attachment anxiety in the prediction of self-reported depressive
symptoms and the multi-informant compound score. A medium (Cohen’s f² = .19) and medium-low (Cohen’s f²
= .08) effect size were obtained, respectively.
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
attachment anxiety and avoidance as IV’s, RTna and RTm as M’s, and depressive symptoms as DV were also
conducted. There was a marginally significant indirect effect of attachment anxiety on self-reported depressive
symptoms through RTna (B = 0.01, SE = 0.01, p = .09, 95%-BC CI [0.001, 0.027]) and a significant indirect
effect through RTm (B = 0.02, SE = 0.01, p = .04, 99%-BC CI [0.002, 0.037]). There was no significant indirect
effect of attachment anxiety on the multi-informant compound score through RTna (B = 0.03, SE = 0.03, p = .35,
90%-BC CI [-0.003, 0.098]), but a marginally significant indirect effect through RTm (B = 0.09, SE = 0.05, p =
.07, 99%-BC CI [0.004, 0.250]). However, there were no significant indirect effects of attachment avoidance on
depressive symptoms, through RTna or RTm.
Discussion
Discussion
Study 2 was carried out to investigate whether the association between attachment anxiety and
depressive symptoms could be explained by children’s RTna and RTm. The effects depended on who reported
on the presence of depressive symptoms. This study replicated the findings of Study 1 and extended these
findings by revealing that the association between attachment anxiety and depressive symptoms not only reflects
children’s RTna, but also children’s RTm
The association between attachment anxiety and RTna found in Study 1 was replicated in Study 2.
Higher levels of attachment anxiety were associated with higher levels of RTna. In addition, higher levels of
attachment anxiety were associated with higher levels of RTm and higher levels of RTm were associated with
higher levels of both self-reported depressive symptoms and depressive symptoms agreed upon by mother and
child. However, neither RTna, nor RTm, were associated with mother-reported depressive symptoms. This
finding is in line with other studies that show that there is a small agreement between mothers and children on
children’s unobservable, internal cognitions and feelings, like depressive symptoms (Angold et al., 1987; De Los
Reyes & Kazdin, 2005). Nevertheless, the fact that the effects were found again when using a multi-informant
compound score, which reflects depressive symptoms agreed upon by mother and child, does reflect that the
correlations between RTna/RTm and self-reported symptoms are not merely the result of reporter bias.
Regarding the mediation analyses, Study 2 replicated the results of Study 1 for self-reported depressive
symptoms. More specifically, RTna mediated the association between attachment anxiety and self-reported
depressive symptoms. These findings suggested that children who reported being more anxiously attached, also
reported more repetitive thoughts about negative affect, which in turn, was related to increased self-reported
16
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
depressive symptoms. Adding to Study 1, there was a trend for mediation by RTna in the association between
attachment anxiety and depressive symptoms agreed upon by mother and child. This finding suggests that the
effect might not be merely the result of reporter bias or shared method variance because the multi-informant
compound score theoretically reflects the variance in depressive symptoms that is shared or agreed upon by the
two informants. Further adding to Study 1, RTm mediated the relationship between attachment anxiety and
depressive symptoms, over and above RTna. When children reported being more anxiously attached, they also
reported more RTm, which in turn, was related to their self-reported depressive symptoms. Interestingly, for the
depressive symptoms agreed upon by mother and child, adding RTm reduced the mediation by RTna to nonsignificance while the mediation by RTm remained significant. Importantly, these effects could not be explained
by negative affectivity. This further supports the hypothesis that the current studies identified attachment
anxiety-specific depressogenic mechanisms. Additionally supporting that this mechanism is specific for
attachment anxiety, there was no mediation by RTna or RTm in the association between attachment avoidance
and depressive symptoms. Finally, both the multiple mediation and the path analyses suggested that the
mediation by RTm had a larger effect size than the mediation of RTna. Although more research is needed to
investigate whether this finding replicates, this could indicate that RTna might be a part or a consequence of
RTm instead of an unique, equally important mechanism in the association between attachment anxiety and
depressive symptoms as suggested by the two components of the heightening strategy.
General Discussion
The aim of the current studies was to examine the mechanisms explaining the link between attachment
anxiety and depressive symptoms in middle childhood. In two studies, we investigated age-appropriate indicators
of two components of the heightening ER strategy observed in insecure-anxiously attached individuals, namely
heightening negative affect and heightening the importance of the attachment relationship. More specifically, it
was proposed that these heightening strategies might be reflected in increased repetitive thinking about negative
affect (RTna) and increased repetitive thinking about mother (RTm) respectively. Two studies provided first
evidence for the claim that the association between attachment anxiety and depressive symptoms is mediated by
repetivitive thoughs about negative affect and mother, although the strength of the effects depended on who
reported on children’s depressive symptoms.
17
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Indicating that the current sample and data can be used to test these mediation hypotheses, in both
samples, the means of depressive symptoms and the percentage of children displaying (sub)clinical levels of
depressive symptoms are in line with the prevalence rates that are on average found in samples of this age-group
(Roelofs et al., 2010; Twenge & Nolen-Hoeksema, 2002). Moreover, as in previous research (see for example
the review by Brumariu & Kerns, 2010; Madigan et al., n.d.), insecure attachment was linked to depressive
symptoms. Although often stronger links with depressive symptoms are found for attachment anxiety compared
to avoidance (Brumariu & Kerns, 2010; Madigan et al., n.d.), in the current samples, both insecure attachment
dimensions were linked with depressive symptoms. However, similar patterns of results were found in several
other studies (Brenning et al., 2012; Groh et al., 2012; Madigan et al., 2013). This is not surprising as also
avoidantly attached children are less likely to seek maternal support during distress making them more
vulnerable to the detrimental effects of prolonged exposure to stress and stressful situations (Dujardin et al.,
n.d.). Nevertheless, several studies also suggested that, even though both insecure attachment dimensions can be
equally strong related to depressive symptoms, the underlying mechanisms differ (Brenning et al., 2012).
The current findings are in line with that suggestion, showing that RTna and RTm mediate the
association between attachment anxiety and depressive symptoms, but not the association between attachment
avoidance and depressive symptoms. These effects were predicted by Cassidy (1994), and the current study
provides first convincing evidence for these attachment-anxiety specific depressogenic mechanisms. Hereby, the
mediating effect of RTna appears to be highly robust, as it was replicated in both studies for self-reported
depressive symptoms and as there was a trend of replication for depressive symptoms agreed upon by mother
and child. Additionally, RTm mediated the relationship between attachment anxiety and both depressive
symptoms scores . There was no mediation by RTna and RTm in the relationship between attachment avoidance
and depressive symptoms. Theoretically it has been proposed that attachment avoidance might influence
depressive symptoms through other maladaptive emotion regulation strategies such as supression (Brenning et
al., 2012; Wei, Vogel, Ku, & Zakalik, 2005). However, a systematic review suggests that evidence for such a
mechanism is less robustly found (Malik, Wells, & Wittkowski, 2015) suggesting that mre research is needed to
explain the maladaptive effects of attachment avoidance.
Interestingly, visual inspection of the effect sizes in the singleand multiple mediation analyses of Study
2 (in row 1, 2, and 3 in Table 4 and 5) suggests that the indirect effect through RTm has a larger effect size than
the indirect effect through RTna, and that adding RTm to the mediation model reduces the indirect effect of
RTna. More research is needed to test whether this means that RTna might be a part or a consequence of RTm
18
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
instead of an unique, equally important mechanism in the association between attachment anxiety and depressive
symptoms as suggested by the two components of the heightening strategy.
Furthermore, research is needed to further identify the maladaptive mechanisms behind repetitive
thinking about mother. The current study was based on hypotheses about the maladaptive nature of repetitive
thoughts in general. According to attachment literature, the focus on the attachment figure should decline in this
age period. Instead, in normative development, theory assumes that children’s focus shifts away from mother to
foster autonomous exploration (Koehn & Kerns, 2015; Mayseless, 2005). In support of this assumption that a
reduced focus on mother is beneficial for explarotaiton, attentional processing research shows that children with
more trust are better able to ignore mother and to explore potentially challenging stimuli (Dujardin et al.,
2015)(Bosmans field etc, 2015).. Instead, a heightened focus on mother might interfere with children’s
engagement in important developmental tasks, like learning to cope with mild distress. For example, children
with a heightened focus on mother seek maternal support more quickly when feeling mildly distressed
(Bosmans, Braet, Heylen, & De Raedt, 2015). However, once they become highly distressed, the latter study
showed that children with an heightened focus on mother actually waited longer to seek her support, further
suggesting that an increased attentional focus on mother interferes with actual support seeking behavior at times
when this support is most needed (Bosmans, 2015). Although the current findings are in line with the repetitive
thinking literature that shows that repetitive thinking in general is a maladaptive cognitive process as it interferes
with individual’s healthy ability to flexibily shift their focus between different stimuli and thoughts, the current
study’s operationalization of RTm, did not allow testing the possibility that some repetitive thoughts about
mother are more maladaptive then others, depending on the content of the thoughts. In support of the possibility
that the current effect might be explained by the content of anxiously attached children’s repetitive thoughts
about mother, Mikulincer et al. (2000, 2002) found that negatively valenced proximity-related worries are
chronically accessible in anxiously attached individuals, whereas in securely attached individuals only thoughts
about love and support are accessible. This might mean that, in a short-term perspective, a focus on mother
might be beneficial, as it might lower distress by creating a sense of connection with an unavailable mother in
times of need (Mayseless, 2005; Seltzer, Ziegler, & Pollak, 2010). So although the maladaptive nature of RTm
seems to be situated primarily in its repetitiveness instead of in its possible negatively valenced content, in view
of both possible explanations, it could be useful to examine the content of repetitive thoughts in future research.
Limitations
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Although the findings of both current studies seem to increase our understanding of the mechanisms
explaining the association between attachment anxiety and depressive symptoms, some limitations should be
taken into account while drawing conclusions. Firstly, the design of both studies was cross-sectional. Although
mediation analyses at first glance seem to suggest causal and temporal relationships, no conclusions can be made
about the causality or the direction of the effects. Nevertheless, regarding RTna, the current findings are in line
with previous studies suggesting longitudinal associations between parenting (e.g., psychological control), RTna
and depressive symptoms (Gaté et al., 2013; Hilt et al., 2012). Parenting is closely related to attachment
development (Ainsworth, Blehar, Waters, & Wall, 1978), and controlling parenting behavior mediates the
association between attachment and psychopathology (Bosmans et al., 2011; Bosmans, Braet, Van Leeuwen, &
Beyers, 2006), and between attachment anxiety and depressive symptoms in particular (Brenning et al., 2012).
Although one could assume that similar longitudinal associations might be found between attachment anxiety,
RTna, and depressive symptoms, this has not been investigated so far. Regarding RTm, the second study served
as a first test of a novel hypothesis. Consequently, future research should invest in experimental and longitudinal
designs (using cross-lagged analyses) to overcome the current studies’ limitation and to determine the direction
of the effects between attachment anxiety, RTna, RTm, and depressive symptoms.
Furthermore, in the current studies only questionnaires were administered and no other methods were
used to measure attachment anxiety, RTna, RTm and depressive symptoms. Consequently, it is possible that thce
current effects reflected shared method variance effects instead of a mechanism explaining the link between
anxious attachment and depressive symptoms. In an attempt to test whether the effects are indeed only the result
of shared method variance or, instead, reflect a specific mechanism, we performed path analyses during which
the order of the predictor and mediator variabels was reversed. Comparing the fits between models can give
some indication that XXX. In the current studies, we could only perform such an analysis for the data fo study 2
because the mdoel of study 1 was saturated. For Study 2, fit indices suggested that the attachment –RTm/RTna –
depressive symptoms model fitted the data better (RMSEA = , CFI =, ) better than the reversed model (RMSEA
=, CFI = ). Consequently, this seems to suggest that the findings might reflect more than just shared-method
variance. Nevertheless, it would be more appropriate to test the current studies’ hypotheses using different
methods for the different variables. With regard to attachment, it could be important to include interviews such
as CAI? or prompt-word methods such as the SBS test. With regard to depressive symptns, it oculd be
interesting to use interviews such as….
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Finally, the interpretation of the findisngs regarding RTm should take into account that the way we
operationalized the heightened focus on mother in middle childhood is innovative and consequently, this has as
disadvantage that much more research is needed to evaluate the PTMQ’s validity and reliability. In the current
study, RTm mediated the relationship between attachment anxiety (but not attachment avoidance) and depressive
symptoms over and above, and sometimes even beyond RTna, and these constructs were moderately but not
highly correlated (r = .30). This suggests that RTm might be a different form of repetitive thinking that explains
unique variation in depressive symptoms, and thus, is a first indication for divergent and predictive validity for
the PTMQ. However, future research is needed to ensure this is really the case.
Clinical implications
Despite these limitations, both current studies demonstrate the role of repetitive thinking about negative
affect and about mother in the association between attachment anxiety and depressive symptoms. These findings
may have some clinical implications. Treatment methods for depression are generally less effective than
treatment methods for other disorders (Weisz et al., 2006). As the current study highlights that RTna as well as
RTm contribute to depressive symptoms, it seems important to target both components to reduce current
depressive symptoms and further relapse. By reducing RTm, more cognitive capacity might become available to
learn from new experiences. Therefore, on the one hand, it could be useful to combine interventions targeting
RTm with existing interventions that have been proven successful in reducing RTna, like Cognitive behavioral
therapy (CBT), and rumination-focused CBT (RFCBT) (Watkins et al., 2007; Wilkinson & Goodyer, 2008).
These interventions try to switch individuals from less helpful to more helpful thoughts (Watkins et al., 2007;
Wilkinson & Goodyer, 2008). As RTm is a novel construct, interventions focusing specifically on reducing RTm
could be developed by analogy WITH? Beter ANALOGUOUS TO (what?). On the other hand, as RTm and
RTna are both types of repetitive thinking, it could be more efficient to target the repetitive and intrusive
thinking process, instead of the content of the thoughts, like in CBT. To this end, Mindfulness Based Cognitive
Therapy (MBCT; Teasdale et al., 2000) focuses on increasing awareness of thoughts and on relating to them in a
detached and decentered perspective, and seems a promising intervention to target RTna and RTm
simultaneously. Further research could disentangle active components of (RF)CBT and MBCT and investigate
effectiveness of combinations of these components in preventing different types of repetitive thinking in middle
childhood. WAAROM NIET DE RELATIE HERSTELLEN ZOALS IN ABFT?
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Conclusion
In sum, the current studies provided insight in the mechanisms explaining the relationship between
attachment anxiety and depressive symptoms in middle childhood. The two studies extended the findings of
Brenning et al. (2012) and Ruijten et al. (2011) in three ways: by focusing not only on heightening negative
affect, but also on heightening the importance of the attachment relationship, by investigating these mechanisms
in middle childhood, and by assessing specific insecure attachment dimensions instead of general insecure
attachment. Repetitive thinking about negative affect and about mother were found to play a significant role in
the association between attachment anxiety and depressive symptoms. Especially repetitive thinking about
mother seems a promising direction for future research as it could fill the gap on the role of attachment in the
development of depressive symptoms.
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
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Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Appendix
Factor loadings of exploratory factor analysis on the PTMQ
Item
When I am going through an unpleasant time or am experiencing some problems…
Factor 1
13.
… I feel as if I must keep thinking about my mother.
.76
11.
…I keep thinking about my mother all the time.
.76
6.
…the same thoughts about my mother return into my mind.
.75
7.
…thoughts about my mother come into my mind without me wanting them to.
.70
10.
… my thoughts about my mother prevent me from focusing my attention on other things.
.68
9.
…I keep asking myself questions about my mother without finding an answer.
.67
4.
…I think about my mother without it helping me solve any of these problems.
.67
8.
…when I am thinking about my mother, I get stuck and I find it difficult to stop these
.67
thoughts.
15.
…my thoughts about my mother take up all my attention.
.64
2.
…thoughts about my mother come on and I can’t do anything against it.
.63
1.
… the same thoughts about my mother keep going through my mind again and again.
.61
3.
… I can’t stop thinking about my mother.
.60
12.
…thoughts about my mother just pop into my mind.
.57
5.
…I can’t do anything else while thinking about my mother.
.55
14.
…my thoughts about my mother are not much help to me.
.45
31
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Table 1
Means, Standard Deviations, and Correlation Coefficients Among the Variables of Study 1 (N = 381)
1
2
3
4
1
Attachment anxiety
-
2
Attachment avoidance
.56***
-
3
RTna
.32***
.19***
-
4
Depressive symptoms
.50***
.46***
.52***
-
M
2.05
2.52
2.23
0.34
SD
0.90
1.08
0.73
0.25
Note. RTna = Repetitive thinking about negative affect; Depressive symptoms = Self-reported depressive
symptoms.
*** p < .001
32
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Table 2
Means, Standard Deviations, and Correlation Coefficients Among the Variables in Study 2 (n=139-154)
1
2
3
4
5
6
7
1
Attachment anxiety
-
2
Attachment avoidance
.43***
-
3
RTna
.23**
.11
-
4
RTm
.30***
.14
.30***
-
5
Depressive symptoms S
.51***
.36***
.39***
.44***
-
6
Depressive symptoms M
.25**
.23**
-.02
.12
.31***
-
7
Depressive symptoms C
.45***
.34***
.26**
.38***
.81***
.81***
-
M
1.49
2.81
2.04
1.08
0.24
0.22
0.00
SD
0.71
1.16
0.69
0.66
0.18
0.27
1.00
Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother; Depressive
symptoms S= Self-reported depressive symptoms; Depressive symptoms M = Mother-reported depressive
symptoms; Depressive symptoms C = compound score for self-reported and mother-reported depressive
symptoms.
** p < .01 *** p < .001
33
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Table 3
Results of Hierarchical Multiple Regression Analyses at Step 2, Predicting RTna, RTm, and Depressive
Symptoms by Attachment Anxiety or Attachment Avoidance, Controlled for the Other Attachment Dimension.
R²
R²-
F-
change
change
t
df

p
Prediction by attachment anxiety, controlled for attachment avoidance
RTna
.05*
.04
5.47
2.34
139
.22
.021
RTm
.07**
.05
7.60
2.76
135
.25
.007
Depressive symptoms S
.34***
.20
39.27
6.27
132
.48
< .001
Depressive symptoms M
.10***
.04
6.42
2.53
142
.22
.012
Depressive symptoms C
.28***
.15
28.02
5.29
132
.43
< .001
Prediction by attachment avoidance, controlled for attachment anxiety
RTna
.05*
.00
0.05
0.22
139
.02
.826
RTm
.07**
.00
0.08
0.27
135
.03
.784
Depressive symptoms S
.34***
.03
5.45
2.33
132
.18
.021
Depressive symptoms M
.10***
.02
3.06
1.75
142
.15
.083
Depressive symptoms C
.28***
.03
5.39
2.32
132
.19
.022
Note: RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother; Depressive
symptoms S= Self-reported depressive symptoms; Depressive symptoms M = Mother-reported depressive
symptoms; Depressive symptoms C = compound score for self-reported and mother-reported depressive
symptoms.
* p < .05 ** p < .01 *** p < .001
34
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Table 4
Unstandardized Regression Coefficients With Standard Errors for the Different Effects, Point Estimate, Confidence Interval (CI), and Effect Size (Completely Standardized)
of Indirect Effects, and Proportion Explained Variance of the Mediation Analyses With Attachment Anxiety or Avoidance as Independent Variables (IV), RTna or/and RTm as
Mediators (M), and Self-reported Depressive Symptoms as Dependent Variable (DV)(10,000 bootstrap samples, n = 127-133)
M
Effect of IV on
Effect of M on
M
DV
Total effect
Direct effect
Indirect effect
Bias corrected CI of
Effect
indirect effect
size
R²
Attachment anxiety
1
RTna
0.26** (0.09)
0.06** (0.02)
0.13*** (0.02)
0.12*** (0.02)
0.02b (0.01)
0.002 <
< 0.039
.06b
.38***
2
RTm
0.28** (0.09)
0.08*** (0.02)
0.13*** (0.02)
0.11*** (0.02)
0.02a (0.01)
0.003 <
< 0.056
.08a
.41***
3
RTna
0.26** (0.10)
0.06** (0.02)
0.14*** (0.02)
0.10*** (0.02)
0.01b (0.01)
0.002 <
< 0.035
.05b
.45***
RTm
0.30** (0.09)
0.07** (0.02)
0.02a (0.01)
0.003 <
< 0.058
.07a
Attachment avoidance
4
RTna
0.05 (0.05)
0.06** (0.02)
0.03* (0.01)
0.02 (0.01)
0.00 (0.00)
-0.003 <
< 0.009
.02
.38***
5
RTm
0.05 (0.05)
0.08*** (0.02)
0.03* (0.01)
0.03* (0.01)
0.00 (0.00)
-0.002 <
< 0.013
.02
.41***
6
RTna
0.04 (0.05)
0.06** (0.02)
0.03* (0.01)
0.03* (0.01)
0.00 (0.00)
-0.003 <
< 0.008
.01
.45***
RTm
0.03 (0.05)
0.07** (0.02)
0.00 (0.00)
-0.003 <
< 0.010
.01
Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother. Age and the other attachment dimension were controlled for in all analyses.
z
Completely standardized indirect effect and CI; a Significant point estimate of indirect effect at the 99% CI; b Significant point estimate of indirect effect at the 95% CI.
Otherwise, the point estimate of indirect effect lies not in the 90% CI.
 p < .10 * p < .05 ** p < .01 *** p < .001
35
Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Table 5
Unstandardized Regression Coefficients With Standard Errors for the Different Effects, Point Estimate, Confidence Interval (CI), and Effect Size (Completely Standardized)
of Indirect Effects, and Proportion Explained Variance of the Mediation Analyses With Attachment Anxiety or Avoidance as Independent Variables (IV), RTna or/and RTm as
Mediators (M), and the Multi-informant Compound Score as Dependent Variable (DV)(10,000 bootstrap samples, n = 127-133)
M
Effect of IV on
Effect of M on
M
DV
Total effect
Direct effect
Indirect effect
Bias Corrected CI of
Effect
Indirect effect
size
R²
Attachment anxiety
1
RTna
0.26** (0.09)
0.19 (0.12)
0.68*** (0.13)
0.63*** (0.13)
0.05c (0.04)
0.003 <
< 0.137
.03
.30***
2
RTm
0.28** (0.09)
0.35** (0.12)
0.65*** (0.13)
0.55*** (0.13)
0.10a (0.05)
0.005 <
< 0.286
.06
.33***
3
RTna
0.26** (0.10)
0.15 (0.12)
0.69*** (0.13)
0.56*** (0.14)
0.04 (0.04)
-0.002<
< 0.124
.02
.34***
RTm
0.30** (0.09)
0.31* (0.12)
0.10a (0.06)
0.002 <
< 0.292
.06
Attachment avoidance
4
RTna
0.05 (0.05)
0.19 (0.12)
0.14* (0.07)
0.13 (0.07)
0.01 (0.01)
-0.006 <
< 0.040
.01
.30***
5
RTm
0.05 (0.05)
0.35** (0.12)
0.18* (0.07)
0.16* (0.07)
0.02 (0.02)
-0.009 <
< 0.064
.02
.33***
6
RTna
0.04 (0.05)
0.15 (0.12)
0.16* (0.07)
0.15* (0.07)
0.01 (0.01)
-0.006 <
< 0.035
.01
.34***
RTm
0.03 (0.05)
0.31* (0.12)
0.01 (0.02)
-0.014 <
< 0.050
.01
Note. RTna = Repetitive thinking about negative affect; RTm = Repetitive thinking about mother. Age and the other attachment dimension were controlled for in all analyses.
z
Completely standardized indirect effect and CI; a Significant point estimate of indirect effect at the 99% CI; c Marginally significant point estimate of indirect effect at the
90% CI. Otherwise, the point estimate of indirect effect lies not in the 90% CI.
 p < .10 * p < .05 ** p < .01 *** p < .001
36