Psychophysiological Responses Underlying the Discussion of Unresolved Loss and Trauma in the Adult Attachment Interview

Background
Participants in the Adult Attachment Interview (AAI) are asked to bring to mind memories of loss and trauma. Unresolved loss/trauma is indicated by lapses in speech about these experiences, which are theorised to reflect fear and/or dissociative states. However, its emotion regulation mechanisms are still unknown. This study examined the effect of discussing loss/trauma in the AAI on autonomic nervous system (ANS) reactivity, moderated by being classified as unresolved/disorganised (U/d).

Methods
Participants were 235 first-time pregnant women from the Generations2 cohort. ANS reactivity was recorded during the AAI. Interbeat interval (IBI) and measures of parasympathetic reactivity (respiratory sinus arrhythmia; RSA) and sympathetic reactivity (pre-ejection period; PEP, skin conductance; SC) were averaged across women’s responses to the AAI questions. Linear mixed models tested associations between ANS reactivity, responding to the loss/trauma questions, and U/d, using the first question as reference. Hypotheses and analyses were pre-registered (http://doi.org/10.17605/OSF.IO/A4J6Q). Exploratory analyses tested trajectories of ANS reactivity and its moderation by U/d throughout the interview.

Results
Table 1 shows hypothesis testing results. IBI and RSA increased when discussing loss/trauma. This relationship was not moderated by U/d. U/d was associated with decreased PEP when discussing trauma, indicating increased sympathetic reactivity, and with decreased SC levels when discussing loss and trauma. Exploratory analyses showed a curvilinear trend for PEP, and a cubic trend for SC; indicating blunted SC responses for U/d (Figure 1).

Discussion
The results on PEP indicate that discussing trauma is associated with increased sympathetic reactivity for interviewees classified as U/d. Exploratory findings suggest blunted SC responses throughout the interview for U/d. These results may seem contradictory but agree with previous findings among PTSD patients, where similar contrasting results were found in relation to mental dissociation (D’Andrea et al., 2013). Our findings will be discussed with reference to some tensions in the conceptualisation of dissociation within attachment theory.