Autonomic arousal (or affective states, e.g. stress, anxiety), symptoms (e.g. fatigue, pain), sle... more Autonomic arousal (or affective states, e.g. stress, anxiety), symptoms (e.g. fatigue, pain), sleep-disrupting behaviour (e.g. physical inactivity, electronic device use, TV watching, shift work) and medications are linked to impaired sleep and, in many cases, overweight/obesity. Further, in many cases, the phenomena are linked to an elevated BT, and in some cases, a high nocturnal BT, although there is a lack of specific research pertaining to nocturnal BT and the relationship between BT and chronic pain. A relative hyperthermia at night is known to interfere with sleep onset, possible via a phase-shift in the sleep-wake cycle. However, an elevated BT can additionally lead to activation of the inflammatory response system (e.g. cytokine secretion), which may represent another possible mechanism by which the aforementioned states, symptoms, disorders and behaviour can develop.
Comorbidity among psychiatric illnesses is common, as is comorbidity between psychiatric and phys... more Comorbidity among psychiatric illnesses is common, as is comorbidity between psychiatric and physical illnesses. Current knowledge of psychiatric comorbidity points to several possible underlying factors, notably an overlap in their definitions and symptoms; unidirectional and bidirectional causation; disordered sleep; and a range of shared risk factors. Psychiatric illness may lead to poorer self-care and sleep problems, whereas being physically ill may impact upon an individual’s psychological wellbeing. An integration of the various causal models that have been proposed to explain the comorbidities is discussed, incorporating different socio-psychological and biological factors to explain the development of depression and anxiety. These issues are detailed in the following chapter with a focus on depression. Implications for treatment are also discussed.
Objective: Individual differences in the perception of bodily sensations is known to be associate... more Objective: Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies. Method: In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1. Results: In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described ...
Comorbidity refers to any distinct clinical entity that coexists with or occurs during the clinic... more Comorbidity refers to any distinct clinical entity that coexists with or occurs during the clinical course of another illness or condition. In other words, it refers to the co-occurrence of two or more distinct illnesses, disorders or conditions in a single individual. As a result of the comorbidity, some disorders tend to occur together more often than they occur alone. For example, anxiety, depressed mood and impaired sleep often co-occur, and in this instance, the co-occurrence appears to be the rule rather than the exception.
Comorbidity is common, affecting one-third or more of the global population; and recent co-preval... more Comorbidity is common, affecting one-third or more of the global population; and recent co-prevalence estimates suggest that its presence is increasing. It is associated with substantial chronic illness burden, disability, high mortality, and high ongoing costs to the individual and the community, reflecting its substantial impact within and beyond the health care system. Thus, unravelling the causes of comorbidity currently ranks among the top priorities in clinical practice. However, there are currently few protocols and clinical practice guidelines that can be used to assist clinicians in treating comorbid conditions in a coordinated way. Instead, the guidelines and protocols have tended to focus on single disorders and they generally fail to take comorbidities into account. This has resulted in the comorbid disorders being treated as if they are isolated clinical entities, with each condition managed separately, often by different clinicians. Therefore, there is a clear need to develop new clinical practice guidelines and therapeutic approaches that do take comorbidity into account; especially in patients with highly prevalent and highly comorbid disorders.
International Journal of Sport Psychology, Mar 1, 2016
This research investigated a model of connecting greater mindfulness to more occurrences of flow ... more This research investigated a model of connecting greater mindfulness to more occurrences of flow and less sport-specific anxiety and pessimistic sport attributions in competitive cyclists. The research examined direct and indirect paths from mindfulness to the subjective state of being in flow. Indirect paths examined were through pessimistic sports attributions, sport-specific anxiety and flow conditions. Key findings were that higher levels of mindfulness were associated with more experience of flow, fewer sports-related pessimistic cognitions, and less sport-specific anxiety. Lower levels of sport-specific pessimistic attributions and sport-specific anxiety were associated with a higher frequency of experienced flow conditions. A higher frequency of flow conditions was associated with more occurrence of the subjective state of being in flow. The results support a model connecting mindfulness to flow experience through the meeting of flow conditions and through less experience of pessimism and anxiety. The results have implications for possible interventions focused upon increasing mindfulness to enhance the occurrence of flow.
Research of disease comorbidity and symptom co-occurrence raises several issues relating to study... more Research of disease comorbidity and symptom co-occurrence raises several issues relating to study design and analytical techniques that require careful consideration. In this chapter, we first address methodological issues that are of particular relevance in comorbidity research, including symptom overlap and the resultant double counting of symptoms; the pitfalls and advantages of removing overlapping scale items; and the utility of creating latent variables or ‘symptom groups’. We then discuss the advantages and limitations of employing various study designs in the context of comorbidity research and make recommendations for maximising the scientific rigour of statistical analyses whilst ensuring that ethical standards are met. Finally, we highlight analytical techniques that are relatively novel and/or less commonly utilised in studies of comorbidity, and how these techniques might advance research in this field.
Supplemental material, AUT738392_Lay_Abstract for Autism spectrum disorder and interoception: Abn... more Supplemental material, AUT738392_Lay_Abstract for Autism spectrum disorder and interoception: Abnormalities in global integration? by Timothy R Hatfield, Rhonda F Brown, Melita J Giummarra and Bigna Lenggenhager in Autism
Overweight/obesity tends to co-occur with disturbed sleep and disordered eating (e.g. binge-eatin... more Overweight/obesity tends to co-occur with disturbed sleep and disordered eating (e.g. binge-eating, night-eating), although the precise mechanism/s underpinning the relationships is unclear. However, overweight/obese people are more likely to eat late at night than normal-weight people, thus, late night-eating (or binge-eating, which often occurs at night) may at least partly explain the observed relationship between overweight/obesity and impaired sleep in affected individuals. For example, night-eating and binge-eating are related to impaired sleep (e.g. longer sleep onset latency) and weight gain in obese people, and clinically, obese people are at an increased risk of a binge eating disorder and/or night eating syndrome diagnosis. A similar profile of sleep deficits is evident in overweight/obese people, binge-eaters, and night-eaters, and impaired sleep (e.g. longer sleep onset latency, shorter sleep duration) is associated with overweight/obesity, night-eating, and binge-eatin...
ABSTRACT Objective: Stress, psychological distress and fatigue are frequently co-morbid experienc... more ABSTRACT Objective: Stress, psychological distress and fatigue are frequently co-morbid experiences, but the nature of any temporal and/or causal relationships is unclear. This study examined possible mediators and moderators of the stress/psychological distress – fatigue relationship in a non-clinical sample. Methods: A questionnaire assessed stress (i.e., stressful life-events, perceived stress), psychological distress (i.e., state and trait anxiety, depression), sleep quality, social support (i.e., number, quality), illness symptoms and fatigue in 97 female and 40 male university students, aged 18-63 years. Results: Regression models indicated that high perceived stress and state-anxiety, poor sleep quality and general illness symptoms predicted 48% of the variance in fatigue severity. Poor sleep quality and gastrointestinal (GIT) symptoms partly mediated between stress and fatigue, and poor sleep quality partly mediated between psychological distress and fatigue. Social support quality moderated the stress – fatigue relationship. Conclusions: Stress and psychological distress may contribute to fatigue in healthy adults by first impairing sleep quality and/or increasing vulnerability to infection, which may then directly induce fatigue symptoms.
IntroductionThere are little published data on the long-term psychological outcomes in intensive ... more IntroductionThere are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting.Methods and analysisThis will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective sympt...
Background: A better understanding of the workplace difficulties experienced by people with multi... more Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2017
Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occu... more Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. Level V, narrative review.
The purpose of this paper was to evaluate the relationship between attachment-avoidance and -anxi... more The purpose of this paper was to evaluate the relationship between attachment-avoidance and -anxiety, and marital relationship quality during pregnancy to the expression of depression, anxiety, and stress postpartum. One-hundred-five women participated in a two-phase longitudinal study during the third trimester of pregnancy and at four to six months postpartum. They completed the attachment and relationship measures at Time 1, and the measures of stress, anxiety, and depression at both times. The marital relationship variables of affectional expression and dyadic satisfaction significantly predicted depression levels post-partum, whereas dyadic satisfaction significantly predicted anxiety levels. No variables predicted maternal stress levels. Mediational analyses indicated that dyadic satisfaction significantly mediated the relationships between high attachment-anxiety to worse anxiety and depression, and also the relationship between high attachment-avoidance to later anxiety and depression. The study r...
Autonomic arousal (or affective states, e.g. stress, anxiety), symptoms (e.g. fatigue, pain), sle... more Autonomic arousal (or affective states, e.g. stress, anxiety), symptoms (e.g. fatigue, pain), sleep-disrupting behaviour (e.g. physical inactivity, electronic device use, TV watching, shift work) and medications are linked to impaired sleep and, in many cases, overweight/obesity. Further, in many cases, the phenomena are linked to an elevated BT, and in some cases, a high nocturnal BT, although there is a lack of specific research pertaining to nocturnal BT and the relationship between BT and chronic pain. A relative hyperthermia at night is known to interfere with sleep onset, possible via a phase-shift in the sleep-wake cycle. However, an elevated BT can additionally lead to activation of the inflammatory response system (e.g. cytokine secretion), which may represent another possible mechanism by which the aforementioned states, symptoms, disorders and behaviour can develop.
Comorbidity among psychiatric illnesses is common, as is comorbidity between psychiatric and phys... more Comorbidity among psychiatric illnesses is common, as is comorbidity between psychiatric and physical illnesses. Current knowledge of psychiatric comorbidity points to several possible underlying factors, notably an overlap in their definitions and symptoms; unidirectional and bidirectional causation; disordered sleep; and a range of shared risk factors. Psychiatric illness may lead to poorer self-care and sleep problems, whereas being physically ill may impact upon an individual’s psychological wellbeing. An integration of the various causal models that have been proposed to explain the comorbidities is discussed, incorporating different socio-psychological and biological factors to explain the development of depression and anxiety. These issues are detailed in the following chapter with a focus on depression. Implications for treatment are also discussed.
Objective: Individual differences in the perception of bodily sensations is known to be associate... more Objective: Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies. Method: In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1. Results: In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described ...
Comorbidity refers to any distinct clinical entity that coexists with or occurs during the clinic... more Comorbidity refers to any distinct clinical entity that coexists with or occurs during the clinical course of another illness or condition. In other words, it refers to the co-occurrence of two or more distinct illnesses, disorders or conditions in a single individual. As a result of the comorbidity, some disorders tend to occur together more often than they occur alone. For example, anxiety, depressed mood and impaired sleep often co-occur, and in this instance, the co-occurrence appears to be the rule rather than the exception.
Comorbidity is common, affecting one-third or more of the global population; and recent co-preval... more Comorbidity is common, affecting one-third or more of the global population; and recent co-prevalence estimates suggest that its presence is increasing. It is associated with substantial chronic illness burden, disability, high mortality, and high ongoing costs to the individual and the community, reflecting its substantial impact within and beyond the health care system. Thus, unravelling the causes of comorbidity currently ranks among the top priorities in clinical practice. However, there are currently few protocols and clinical practice guidelines that can be used to assist clinicians in treating comorbid conditions in a coordinated way. Instead, the guidelines and protocols have tended to focus on single disorders and they generally fail to take comorbidities into account. This has resulted in the comorbid disorders being treated as if they are isolated clinical entities, with each condition managed separately, often by different clinicians. Therefore, there is a clear need to develop new clinical practice guidelines and therapeutic approaches that do take comorbidity into account; especially in patients with highly prevalent and highly comorbid disorders.
International Journal of Sport Psychology, Mar 1, 2016
This research investigated a model of connecting greater mindfulness to more occurrences of flow ... more This research investigated a model of connecting greater mindfulness to more occurrences of flow and less sport-specific anxiety and pessimistic sport attributions in competitive cyclists. The research examined direct and indirect paths from mindfulness to the subjective state of being in flow. Indirect paths examined were through pessimistic sports attributions, sport-specific anxiety and flow conditions. Key findings were that higher levels of mindfulness were associated with more experience of flow, fewer sports-related pessimistic cognitions, and less sport-specific anxiety. Lower levels of sport-specific pessimistic attributions and sport-specific anxiety were associated with a higher frequency of experienced flow conditions. A higher frequency of flow conditions was associated with more occurrence of the subjective state of being in flow. The results support a model connecting mindfulness to flow experience through the meeting of flow conditions and through less experience of pessimism and anxiety. The results have implications for possible interventions focused upon increasing mindfulness to enhance the occurrence of flow.
Research of disease comorbidity and symptom co-occurrence raises several issues relating to study... more Research of disease comorbidity and symptom co-occurrence raises several issues relating to study design and analytical techniques that require careful consideration. In this chapter, we first address methodological issues that are of particular relevance in comorbidity research, including symptom overlap and the resultant double counting of symptoms; the pitfalls and advantages of removing overlapping scale items; and the utility of creating latent variables or ‘symptom groups’. We then discuss the advantages and limitations of employing various study designs in the context of comorbidity research and make recommendations for maximising the scientific rigour of statistical analyses whilst ensuring that ethical standards are met. Finally, we highlight analytical techniques that are relatively novel and/or less commonly utilised in studies of comorbidity, and how these techniques might advance research in this field.
Supplemental material, AUT738392_Lay_Abstract for Autism spectrum disorder and interoception: Abn... more Supplemental material, AUT738392_Lay_Abstract for Autism spectrum disorder and interoception: Abnormalities in global integration? by Timothy R Hatfield, Rhonda F Brown, Melita J Giummarra and Bigna Lenggenhager in Autism
Overweight/obesity tends to co-occur with disturbed sleep and disordered eating (e.g. binge-eatin... more Overweight/obesity tends to co-occur with disturbed sleep and disordered eating (e.g. binge-eating, night-eating), although the precise mechanism/s underpinning the relationships is unclear. However, overweight/obese people are more likely to eat late at night than normal-weight people, thus, late night-eating (or binge-eating, which often occurs at night) may at least partly explain the observed relationship between overweight/obesity and impaired sleep in affected individuals. For example, night-eating and binge-eating are related to impaired sleep (e.g. longer sleep onset latency) and weight gain in obese people, and clinically, obese people are at an increased risk of a binge eating disorder and/or night eating syndrome diagnosis. A similar profile of sleep deficits is evident in overweight/obese people, binge-eaters, and night-eaters, and impaired sleep (e.g. longer sleep onset latency, shorter sleep duration) is associated with overweight/obesity, night-eating, and binge-eatin...
ABSTRACT Objective: Stress, psychological distress and fatigue are frequently co-morbid experienc... more ABSTRACT Objective: Stress, psychological distress and fatigue are frequently co-morbid experiences, but the nature of any temporal and/or causal relationships is unclear. This study examined possible mediators and moderators of the stress/psychological distress – fatigue relationship in a non-clinical sample. Methods: A questionnaire assessed stress (i.e., stressful life-events, perceived stress), psychological distress (i.e., state and trait anxiety, depression), sleep quality, social support (i.e., number, quality), illness symptoms and fatigue in 97 female and 40 male university students, aged 18-63 years. Results: Regression models indicated that high perceived stress and state-anxiety, poor sleep quality and general illness symptoms predicted 48% of the variance in fatigue severity. Poor sleep quality and gastrointestinal (GIT) symptoms partly mediated between stress and fatigue, and poor sleep quality partly mediated between psychological distress and fatigue. Social support quality moderated the stress – fatigue relationship. Conclusions: Stress and psychological distress may contribute to fatigue in healthy adults by first impairing sleep quality and/or increasing vulnerability to infection, which may then directly induce fatigue symptoms.
IntroductionThere are little published data on the long-term psychological outcomes in intensive ... more IntroductionThere are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting.Methods and analysisThis will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective sympt...
Background: A better understanding of the workplace difficulties experienced by people with multi... more Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2017
Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occu... more Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. Level V, narrative review.
The purpose of this paper was to evaluate the relationship between attachment-avoidance and -anxi... more The purpose of this paper was to evaluate the relationship between attachment-avoidance and -anxiety, and marital relationship quality during pregnancy to the expression of depression, anxiety, and stress postpartum. One-hundred-five women participated in a two-phase longitudinal study during the third trimester of pregnancy and at four to six months postpartum. They completed the attachment and relationship measures at Time 1, and the measures of stress, anxiety, and depression at both times. The marital relationship variables of affectional expression and dyadic satisfaction significantly predicted depression levels post-partum, whereas dyadic satisfaction significantly predicted anxiety levels. No variables predicted maternal stress levels. Mediational analyses indicated that dyadic satisfaction significantly mediated the relationships between high attachment-anxiety to worse anxiety and depression, and also the relationship between high attachment-avoidance to later anxiety and depression. The study r...
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Papers by Rhonda Brown