Adult Attachment, Sensory Processing, and Distress in
Healthy Adults
Pamela J. Meredith, Kirsty J. Bailey, Jenny Strong, Georgia Rappel
MeSH TERMS
anxiety
object attachment
pain
sensation
sensory thresholds
OBJECTIVE. To better understand the ways in which adult attachment, sensory processing, and distress
may be interrelated in healthy adults.
METHOD. A cross-sectional study design was used with a convenience sample of 116 healthy participants
who completed questionnaires before participating in a cold pressor pain-inducement task.
RESULTS. Attachment anxiety was significantly positively correlated with sensory sensitivity as measured
using the Highly Sensitive Persons Scale and the Sensory Profile and with distress (i.e., stress, anxiety, and
depression). Associations between attachment anxiety and both sensory sensitivity variables were lost when
controlling for stress. Attachment avoidance was correlated only with sensory sensitivity measured using the
Sensory Profile, and this relationship was retained when controlling for stress. Neither the attachment nor the
stress variables were associated with sensation seeking.
CONCLUSION. Findings suggest that developing active coping approaches to deal with sensory sensitivities may be a valuable way to minimize distress. Recommendations for future research are provided.
Meredith, P. J., Bailey, K. J., Strong, J., & Rappel, G. (2016). Adult attachment, sensory processing, and distress in healthy
adults. American Journal of Occupational Therapy, 70, 7001250010. http://dx.doi.org/10.5014/ajot.2016.017376
Pamela J. Meredith, PhD, is Senior Lecturer,
Occupational Therapy, School of Health and Rehabilitation
Sciences, The University of Queensland, St. Lucia,
Queensland, Australia; [email protected]
Kirsty J. Bailey, BOccThy(Hons), is Graduate,
Occupational Therapy, School of Health and Rehabilitation
Sciences, The University of Queensland, St. Lucia,
Queensland, Australia, and Queensland Health, Brisbane,
Queensland, Australia.
Jenny Strong, PhD, MOccThy, is Professor,
Occupational Therapy, School of Health and Rehabilitation
Sciences, The University of Queensland, St. Lucia,
Queensland, Australia.
Georgia Rappel, BOccThy(Hons), is Graduate,
Occupational Therapy, School of Health and Rehabilitation
Sciences, The University of Queensland, St. Lucia,
Queensland, Australia.
T
he ways in which attachment and sensory processing may be integrated to
inform occupational therapy practice have received some theoretical attention
in the pediatric (Alers, 2005; Koomar, 2009) and adult (Champagne, 2011)
mental health literature. In addition, these variables have each been empirically
linked to a range of clinical phenomena, including mental illness (Brown,
Cromwell, Filion, Dunn, & Tollefson, 2002; Mikulincer, Horesh, Eilati, &
Kotler, 1999), perceptions of pain (Engel-Yeger & Dunn, 2011a; Meredith,
Strong, & Feeney, 2006), coping (Meredith, Rappel, Strong, & Bailey, 2015;
Schmidt, Nachtigall, Wuethrich-Martone, & Strauss, 2002), and psychological
distress (Engel-Yeger & Dunn, 2011b; Jinyao et al., 2012). Nevertheless, specific
associations between attachment and sensory processing have received little empirical consideration. The aim of this study was to replicate and extend previous
findings regarding interrelationships among attachment and sensory variables to
inform clinical approaches and guide future research.
Attachment Theory
Bowlby (1969) conceptualized attachment theory as a theoretical model of social
and emotional development in infancy and childhood that has lifelong implications. Internalized early caregiving experiences have been proposed to influence individual perceptions of oneself as being worthy of care and of caregivers
as being trustworthy to provide care (Bartholomew & Horowitz, 1991). When
early childhood experiences are not adequate, negative perceptions of oneself or
others are proposed to develop, reflecting attachment anxiety and attachment
avoidance, respectively (Bartholomew & Horowitz, 1991). (A summary of terms
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7001250010p1
used in this article is in Appendix 1, available online at
http://otjournal.net; navigate to this article, and click on
“Supplemental.”) On the basis of early experiences, individual internal working models are formed that are believed
to influence perceptions throughout life (Bowlby, 1969).
Sensory Processing
People differ in the ways in which they process sensory
information (Aron & Aron, 1997; Dunn, 2001), and
Dunn’s (1997) Model of Sensory Processing offers a
theoretical framework for these differences. According to
this model, four distinct sensory processing categories are
defined according to a person’s neurological threshold (the
point at which stimulation is sufficient to elicit a response;
the threshold can be high or low) and response strategy
(active or passive; Dunn, 1997). People with a high neurological threshold are classified as having either a low registration pattern, reflecting passive responses to stimuli, or a
sensation-seeking pattern, reflecting active responses (Dunn,
1997). People with a low neurological threshold are classified
as having a sensation-avoiding pattern (they actively limit
stimulation) or a sensory sensitivity pattern (they respond
passively, experiencing discomfort and being distracted by
stimulation; Dunn, 1997; see Appendix 1). As with attachment, Dunn (2001) proposed that sensory processing patterns remain largely consistent across the lifespan.
Associations Between Attachment and
Sensory Patterns
A literature review yielded only three articles in which
associations among attachment and sensory patterns were
considered. A study by Jerome and Liss (2005) with a
sample of 133 psychology students provided preliminary support for a relationship between attachment
anxiety and avoidance and Dunn’s (1997) four sensory
processing categories. Specifically, positive associations
were demonstrated between sensory sensitivity and attachment anxiety, sensory avoidance and attachment
avoidance, and low registration and both avoidant and
anxious attachment patterns. The lack of association between sensation seeking and either attachment classification was speculated to indicate a relationship between
sensation seeking and secure attachment.
Using different measures of attachment and sensory
sensitivity, Meyer, Ajchenbrenner, and Bowles (2005) also
found a link between sensory sensitivity and attachment in
a nonclinical sample (N 5 156) drawn from college and
community populations. These authors found a correlation
between the Highly Sensitive Persons Scale (HSPS; Aron
& Aron, 1997) and the Upset and Misunderstood subscale
of the Inventory of Parent and Peer Attachment (Armsden
& Greenberg, 1987) indicating a link between attachment
insecurity and sensory sensitivity.
More recently, Levit-Binnun, Szepsenwol, SternEllran, and Engel-Yeger (2014) conducted a study with
194 first-year psychology students in which they considered the mediational role of attachment patterns in the
relationship between Dunn’s (1997) sensory quadrants
and anxiety. Although not the focus of the study, correlations between sensory responsiveness profiles and attachment were reported, and the following significant
positive relationships were identified: sensory sensitivity
and attachment anxiety, sensory avoidance and both attachment anxiety and avoidance, and low registration and
anxious attachment. In addition, sensory seeking was
negatively correlated with attachment avoidance, lending
more confidence to associations between sensory seeking
and secure attachment.
Although findings of these studies support theoretical
expectations, the participants’ attachment system was not
activated before data gathering. Ravitz, Maunder, Hunter,
Sthankiya, and Lancee (2010) noted that it is important to
activate attachment phenomena so that they become manifest, thus increasing the validity of measurement. Activation
requires evocation of fear, pain, or distress, which suggests
that studies that have not provided this stimulus may misrepresent the strength of relationships among the variables.
Although no other studies have specifically investigated
associations between attachment and sensory processing,
evidence in the wider literature has supported these associations. For example, links have been demonstrated
between sensory sensitivity and mental health diagnoses that
involve strong attachment components, such as personality
disorders and social phobia (Meyer et al., 2005). Moreover,
traumatic childhood events and reduced ability to selfregulate (associated with insecure attachment) have been
associated with susceptibility to sensory modulation difficulties (Alers, 2005), and early institutionalization has been
associated with both attachment disorders (Zeanah, 2000)
and sensory modulation difficulties (Wilbarger, Gunnar,
Schneider, & Pollak, 2010).
Links With Psychological Distress
Attachment (Jinyao et al., 2012) and sensory processing
(Engel-Yeger & Dunn, 2011b; Liss, Timmel, Baxley, &
Killingsworth, 2005) have separately been linked with
psychological distress (i.e., anxiety, stress, or depression).
These associations have been investigated concurrently
in one study (Levit-Binnun et al., 2014) in which
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attachment anxiety and avoidance mediated the relationship between anxiety symptoms and all four sensory
profiles. Given these known relationships, level of distress
needs to be controlled to ensure that associations between
attachment and sensory processing are not better explained by shared variance with emotional distress.
Hypotheses
With attachment and sensory theories increasingly being
integrated to inform clinical practice, the aim of this study
was to gain insight into the empirical relationships between attachment and sensory patterns, with a view toward
using this knowledge to guide interventions. To elaborate
on existing evidence, the associations among adult attachment,
sensory processing, and distress (anxiety, stress, depression)
variables need to be examined concurrently while evoking the
attachment system. On the basis of existing research, four
hypotheses were proposed:
1. Positive associations will be found between sensory
sensitivity and attachment anxiety when controlling
for distress.
2. Positive associations will be found between sensory
avoidance and attachment avoidance when controlling
for distress.
3. Positive associations will be found between low registration and attachment anxiety when controlling for
distress.
4. No association will be found between sensation seeking and attachment avoidance or anxiety.
Method
Participants
A convenience sample of 162 healthy adults was invited to
participate in the study. Thirty-four people either did not
respond to the invitation or declined to participate because
of time constraints or conflicting commitments. Twelve
other participants were excluded because of current pain
complaints, resulting in a sample of 116 eligible participants. The demographic details are summarized in Table
1, and additional descriptive data are provided in Table 2.
The majority of participants were Australian, single, and
employed full-time and had completed Year 12 (senior)
schooling.
Measures
Demographic Variables. Participants were asked their
age, gender, country of origin, relationship status, education level, employment status, and household income.
In addition, on the basis of previous research (Andrews,
Meredith, & Strong, 2011), whether the participant
knew the researcher (participant type) was recorded for
inclusion as a covariate. An additional variable (researcher)
indicated which researcher had gathered the data.
Experiences in Close Relationships–Revised Questionnaire.
The Experiences in Close Relationships–Revised Questionnaire (ECR–R; Fraley, Waller, & Brennan, 2000) is
a self-report measure of romantic attachment that consists of two 18-item scales: Attachment-Related Anxiety
and Attachment-Related Avoidance. The 36 items are
rated on a 7-point scale ranging from 1 (strongly disagree) to
7 (strongly agree). The ECR–R has demonstrated suitable
validity and reliability (Sibley, Fischer, & Liu, 2005). In the
current study, a coefficients for the two dimensions were
.93 (anxiety) and .93 (avoidance). Before completing the
ECR–R, participants were aware that they would participate
in the cold pressor pain-inducement task, which was used to
activate the attachment system.
Adolescent/Adult Sensory Profile. The Adolescent/Adult
Sensory Profile (AASP; Brown & Dunn, 2002) is a selfreport measure of adult responses to everyday sensory
experiences that is based on Dunn’s (1997) Model of
Sensory Processing. Sixty items are scored on a 5-point
Likert-type scale ranging from 1 (almost never) to 5 (almost
always) according to the frequency with which a participant
responds to specific sensory events in the manner described.
These items are equally sorted among four quadrants
(i.e., 15 per quadrant): low registration, sensation seeking,
sensory sensitivity, and sensation avoiding. Each quadrant
reflects a different sensory processing pattern. Raw scores
for each quadrant are converted to reflect the extent to
which a person identifies with each pattern, again rated on
a 5-point scale ranging from 1 (much less than most people)
to 5 (much more than most people). Results of a preliminary
study have supported the measure’s validity and internal
consistency (Brown, Tollefson, Dunn, Cromwell, & Filion,
2001). In the current study, a coefficients were .75 (low
registration), .75 (sensation seeking), .72 (sensory sensitivity), and .78 (sensation avoiding).
Highly Sensitive Person Scale–Shortened Version. The
Highly Sensitive Person Scale–Shortened Version (HSPS–
SV; Aron et al., 2010), a self-report measure of sensory
processing sensitivity in adults, is a short, 11-item version
of the original 27-item HSPS (Aron & Aron, 1997) used
in the Meyer et al. (2005) study. These 11 items have been
shown to be highly correlated with the overall scale, with
internal consistency similar to that of the full version (Aron
et al., 2010). Items are scored on an 8-point Likert-type
scale ranging from 0 (not at all) to 7 (extremely). The a
coefficient in the current study was .88.
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Table 1. Descriptive Details for Demographic Variables of the
Study Sample (N 5 116)
Table 2. Descriptive Data for Continuous Study Variables
Variable
n
%
Gender
Variable
N
Mean
Standard Deviation
Range
Age
116
29.5
12.7
18–64
115
116
3.3
3.0
Male
47
40.5
Low registration
Sensation seeking
Female
69
59.5
Sensory sensitive
116
3.1
0.62
1–5
Sensory avoidant
115
3.1
0.72
1–5
Country of origin
Australia or New Zealand
United Kingdom
99
4
85.3
3.4
United States or Canada
4
Asia
3
South Africa
0.72
0.72
2–5
1–5
HSPS–SV
116
27.8
13.6
0–67
Relationship anxiety
114
47.5
20.6
18–105
3.4
Relationship avoidance
114
45.9
19.0
18–91
2.6
Depression
116
2.6
3.2
0–19
2
1.7
Middle East
2
1.7
Anxiety
Stress
116
116
2.5
5.5
2.6
4.3
0–13
0–20
Missing
2
1.7
Married
De facto married
26
25
22.4
21.6
Never married
61
52.6
Separated
2
1.7
Divorced
1
0.9
Missing
1
0.9
Relationship status
Education level
< Year 10/junior
2
1.7
Completed Year 10/junior
Completed Year 12/senior
8
47
6.9
40.5
Diploma, apprenticeship, TAFE
22
19.0
University degree
31
26.7
6
5.2
University higher degree
Employment statusa
Full time
54
46.6
Part time
20
17.2
Not in paid employment
Studying full time
3
39
2.6
33.6
Annual income, $
<25,000
37
31.9
25,000–35,000
5
4.3
35,000–45,000
6
5.2
45,000–55,000
4
3.4
55,000–65,000
14
12.1
65,000–75,000
>75,000
5
42
4.3
36.2
3
2.6
Known to researcher
77
66.4
Unknown to researcher
39
33.6
Missing
Participant type
Note. HSPS–SV 5 Highly Sensitive Persons Scale–Shortened Version.
0 (did not apply to me at all) to 3 (applied to me very much
or most of the time) on the basis of the previous week.
Adequate internal consistency and validity have been reported across clinical and nonclinical samples (Henry &
Crawford, 2005). Reliability scores in the current study
were .82 (Depression), .59 (Anxiety), and .85 (Stress).
Because of the relatively low a for anxiety, use of this
variable was restricted to correlational analyses, and results
pertaining to anxiety should be interpreted with caution.
Cold Pressor Pain-Inducement Task. The cold pressor is a
methodologically sound device that has frequently been
used to induce temporary hand and forearm pain (e.g.,
Andrews et al., 2011; Meredith et al., 2006, 2015). The
cold pressor consists of an insulated container filled with
ice water maintained at a temperature of 0˚–2˚C. Participants are instructed to submerge their nondominant
hand and forearm into the water for as long as possible. A
4-min time limit (of which participants are not aware) is
imposed to minimize risk. At the conclusion of the cold
pressor task, participants are debriefed. The entire procedure takes approximately 30 min. This task was included
to activate the attachment system.
Procedure
Researcher
1 (Kirsty J. Bailey)
60
51.7
2 (Georgia Rappel)
56
48.3
Note. TAFE 5 technical and further education.
Total >116 because some participants selected more than one option (e.g.,
studying full-time while working part-time).
a
Depression Anxiety Stress Scales 21. The self-report
Depression Anxiety Stress Scales 21 (DASS–21; Lovibond
& Lovibond, 1995a, 1995b), an abbreviated 21-item
version of the 42-item DASS, was used to measure distress.
It comprises three 7-item scales: Depression, Anxiety, and
Stress. Each item is scored on a 4-point scale ranging from
The study protocol was approved by The University of
Queensland’s institutional review board. Participants were
sought through a word-of-mouth snowball sampling
technique, beginning with friends and family of the research team. Testing was undertaken by two members of
the research team (authors Bailey and Rappel). Involvement in the study was voluntary, and no incentives
were offered. Potential participants were given an information sheet and provided written consent before
completing the questionnaires. The cold pressor paininducement task was then conducted in a private, mutually convenient space following standard instructions
(see Meredith et al., 2006). Although specific testing
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locations varied across researchers and participants, the
cold pressor apparatus was the same for all participants.
all distress variables, it was linked only with sensory
sensitivity and the HSPS–SV (Table 3). Attachment
avoidance was correlated only with sensory sensitivity.
Data Analysis
Associations Between Attachment and
Sensory Processing
Statistical analyses were undertaken using IBM SPSS
Statistics for Windows (Version 21; IBM Corporation,
Armonk, NY). Initial data checking revealed six skewed
variables: age, attachment anxiety, attachment avoidance,
depression, anxiety, and stress. After screening of the demographic variables for multicollinearity, age and participant
type were retained as control variables in further analyses.
Attachment anxiety and attachment avoidance were transformed using the square root function for use in parametric
tests. Untransformed variables were retained in nonparametric
tests. As a result of high correlations among the DASS–21
subscales, only the Stress subscale was retained as a covariate in the regression analyses because it had high internal consistency and was most theoretically plausible.
A series of multiple linear regression analyses was then
undertaken to examine the relationships between attachment and sensory variables when controlling for age,
participant type, and stress. Assumptions for regression
analyses were verified through formal (e.g., Shapiro–Wilk
W test for normality of residuals) and informal (e.g.,
graphic) checks.
Four multiple linear regression analyses were conducted,
one for each pair of attachment (anxious–avoidant) and
sensory (sensory sensitivity–HSPS–SV) variables. The sensory
sensitivity variables were entered as independent variables, along with age, participant type, and stress (Table
4). Analyses were not conducted for the remaining three
sensory processing variables (low registration, sensation
seeking, and sensory avoidance) because they were not
correlated with either attachment variable.
In the first step of the regression models analyzing
attachment anxiety and sensory variables, attachment
anxiety was significantly associated with both AASP
sensory sensitivity, F (1, 112) 5 5.35, p 5 .02, and the
HSPS–SV, F (1, 112) 5 6.00, p 5 .02. When stress
and control variables were included in these analyses,
stress was the only significant contributor to the model.
In the regression models analyzing attachment avoidance and sensory variables, attachment avoidance was
significantly associated with only sensory sensitivity,
F (1, 112) 5 7.75, p 5 .006. In analyses including
stress and control variables, sensory sensitivity was retained
as the only significant contributor to this model.
Results
Correlations Among Variables
Discussion
An examination of the correlations between attachment,
sensory processing, distress, and the demographic variables
was conducted using Spearman rank-order correlation
analysis. Although attachment anxiety was correlated with
This study offers valuable insights into the relationship
between adult attachment and sensory processing variables
in healthy adults. It is the first investigation of these
Table 3. Intercorrelations Between Variables Using Spearman’s r
Variable
1. Age
2. Gender
3. Participant type
1
—
2.36***
.26**
2
3
4
5
6
7
8
9
10
—
11
12
13
—
2.12
—
4. Low registration
2.17
.26**
2.20*
5. Sensation seeking
2.22*
.25**
2.07
.18
6. Sensory sensitivity
2.25**
.24**
2.14
.32***
2.05
7. Sensory avoidant
2.12
.08
2.13
.19*
2.24**
.50***
—
8. HSPS–SV
2.26**
.22*
2.15
.21*
.01
.50***
.48***
9. Relationship anxiety
10. Relationship avoidance
2.04
2.07
2.10
.08
2.11
.16
.06
.04
2.02
2.001
.20*
.27**
.14
.14
.23*
.11
—
.66***
11. Depression
2.05
.03
2.05
.18*
2.03
.13
.08
.15
.23*
.16
—
12. Anxiety
2.21*
.18*
2.002
.22*
2.001
.29**
.23*
.32***
.19*
.15
.47***
—
13. Stress
2.10
.18*
2.14
.16
.03
.23*
.10
.30***
.24**
.14
.54***
.66***
—
14. Researcher
2.02
2.29**
.13
.13
.03
.11
.12
.08
.19*
.05
.14
2.01
—
—
—
—
2.02
Note. N 5 116. Distress is represented by the depression, anxiety, and stress variables. HSPS–SV 5 Highly Sensitive Persons Scale–Shortened Version.
*p < .05. **p < .01. ***p < .001.
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Table 4. Results of Regression Analyses for Each Attachment
Dimension
Dependent Variables
Independent Variable
Sensory sensitivity
Attachment Anxiety, t
1.38
Age
20.35
Participant type
Stress
20.34
3.14**
Attachment Avoidance, t
2.10*
20.54
1.12
1.13
Summary statistics
R2
0.13
0.10
F(4, 109)
4.08**
2.85*
1.08
20.03
Age
20.28
20.93
Participant type
20.37
21.18
HSPS–SV
Stress
Summary statistics
2.93**
1.54
R2
0.12
0.06
F(4, 109)
3.87**
1.67
Note. HSPS–SV 5 Highly Sensitive Persons Scale–Shortened Version.
*p < .05. **p < .01.
variables that sought to activate the attachment system
before testing and controlled for participant stress and
relationship with the researcher. It is also the first to incorporate two different measures of sensory sensitivity.
Consistent with previous findings and with Hypothesis 1,
attachment anxiety was related to sensory sensitivity as
measured by both the Sensory Profile (Jerome & Liss, 2005;
Levit-Binnun et al., 2014) and the HSPS–SV (Meyer et al.,
2005). These associations were not retained when controlling
for stress, however, which suggests that the association between attachment anxiety and sensory sensitivity was largely
accounted for by stress. This result highlights the importance
of controlling for distress in future studies in this field.
Contrary to expectations, attachment avoidance was
unrelated to sensory avoidance (Hypothesis 2) and was
linked instead with sensory sensitivity. This relationship
was retained when controlling for stress. Sensory sensitivity is
similar to sensory avoidance in that they both represent low
thresholds for sensory stimuli. According to Dunn (1997),
people with a low sensory threshold respond either passively
(sensory sensitivity) or actively (sensory avoidance). Thus,
although participants who reported high levels of attachment avoidance in all studies reported lowered sensory
thresholds, their preferred coping approach differed.
In contrast to the findings of both Jerome and Liss
(2005) and Levit-Binnun et al. (2014), attachment anxiety
was found to be unrelated to low registration. This lack of
a relationship, although it did not support Hypothesis 3,
was in line with Jerome and Liss’s theoretical expectations.
This inconsistency warrants further empirical attention.
Of the sensory processing variables, sensation seeking
was the only one that was unrelated to any of the distress or
attachment variables, providing support for Hypothesis 4.
This finding was consistent with our theoretical expectations because sensation seeking indicates both a high
sensory threshold and an active coping approach. Indeed,
Engel-Yeger and Dunn (2011b) found that sensation
seeking was correlated with positive affect. Although an
association between sensation seeking and secure attachment
was suggested, further validation using an attachment measure that specifically includes a secure variable is required.
The inclusion of distress variables (anxiety, depression,
and stress) in this research afforded further insight into the
relationships between sensory processing and attachment. As
expected, attachment anxiety was significantly associated with
all three distress variables. In contrast, although attachment
avoidance was highly correlated with attachment anxiety, it
was unrelated to any of the distress variables. Kobak, Cole,
Ferenz-Gillies, Fleming, and Gamble (1993) suggested that
people with an avoidant attachment pattern adopt a deactivating coping strategy that serves to deny attachment needs
and to deny or minimize the emotions and cognitions associated with these needs. Thus, the lack of a significant
association between attachment avoidance and distress suggests that the deactivating coping strategies may have been
effective in this sample of healthy adults.
Also noteworthy was the lack of significant associations
between sensory avoidance and both depression and stress.
Although inconsistent with Engel-Yeger and Dunn (2011a),
who found a link between sensory avoidance and negative
affect, this finding is theoretically plausible: Although people who are sensory avoidant have a low sensory threshold,
they adopt active coping strategies that appear to provide
some protection from distress. Despite this explanation, a
significant result was obtained between sensory avoidance
and anxiety. Although this result was tentative, given the low
level of internal consistency obtained for anxiety, it does
support the link between sensory avoidance and trait
anxiety reported by Engel-Yeger and Dunn (2011b).
Consistent with expectations, low registration and sensory
sensitivity (measured using both the Sensory Profile and the
HSPS–SV) were all positively linked with distress. Given that
these two sensory variables indicate a passive coping approach, these findings are consistent with the coping literature, which has suggested that passive coping is less adaptive
than active coping (Snow-Turek, Norris, & Tan, 1996).
Limitations and Future Research Directions
The results of this study should be interpreted cautiously.
First, the cross-sectional nature of the study did not permit
causal conclusions, so the direction of the associations
remains unclear. Both insecure attachment (Jinyao et al.,
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2012) and sensory processing patterns (Engel-Yeger &
Dunn, 2011b) have previously been conceptualized as vulnerability factors for the development of anxious symptomatology. In contrast, Liss et al. (2005) suggested that anxiety
may be a risk factor for developing extreme sensory processing patterns, and anxiety may also increase the salience of
insecure attachment (Ravitz et al., 2010). The complex interrelationships among these variables warrant further longitudinal investigation to inform clinical approaches.
Second, the use of a convenience sampling method in
the current study may have introduced sampling bias. To
minimize this bias, two researchers gathered data, both
remained blind to participants’ attachment and sensory
processing classifications, and whether participants were
known to the researcher was retained as a control variable.
Third, the need to use transformed dependent variables
complicates interpretation of results.
Reliance on self-report measures is also a limitation of
this study because these measures are known to be
influenced by error and method variance factors including
social desirability, memory, and mood. Consequently,
future studies should include objective measures and
measures of social desirability.
Replication of this study is recommended with a
larger, more representative sample and a longitudinal study
design. Using an attachment measure that conceptualizes
attachment as a four-category (secure, fearful, preoccupied,
dismissing) or three-dimensional (secure, anxious, avoidant)
construct will also improve clarity regarding the associations
between sensory variables and attachment security.
Implications for Occupational
Therapy Practice
Although our conclusions are tentative, the results of this
study lend support for the association between insecure
attachment and sensory sensitivity and highlight the role
of distress in this relationship. These associations have
some implications for occupational therapy practice:
• A person who is insecurely attached, sensory sensitive,
and distressed may feel more compromised in therapy
than others who do not have these characteristics.
• Awareness of these interrelationships alerts practitioners
to possible relationship-based or sensory informed therapeutic approaches that may be acceptable to this potentially vulnerable group.
• It is possible that working with one domain (sensory/
relationship) may improve outcomes in all three interrelated domains (sensory, attachment, and distress). For
example, for someone who has an avoidant attachment
pattern, commencing treatment with sensory-informed
approaches may prove less threatening than providing
emotional support.
Further research is needed to better understand the complex
ways in which attachment insecurity and sensory sensitivities
coexist to inform early intervention and prevention practices
for a range of clinical populations across the lifespan.
Conclusion
The findings of this study offer support for associations
between insecure attachment and high scores on measures
of sensory sensitivity in healthy adults. The findings further
suggest that, for insecurely attached people and people with
passive coping strategies, treatment providing education on
these factors and instruction in active sensory-related coping
approaches may minimize distress. Additional research is
needed to validate and extend these findings to offer insight
into how best to integrate these concepts to achieve better
informed and more client-centered clinical practice. s
Acknowledgments
The authors acknowledge the statistical advice of Asad
Khan. This research was approved by The University of
Queensland’s Behavioral and Social Science Ethical Review Committee (No. 2012000013).
References
Alers, V. (2005). Treating severely traumatised children and adolescents using sensory integration, attachment theory, and clinical reasoning. Journal of Child and Adolescent Mental Health,
17, vi–vii. http://dx.doi.org/10.2989/17280580509486599
Andrews, N. E., Meredith, P. J., & Strong, J. (2011). Adult
attachment and reports of pain in experimentally-induced
pain. European Journal of Pain, 15, 523–530. http://dx.
doi.org/10.1016/j.ejpain.2010.10.004
Armsden, G. C., & Greenberg, M. T. (1987). The Inventory
of Parent and Peer Attachment: Individual differences and
their relationship to psychological well-being in adolescence. Journal of Youth and Adolescence, 16, 427–454.
http://dx.doi.org/10.1007/BF02202939
Aron, A., Ketay, S., Hedden, T., Aron, E. N., Markus, H. R.,
& Gabrieli, J. D. E. (2010). Temperament trait of sensory
processing sensitivity moderates cultural differences in
neural response. Social Cognitive and Affective Neuroscience, 5, 219–226. http://dx.doi.org/10.1093/scan/nsq028
Aron, E. N., & Aron, A. (1997). Sensory-processing sensitivity
and its relation to introversion and emotionality. Journal
of Personality and Social Psychology, 73, 345–368. http://
dx.doi.org/10.1037/0022-3514.73.2.345
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles
among young adults: A test of a four-category model. Journal
of Personality and Social Psychology, 61, 226–244. http://dx.
doi.org/10.1037/0022-3514.61.2.226
The American Journal of Occupational Therapy
Downloaded From: http://ajot.aota.org/ on 03/03/2016 Terms of Use: http://AOTA.org/terms
7001250010p7
Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment.
New York: Basic Books.
Brown, C., Cromwell, R. L., Filion, D., Dunn, W., & Tollefson, N.
(2002). Sensory processing in schizophrenia: Missing and
avoiding information. Schizophrenia Research, 55, 187–195.
http://dx.doi.org/10.1016/S0920-9964(01)00255-9
Brown, C., & Dunn, W. (2002). The Adult Sensory Profile. San
Antonio: Psychological Corporation.
Brown, C., Tollefson, N., Dunn, W., Cromwell, R., & Filion, D.
(2001). The Adult Sensory Profile: Measuring patterns of
sensory processing. American Journal of Occupational Therapy, 55, 75–82. http://dx.doi.org/10.5014/ajot.55.1.75
Champagne, T. (2011). Sensory modulation and environment:
Essential elements of occupation (3rd ed.). Sydney, New
South Wales, Australia: Pearson.
Dunn, W. (1997). The impact of sensory processing abilities
on the daily lives of young children and their families: A
conceptual model. Infants and Young Children, 9, 23–35.
http://dx.doi.org/10.1097/00001163-199704000-00005
Dunn, W. (2001). The sensations of everyday life: Empirical,
theoretical, and pragmatic considerations. American Journal
of Occupational Therapy, 55, 608–620. http://dx.doi.org/
10.5014/ajot.55.6.608
Engel-Yeger, B., & Dunn, W. (2011a). Relationship between
pain catastrophizing level and sensory processing patterns
in typical adults. American Journal of Occupational Therapy,
65, e1–e10. http://dx.doi.org/10.5014/ajot.2011.09004
Engel-Yeger, B., & Dunn, W. (2011b). The relationship between
sensory processing difficulties and anxiety level of healthy
adults. British Journal of Occupational Therapy, 74, 210–216.
http://dx.doi.org/10.4276/030802211X13046730116407
Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An
item response theory analysis of self-report measures of
adult attachment. Journal of Personality and Social Psychology,
78, 350–365. http://dx.doi.org/10.1037/0022-3514.78.2.350
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS–21):
Construct validity and normative data in a large nonclinical sample. British Journal of Clinical Psychology, 44,
227–239. http://dx.doi.org/10.1348/014466505X29657
Jerome, E. M., & Liss, M. (2005). Relationships between sensory processing style, adult attachment, and coping. Personality and Individual Differences, 38, 1341–1352. http://
dx.doi.org/10.1016/j.paid.2004.08.016
Jinyao, Y., Xiongzhao, Z., Auerbach, R. P., Gardiner, C. K., Lin, C.,
Yuping, W., & Shuqiao, Y. (2012). Insecure attachment as a
predictor of depressive and anxious symptomology. Depression
and Anxiety, 29, 789–796. http://dx.doi.org/10.1002/da.21953
Kobak, R. R., Cole, H. E., Ferenz-Gillies, R., Fleming, W. S.,
& Gamble, W. (1993). Attachment and emotion regulation during mother-teen problem solving: A control theory analysis. Child Development, 64, 231–245. http://dx.
doi.org/10.2307/1131448
Koomar, J. A. (2009). Trauma- and attachment-informed sensory integration assessment and intervention. Sensory Integration Special Interest Section Quarterly, 32(4), 1–4.
Levit-Binnun, N., Szepsenwol, O., Stern-Ellran, K., & Engel-Yeger,
B. (2014). The relationship between sensory responsiveness
profiles, attachment orientations, and anxiety symptoms. Australian Journal of Psychology, 66, 233–240. http://dx.doi.org/
10.1111/ajpy.12064
Liss, M., Timmel, L., Baxley, K., & Killingsworth, P. (2005).
Sensory processing sensitivity and its relation to parental
bonding, anxiety, and depression. Personality and Individual Differences, 39, 1429–1439. http://dx.doi.org/
10.1016/j.paid.2005.05.007
Lovibond, P. F., & Lovibond, S. H. (1995b). The structure of
negative emotional states: Comparison of the Depression
Anxiety Stress Scales (DASS) with the Beck Depression and
Anxiety Inventories. Behaviour Research and Therapy, 33,
335–343. http://dx.doi.org/10.1016/0005-7967(94)00075-U
Lovibond, S. H., & Lovibond, P. F. (1995a). Manual for the
Depression Anxiety Stress Scales (2nd ed.). Sydney, New
South Wales, Australia: Psychology Foundation.
Meredith, P. J., Rappel, G., Strong, J., & Bailey, K. J. (2015).
Sensory sensitivity and strategies for coping with pain.
American Journal of Occupational Therapy, 69, 690424001.
http://dx.doi.org/ajot.2015.014621
Meredith, P. J., Strong, J., & Feeney, J. A. (2006). The relationship
of adult attachment to emotion, catastrophizing, control,
threshold and tolerance, in experimentally-induced pain. Pain,
120, 44–52. http://dx.doi.org/10.1016/j.pain.2005.10.008
Meyer, B., Ajchenbrenner, M., & Bowles, D. P. (2005). Sensory
sensitivity, attachment experiences, and rejection responses
among adults with borderline and avoidant features. Journal
of Personality Disorders, 19, 641–658. http://dx.doi.org/
10.1521/pedi.2005.19.6.641
Mikulincer, M., Horesh, N., Eilati, I., & Kotler, M. (1999).
The association between adult attachment style and mental health in extreme life-endangering conditions. Personality and Individual Differences, 27, 831–842. http://dx.
doi.org/10.1016/S0191-8869(99)00032-X
Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B., & Lancee,
W. (2010). Adult attachment measures: A 25-year review.
Journal of Psychosomatic Research, 69, 419–432. http://dx.
doi.org/10.1016/j.jpsychores.2009.08.006
Schmidt, S., Nachtigall, C., Wuethrich-Martone, O., & Strauss,
B. (2002). Attachment and coping with chronic disease.
Journal of Psychosomatic Research, 53, 763–773. http://dx.
doi.org/10.1016/S0022-3999(02)00335-5
Sibley, C. G., Fischer, R., & Liu, J. H. (2005). Reliability and
validity of the Revised Experiences in Close Relationships
(ECR–R) self-report measure of adult romantic attachment.
Personality and Social Psychology Bulletin, 31, 1524–1536.
http://dx.doi.org/10.1177/0146167205276865
Snow-Turek, A. L., Norris, M. P., & Tan, G. (1996). Active and
passive coping strategies in chronic pain patients. Pain, 64,
455–462. http://dx.doi.org/10.1016/0304-3959(95)00190-5
Wilbarger, J., Gunnar, M., Schneider, M., & Pollak, S.
(2010). Sensory processing in internationally adopted,
post-institutionalized children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51, 1105–1114.
http://dx.doi.org/10.1111/j.1469-7610.2010.02255.x
Zeanah, C. H. (2000). Disturbances of attachment in young
children adopted from institutions. Journal of Developmental and Behavioral Pediatrics, 21, 230–236.
7001250010p8
Downloaded From: http://ajot.aota.org/ on 03/03/2016 Terms of Use: http://AOTA.org/terms
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