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J Affect Disord. 2017 Aug 15;218:253-259. doi: 10.1016/j.jad.2017.04.047. Epub 2017 Apr 28.

Adult attachment style and anxiety - The mediating role of emotion regulation.

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Department of Psychology, University of Copenhagen, 2A Oester Farimagsgade, 1353 Copenhagen C, Denmark. Electronic address:
Mental Health Services, Capital Region of Denmark, Denmark.
Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California-Los Angeles, CA, USA.
Copenhagen University Hospital, Denmark.
Department of Psychology, University of Copenhagen, 2A Oester Farimagsgade, 1353 Copenhagen C, Denmark.



Although there is substantial evidence for the role of emotion regulation in the etiology and maintenance of anxiety disorders, knowledge about what contributes to emotion dysregulation is sparse. Attachment style is related to emotion regulation and anxiety symptoms, but these variables have rarely been examined together. Examining emotion dysregulation within the context of anxiety disorders through an attachment theory framework will lead to a better understanding of the etiology and maintenance of anxiety disorders. In the present study we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and anxiety symptoms.


A total of 147 individuals were assessed with Beck Anxiety Inventory (BAI), Experiences in Close Relationships-Revised (ECR-R) and Difficulties in Emotion Regulation Scale (DERS), and statistical mediation analyses were conducted.


Our results indicate that the significant association between anxiety and attachment anxiety was mediated by emotion dysregulation, whereas attachment avoidance was not significantly related to anxiety when covarying for attachment anxiety. The primary limitation of our study is that data is cross-sectional and so causation cannot be inferred. Secondly, all measures used in this study were derived from self-reported questionnaires, which may be more susceptible to bias.


Our results suggest that it is not insecure attachment in general that is important in anxiety disorders, but that attachment anxiety is specifically relevant. Thus, clinical interventions for anxiety disorders may improve by targeting attachment related difficulties.


Adult attachment style; Anxiety disorders; Emotion regulation; Mediation analysis

[Indexed for MEDLINE]

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