Elisabeth Waller - Academia.edu (original) (raw)
Papers by Elisabeth Waller
Journal of Psychosomatic Research, 2012
The purpose of this study was to examine the influence of attachment, social support and the qual... more The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupie...
Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, Feb 1, 1999
Theoretical issues and research emphasis within the field of of attachment theory have shifted fr... more Theoretical issues and research emphasis within the field of of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology, and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.
Pid Psychotherapie Im Dialog, 2008
Pid Psychotherapie Im Dialog, 2005
Psychotherapie Forum, 2005
Summary Various psychodynamic processes may underlie the development of psychogenic pain disorde... more Summary Various psychodynamic processes may underlie the development of psychogenic pain disorder such as conversion, the displacement of affect or narcissistic defences. However, many of the processes suggested are related to a disorder of affect regulation. The term affect regulation in the psychoanalytic literature refers to phenomena which often are described by the concept of alexithymia. Empirical observations suggest that alexithymia
Pdp Psychodynamische Psychotherapie, 2007
Gruppenpsychotherapie und Gruppendynamik, 2007
Zusammenfassung Familienrekonstruktionen als spezifische Form familienorientierter Selbsterfahrun... more Zusammenfassung Familienrekonstruktionen als spezifische Form familienorientierter Selbsterfahrung sind seit langer Zeit fester Bestandteil in der Ausbildung von Familientherapeuten und haben sich in der Folge auch als eigenständige ...
Journal of health psychology, Jan 30, 2015
This study examined the prevalence of unresolved attachment-related trauma and its association wi... more This study examined the prevalence of unresolved attachment-related trauma and its association with physical and psychological health status in 34 patients with fibromyalgia. Unresolved trauma was assessed with the Adult Attachment Interview. In addition, participants completed self-report measures of childhood trauma, fibromyalgia-related health status and depression. Of the sample, 50 per cent was classified as unresolved on the Adult Attachment Interview. Neither interview-based ratings of unresolved trauma nor self-reported childhood sexual or physical abuse were associated with health outcomes. Only for self-reported emotional abuse, a positive correlation with depression emerged. The implications of the findings are discussed.
PiD - Psychotherapie im Dialog, 2008
Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 1999
Theoretical issues and research emphasis within the field of of attachment theory have shifted fr... more Theoretical issues and research emphasis within the field of of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology, and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.
Psychotherapy and Psychosomatics, 2000
OBJECTIVE: The study investigates individual differences in the mental representation of attachme... more OBJECTIVE: The study investigates individual differences in the mental representation of attachment and their impact on the cortisol response to psychosocial stress in idiopathic spasmodic torticollis (IST). It was hypothesized (a) that in IST insecure attachment is more prevalent than in a non-clinical control group and (b) that subjects with dismissing attachment respond with higher physiological arousal to a specific stimulus activating the attachment behavioural system than subjects with secure attachment. METHOD: 20 patients with IST and 20 healthy controls matched for age and sex underwent the Adult Attachment Interview, an hour-long, semiclinical interview on attachment experiences. During the interview salivary cortisol levels were monitored. The subjects' mental state with regard to attachment was classified using the attachment Q-sort method. Anxiety and depression were measured as potential covariates of the adrenocortical stress response. RESULTS: Compared to the non-clinical group, dismissing attachment was strongly overrepresented in IST. In IST, but not in the healthy control group, dismissing attachment correlated with an elevated cortisol response to the interview. CONCLUSION: In clinical, but not in non-clinical samples dismissing attachment may be associated with increased vulnerability to psychosocial stress. The factors contributing to this interaction are not yet fully elucidated.
Nordic Journal of Psychiatry, 2014
Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The a... more Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The aim of the present study was to investigate the interrelationship between self-reported symptoms of depression and pain in FMS compared with rheumatoid arthritis (RA). In a cross-sectional study, 100 patients with FMS and 50 patients with RA were compared with regard to depression and psychopathology using the Symptom Check List (SCL-27). Group comparisons were calculated by parametric and non-parametric tests. The association between pain intensity and depression was determined by correlation analyses and multivariate statistical procedures (CATREG). Pain intensity was significantly higher in FMS compared with RA. FMS patients also scored significantly higher on all subscales of the SCL-27 including the depression scale and the General Symptom Index (GSI) (P < 0.001). These group differences remained stable even after correcting for pain intensity. Correlation analyses revealed an association between pain intensity and depression in FMS but not in RA (R = 0.419, P < 0.001). FMS patients in tertiary referral centers suffer from higher levels of pain intensity than RA patients. Depression predicts levels of pain in FMS but not in RA and is therefore an important target of intervention.
Journal of Psychosomatic Research, 2012
The purpose of this study was to examine the influence of attachment, social support and the qual... more The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R2=.698, P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R2=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R2=.432, P=.014). Attachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support.
The Journal of Nervous & Mental Disease, 1999
We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic t... more We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic torticollis (IST). It was hypothesized a) that alexithymia in IST is more prevalent than in a nonclinical control group and b) that significant correlations emerge between alexithymia and a dismissing attachment representation. Twenty patients with IST and 20 healthy controls matched for age and sex were administered the Toronto Alexithymia Scale (TAS-20) and the Adult Attachment Interview (AAI). Attachment was classified using the Attachment Interview Q-sort. IST patients scored significantly higher on the measure of alexithymia than subjects in the comparison group. In IST a dismissing attachment representation was significantly more frequent than in the control group. Across the total sample, externally oriented thinking correlated positively with dismissing attachment, and both externally oriented thinking and difficulty communicating feelings (two of the three subscales of the TAS-20) correlated inversely with secure attachment. Alexithymia is more prevalent in IST than in normals. As was hypothesized, alexithymia in adults is significantly interrelated with the mental representation of attachment.
General Hospital Psychiatry, 2013
There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in prim... more There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. Forty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. Both treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. A high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.
General Hospital Psychiatry, 2014
Erratum to "Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent... more Erratum to "Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial" General Hospital Psychiatry 35 (2013) 160-167
Journal of Psychosomatic Research, 2012
The purpose of this study was to examine the influence of attachment, social support and the qual... more The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupie...
Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, Feb 1, 1999
Theoretical issues and research emphasis within the field of of attachment theory have shifted fr... more Theoretical issues and research emphasis within the field of of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology, and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.
Pid Psychotherapie Im Dialog, 2008
Pid Psychotherapie Im Dialog, 2005
Psychotherapie Forum, 2005
Summary Various psychodynamic processes may underlie the development of psychogenic pain disorde... more Summary Various psychodynamic processes may underlie the development of psychogenic pain disorder such as conversion, the displacement of affect or narcissistic defences. However, many of the processes suggested are related to a disorder of affect regulation. The term affect regulation in the psychoanalytic literature refers to phenomena which often are described by the concept of alexithymia. Empirical observations suggest that alexithymia
Pdp Psychodynamische Psychotherapie, 2007
Gruppenpsychotherapie und Gruppendynamik, 2007
Zusammenfassung Familienrekonstruktionen als spezifische Form familienorientierter Selbsterfahrun... more Zusammenfassung Familienrekonstruktionen als spezifische Form familienorientierter Selbsterfahrung sind seit langer Zeit fester Bestandteil in der Ausbildung von Familientherapeuten und haben sich in der Folge auch als eigenständige ...
Journal of health psychology, Jan 30, 2015
This study examined the prevalence of unresolved attachment-related trauma and its association wi... more This study examined the prevalence of unresolved attachment-related trauma and its association with physical and psychological health status in 34 patients with fibromyalgia. Unresolved trauma was assessed with the Adult Attachment Interview. In addition, participants completed self-report measures of childhood trauma, fibromyalgia-related health status and depression. Of the sample, 50 per cent was classified as unresolved on the Adult Attachment Interview. Neither interview-based ratings of unresolved trauma nor self-reported childhood sexual or physical abuse were associated with health outcomes. Only for self-reported emotional abuse, a positive correlation with depression emerged. The implications of the findings are discussed.
PiD - Psychotherapie im Dialog, 2008
Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 1999
Theoretical issues and research emphasis within the field of of attachment theory have shifted fr... more Theoretical issues and research emphasis within the field of of attachment theory have shifted from attachment behavior "to the level of representation" (Bretherton, 1985) since the middle of the 80ies. The paper presents an overview on basic assumptions, research methodology, and empirical findings in the field of attachment research. Four issues are addressed, which are relevant for psychosomatic research. These concern: (1) The prevalence of insecure attachment representation in psychosomatic disorders; (2) the association between insecure attachment representation and an increased psychophysiological reactivity; (3) the potential link between attachment and affect regulation and (4) the question, whether the classification of attachment representations may increase our understanding of specific aspects of illness behavior in psychosomatic conditions such as somatoform disorders.
Psychotherapy and Psychosomatics, 2000
OBJECTIVE: The study investigates individual differences in the mental representation of attachme... more OBJECTIVE: The study investigates individual differences in the mental representation of attachment and their impact on the cortisol response to psychosocial stress in idiopathic spasmodic torticollis (IST). It was hypothesized (a) that in IST insecure attachment is more prevalent than in a non-clinical control group and (b) that subjects with dismissing attachment respond with higher physiological arousal to a specific stimulus activating the attachment behavioural system than subjects with secure attachment. METHOD: 20 patients with IST and 20 healthy controls matched for age and sex underwent the Adult Attachment Interview, an hour-long, semiclinical interview on attachment experiences. During the interview salivary cortisol levels were monitored. The subjects' mental state with regard to attachment was classified using the attachment Q-sort method. Anxiety and depression were measured as potential covariates of the adrenocortical stress response. RESULTS: Compared to the non-clinical group, dismissing attachment was strongly overrepresented in IST. In IST, but not in the healthy control group, dismissing attachment correlated with an elevated cortisol response to the interview. CONCLUSION: In clinical, but not in non-clinical samples dismissing attachment may be associated with increased vulnerability to psychosocial stress. The factors contributing to this interaction are not yet fully elucidated.
Nordic Journal of Psychiatry, 2014
Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The a... more Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The aim of the present study was to investigate the interrelationship between self-reported symptoms of depression and pain in FMS compared with rheumatoid arthritis (RA). In a cross-sectional study, 100 patients with FMS and 50 patients with RA were compared with regard to depression and psychopathology using the Symptom Check List (SCL-27). Group comparisons were calculated by parametric and non-parametric tests. The association between pain intensity and depression was determined by correlation analyses and multivariate statistical procedures (CATREG). Pain intensity was significantly higher in FMS compared with RA. FMS patients also scored significantly higher on all subscales of the SCL-27 including the depression scale and the General Symptom Index (GSI) (P < 0.001). These group differences remained stable even after correcting for pain intensity. Correlation analyses revealed an association between pain intensity and depression in FMS but not in RA (R = 0.419, P < 0.001). FMS patients in tertiary referral centers suffer from higher levels of pain intensity than RA patients. Depression predicts levels of pain in FMS but not in RA and is therefore an important target of intervention.
Journal of Psychosomatic Research, 2012
The purpose of this study was to examine the influence of attachment, social support and the qual... more The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R2=.698, P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R2=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R2=.432, P=.014). Attachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support.
The Journal of Nervous & Mental Disease, 1999
We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic t... more We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic torticollis (IST). It was hypothesized a) that alexithymia in IST is more prevalent than in a nonclinical control group and b) that significant correlations emerge between alexithymia and a dismissing attachment representation. Twenty patients with IST and 20 healthy controls matched for age and sex were administered the Toronto Alexithymia Scale (TAS-20) and the Adult Attachment Interview (AAI). Attachment was classified using the Attachment Interview Q-sort. IST patients scored significantly higher on the measure of alexithymia than subjects in the comparison group. In IST a dismissing attachment representation was significantly more frequent than in the control group. Across the total sample, externally oriented thinking correlated positively with dismissing attachment, and both externally oriented thinking and difficulty communicating feelings (two of the three subscales of the TAS-20) correlated inversely with secure attachment. Alexithymia is more prevalent in IST than in normals. As was hypothesized, alexithymia in adults is significantly interrelated with the mental representation of attachment.
General Hospital Psychiatry, 2013
There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in prim... more There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. Forty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. Both treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. A high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.
General Hospital Psychiatry, 2014
Erratum to "Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent... more Erratum to "Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial" General Hospital Psychiatry 35 (2013) 160-167