Attachment and coping with chronic disease

In this clinical study, attachment theory was applied to research in the field of coping with chronic disease. The approach was to integrate concepts of coping within a framework of attachment theory. It was hypothesised that attachment concepts have an influence on coping strategies, and that they may predict the subjective emotional and physical health status during the course of medical treatment.

One hundred fifty patients were investigated with an adult attachment interview (AAPR coding system) and a coping interview (Bernese Coping Modes). Self-reported coping modes, social support, the subjective health status and quality of life were also assessed by self-report measures at two or more sampling points of measurement. Three subsamples of patients, suffering from (a) breast cancer, (b) chronic leg ulcers and (c) alopecia, were studied in order to include a broad range of subjective impairment caused by a disease.

Findings indicate a moderate statistical effect of attachment patterns on coping strategies when controlling the influence of confounding variables. Insecure attachment was related to less flexible coping. Coping strategies also differed between the different types of insecure attachment; however, there were differences depending on the perspective of the coping behaviour (self- vs. observer ratings) as well. From the observer perspective, ambivalently attached individuals showed more negative emotional coping while avoidantly attached individuals showed more diverting strategies. In the self-report, ambivalently attached patients revealed hyperactivating tendencies in their coping behaviour while avoidantly attached individuals revealed deactivating tendencies.

As a conclusion, two levels of coping should be differentiated. One level strongly corresponds with affect regulation, in particular the regulation of attachment-related emotions and concerns, while the other level shows a stronger tendency to outwardly oriented coping. A more secure attachment might be considered to be an important inner resource in the emotional adaptation to chronic diseases.