Can Secure Attachment Reduce Death Anxiety and Obsessive Compulsions?
安全依戀可以緩衝“心理強大”人群的死亡焦慮。現在研究人員正在測試對強迫症的影響。
Secure attachment can buffer against death anxiety in “psychologically robust” populations. Now researchers are testing the effect on OCD.
理查德·西爾斯-2022 年 6 月 16 日
By Richard Sears -June 16, 2022

在《行為與認知心理治療》上發表的一篇新文章中， Rachel Verin 和她的同事探討了強迫症 (OCD)、死亡焦慮和依戀風格之間的關係。作者使用了來自 48 名被診斷患有強迫症並尋求治療的參與者的訪談數據。
In a new article published in Behavioral and Cognitive Psychotherapy, Rachel Verin and her colleagues explore the relationships between obsessive-compulsive disorder (OCD), death anxiety, and attachment style. The authors use interview data from 48 participants diagnosed with and seeking treatment for OCD.

本研究發現，與之前關於該主題的研究一致，死亡焦慮強烈預測強迫症的嚴重程度。然而，與作者的假設相反，結果表明焦慮和迴避的依戀風格與強迫症的嚴重程度無關。
The present research finds, in line with previous studies on this topic, that death anxiety strongly predicts OCD severity. However, contrary to the authors’ hypothesis, the results suggest that anxious and avoidant attachment styles do not correlate to OCD severity.

“目前的研究結果雖然具有相關性，但與表明死亡焦慮在強迫症中的核心作用的實驗結果一致，”Verin 和她的合著者寫道。“目前的證據表明，依戀雖然可以作為非臨床樣本中死亡焦慮的有效緩沖劑，但對於強迫症患者來說可能是不夠的。”
“The present findings, while correlational, are consistent with experimental findings that suggest the central role of death anxiety in OCD,” Verin and her co-authors write. “The current evidence suggests that attachment while serving as an effective buffer against death anxiety in non-clinical samples, may be insufficient for individuals with OCD.”

先前的研究發現，就許多終生診斷、藥物治療、住院治療、痛苦/損害、抑鬱、焦慮和壓力而言，死亡焦慮是精神疾病的一個強有力的預測因素。一些作者建議，如果不直接治療死亡焦慮，我們可能會將服務用戶推向診斷的“旋轉門”，一旦我們控制了一組症狀，就會出現一組新症狀。
Previous research has found death anxiety to be a strong predictor of mental illness in terms of a number of lifetime diagnoses, medications, hospitalizations, distress/impairment, depression, anxiety, and stress. Some authors have suggested that by not treating death anxiety directly, we may doom service users to a “revolving door” of diagnoses where once we get a set of symptoms under control, a new set emerges.

眾所周知，強迫症很難治療。最有效的療法之一稱為暴露和反應預防 (ERP)。ERP 類似於暴露療法，因為它指導服務用戶體驗他們的痴迷，而不是反復進行強迫。例如，可能會要求人們對錶現在強迫性梳理行為中的細菌有強迫性想法，但他們可能會被要求在不洗手的情況下弄髒他們的手。
OCD has been notoriously difficult to treat. One of the most effective therapies is called Exposure and Response Prevention (ERP). ERP is similar to exposure therapy in that it directs the service user to experience their obsession without repeatedly engaging in compulsion. For example, people with obsessive thoughts about germs that manifest in compulsive grooming behaviors may be asked to dirty their hands without washing them.

不幸的是，很少有接受過 ERP 培訓的治療師。這可能會嚴重限制沒有大量經濟資源的人獲得治療的機會。作者估計，由於熟悉 ERP 的從業者數量有限，強迫症患者通常需要大約 17 年才能找到合適的治療方法。
Unfortunately, there are few therapists trained in ERP. This can severely limit access to therapy for people that do not have significant financial resources. The authors have estimated that due to the limited number of practitioners familiar with ERP, it typically takes OCD sufferers about 17 years to find proper treatment.

雖然 ERP 確實在治療強迫症方面顯示出巨大的希望，但大多數患者更喜歡其他類型的心理治療，而不是 ERP 和藥物治療。這種偏好可能是由於服務用戶在 ERP 的第一階段體驗到的巨大不適。雖然服務用戶報告了對 ERP 以外的其他治療的偏好，但 ERP的流失率與 OCD 的不同治療相似。
While ERP does show great promise in treating OCD, most patients prefer other kinds of psychotherapy over both ERP and medications. This preference is likely due to the immense discomfort service users experience in the first stages of ERP. While service users report preferences for other treatments besides ERP, the attrition rates for ERP are similar to that of different treatments for OCD.

依戀理論指出，我們在童年早期就與我們的主要照顧者形成了特定的依戀。如果我們得到基本必需品並得到滋養，我們就會形成安全的依戀，讓我們在探索周圍的世界時感到安全。然而，如果我們被忽視，我們就會形成一種不安全的依戀，極大地限制了我們與世界互動的能力。然而，新的研究表明，這些依戀及其假定的後果遠非普遍真理。他們認為，依戀理論不是描述一個客觀的、普遍的事實，而是勾勒出一種文化結構，它只與創造它的文化相關（越來越少）。
Attachment theory states that we form specific attachments with our primary caregivers in our early childhood. If we are provided with our basic necessities and nurtured, we form secure attachments that allow us to feel safe exploring the world around us. However, if we are neglected, we form an insecure attachment, vastly limiting our ability to interact with our world. However, new research has suggested that these attachments and their supposed consequences are far from a universal truth. They argue that rather than describing an objective, universal fact, attachment theory outlines a cultural construct that is only relevant (decreasingly so) to the culture that created it.

目前的研究解釋說，死亡焦慮與強迫症高度相關。先前的研究也表明這種相關性是因果關係，這意味著世界上提醒強迫症患者死亡的事物也可能引發他們的強迫行為。先前的研究還發現，安全依戀可以減輕死亡焦慮。然而，幾乎沒有研究在被診斷患有強迫症的人中探索這種關係。本研究旨在填補這一知識空白。
The present research explains that death anxiety has been highly correlated to OCD. Previous research has also shown this correlation to be causal, meaning that things in the world that remind OCD sufferers of death may also trigger their compulsive behaviors. Previous research has also found that secure attachment mitigates death anxiety. However, little to no research exists exploring this relationship in people diagnosed with OCD. The present study is designed to fill this gap in knowledge.

本研究利用多維死亡恐懼量表、溫哥華強迫症量表和親密關係經歷——修訂後的訪談工具來了解死亡焦慮、強迫症和依戀之間的關係。
The present research utilizes the Multidimensional Fear of Death Scale, the Vancouver Obsessive-Compulsive Inventory, and the Experiences in Close Relationships-Revised interview tools to access the relationship between death anxiety, OCD, and attachment.

研究人員從澳大利亞悉尼的臨床心理學實踐中招募了 48 名參與者。他們年滿 18 歲，當前診斷為強迫症，如果存在不止一種診斷，則將 ODC 作為主要診斷。參與者絕大多數是白種人（93.8% 或 48 人中的 45 人）並受過教育（平均受教育年限為 15.95 年）。
The researchers recruited 48 participants from a clinical psychology practice in Sydney, Australia. They were over 18 years old, had a current diagnosis of OCD, and had ODC as their principal diagnosis if more than one diagnosis was present. The participants were overwhelmingly Caucasian (93.8% or 45 of 48) and educated (with an average of 15.95 years of education).

首先，作者將死亡焦慮評分與強迫症嚴重程度進行了比較。與之前的研究一致，他們發現參與者的死亡焦慮與強迫症嚴重程度之間存在很強的正相關關係。作者還指出，他們的參與者樣本在死亡焦慮方面的得分明顯高於普通人群，進一步表明死亡焦慮與強迫症之間存在聯繫。
First, the authors compared death anxiety scores to OCD severity. Consistent with previous research, they found a strong positive correlation between death anxiety and OCD severity in their participants. The authors also note that their sample of participants scored significantly higher in measures of death anxiety than the general population, further suggesting a link between death anxiety and OCD.

接下來，作者在他們的樣本中調查了依戀風格和強迫症嚴重程度之間的聯繫。與他們的假設相反，焦慮和迴避（因此不安全）的依戀風格並沒有顯著預測強迫症的嚴重程度。作者指出，儘管不安全依戀似乎與參與者的強迫症嚴重程度無關，但他們的樣本確實表明不安全依戀的發生率比普通人群高得多。
Next, the authors investigated the link between attachment styles and OCD severity in their sample. Contrary to their hypothesis, anxious and avoidant (therefore insecure) attachment styles did not significantly predict OCD severity. The authors note that although insecure attachment does not seem to correlate to OCD severity in their participants, their sample does demonstrate considerably higher rates of insecure attachment than the average population.

這些發現表明，安全依戀作為死亡焦慮的緩衝可能僅適用於非臨床人群。換句話說，安全依戀可能會保護“心理健全”的個體免受死亡焦慮，但在臨床上顯著的痛苦水平下並沒有提供這種好處。
These findings indicate that secure attachment as a buffer for death anxiety may only hold in non-clinical populations. In other words, secure attachment likely protects “psychologically robust” individuals from death anxiety but provides no such benefit with clinically significant levels of distress.

作者承認當前研究存在一些局限性。首先，這項研究是相關的，這意味著不可能得出因果結論（例如，死亡焦慮會導致強迫症的嚴重程度，或者不安全的依戀會導致更多的死亡焦慮）。
The authors acknowledge several limitations to the current research. First, this study is correlational, meaning it is impossible to draw causal conclusions (for example, that death anxiety causes OCD severity or that insecure attachment causes more death anxiety).

其次，這項研究是在 Covid-19 大流行期間完成的，這意味著參與者可能會接觸到更多的每日死亡提醒。最後，小樣本量使得對強迫症子類型的探索變得不可能，並且對更大人群的推廣充其量是不穩定的。作者得出結論：
Second, this research was done during the Covid-19 pandemic, which means participants were likely exposed to increased daily death reminders. Last, the small sample size makes an exploration of OCD sub-types impossible and generalization to larger populations shaky at best. The authors conclude:

“目前的研究結果雖然相關，但與表明死亡焦慮在強迫症中的核心作用的實驗結果一致。基於這些越來越多的證據，目前的臨床建議包括使用基於證據的方法直接針對死亡焦慮，例如暴露療法。目前針對強迫症的治療方法通常側重於反駁客戶對威脅的估計（例如，感染疾病的可能性），而不是直接針對根本原因。然而，由於未能針對死亡焦慮，此類治療可能有助於心理健康的“旋轉門”，在這種情況下，個人可能會針對一種疾病接受有效治療，但在以後的生活中又會因另一種疾病而重新接受治療，因為根本原因還沒有解決。”  
“The present findings, while correlational, are consistent with experimental findings that suggest the central role of death anxiety in OCD. Based on this mounting evidence, the current clinical recommendations include directly targeting death anxiety using evidence-based approaches, such as exposure therapy. Current treatment approaches for OCD typically focus on disproving the client’s estimates of threat (e.g., the probability of contracting an illness) rather than directly targeting the underlying cause. However, by failing to target death anxiety, such treatments may contribute to the ‘revolving door’ of mental health, in which an individual may receive effective treatment for one condition, only to later return to treatment later in life with a different disorder, given that the underlying cause has not been resolved.”  

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Verin, RE, Menzies, RE, & Menzies, RG (2021)。強迫症、死亡焦慮和依戀：愛與它有什麼關係？行為和認知心理治療，50（2），131-141。https://doi.org/10.1017/s135246582100045x （鏈接）
Verin, R. E., Menzies, R. E., & Menzies, R. G. (2021). OCD, death anxiety, and attachment: what’s love got to do with it? Behavioural and Cognitive Psychotherapy, 50(2), 131–141. https://doi.org/10.1017/s135246582100045x (Link)

理查德·西爾斯理查德·西爾斯（Richard Sears）在西喬治亞技術學院教授心理學，並正在攻讀西喬治亞大學的意識與社會博士學位。他之前曾在危機穩定部門工作，擔任進氣評估員和危機熱線操作員。他目前的研究興趣包括機構和組成機構的個人之間的劃分、去人性化及其與興奮的關係，以及潛在有害的心理藥理學乾預的天然替代品。

Richard SearsRichard Sears teaches psychology at West Georgia Technical College and is studying to receive a PhD in consciousness and society from the University of West Georgia. He has previously worked in crisis stabilization units as an intake assessor and crisis line operator. His current research interests include the delineation between institutions and the individuals that make them up, dehumanization and its relationship to exaltation, and natural substitutes for potentially harmful psychopharmacological interventions.