ATTACHMENT STYLE AS A MECHANISM FROM INTIMATE PARTNER VIOLENCE TO
DEPRESSIVE SYMPTOMS: AN INFORMATION PROCESSING APPROACH
By
Kathryn Eileen Smagur

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
Psychology—Doctor of Philosophy
2017

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ABSTRACT
ATTACHMENT STYLE AS A MECHANISM FROM INTIMATE PARTNER VIOLENCE TO
DEPRESSIVE SYMPTOMS: AN INFORMATION PROCESSING APPROACH
By
Kathryn Eileen Smagur
Women experiencing intimate partner violence (IPV) are at risk for depressive
symptoms, and an insecure attachment style may account for this relationship. Attachment
insecurity may lead to depressive symptoms because it guides individuals to process information
in a way that is congruent with their negative internal working models. A woman’s history of
interpersonal trauma, such as prior IPV or childhood maltreatment (CM), may also influence this
process, as memories of prior trauma may be recalled when making sense of abuse in the present.
The current study examined attachment style as a mechanism to depressive symptoms for
women currently in abusive relationships. Information processing deficits (i.e., attention and
implicit interpretation bias) were tested as mediators between attachment insecurity and
depressive symptoms. Finally, the effects of interpersonal trauma history on attachment style and
resulting information processing biases were examined. A sample of undergraduate women (n =
301) completed self-report measures as well as attention and interpretation bias tasks. Findings
from structural equation modeling indicated that attachment insecurity fully mediated the effects
of CM and current IPV on depressive symptoms; this effect was driven by attachment anxiety,
rather than attachment avoidance. Implicit negative interpretations about self partially accounted
for the relationship between attachment insecurity and depression. Attention bias did not emerge
as a significant mediator. Findings suggest that unconscious negative perceptions of self are one
mechanism through which attachment anxiety results in depressive symptoms for women

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experiencing IPV. Further, a history of CM contributes to greater attachment insecurity and
negative interpretation biases in adult women, increasing their risk for depressive symptoms.

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TABLE OF CONTENTS

LIST OF TABLES

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LIST OF FIGURES

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INTRODUCTION
IPV and Depressive Symptoms
Attachment
Attachment styles.
Dimensions of attachment style.
Measurement of attachment styles.
Stability of attachment styles across the lifespan.
IPV and Attachment
Attachment and Depression
Attachment and depression in women experiencing IPV.
Stages of Information Processing
Information Processing Biases and Attachment Styles
Attentional biases and attachment styles.
Interpretation biases and attachment styles.
Summary.
Information Processing Biases and Depression
Attentional biases in depression.
Interpretation biases in depression.
Summary.
Information Processing Biases in Attachment and Depression
Attachment Style as a Mechanism from IPV to Depression
Attention biases in women experiencing IPV .
Interpretation biases in women experiencing IPV.
Summary.
The Role of Interpersonal Trauma History in Information Processing Biases and
Depression
Summary of Current Study

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METHOD
Participants
Measures
Intimate partner violence.
Attachment style.
Depressive symptoms.
Childhood maltreatment.
Attentional biases.
Implicit interpretation bias.
Covariates.

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Procedure
Data Analysis

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RESULTS
Data Preparation and Descriptive Statistics
Hypothesis 1
Hypothesis 2
Hypothesis 3
Hypothesis 4
Hypothesis 5
Hypothesis 6
Hypothesis 7

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DISCUSSION
Attachment Style Mediates the Relationship between IPV and Depression
Dimensions of Attachment Associated with Depression
Interpretation Biases Associated with Depression
Relationship between Attachment Dimensions and Interpretation Biases
Other Pathways Linking Attachment Insecurity and Depression
Effects of Trauma on Information Processing
Attention Bias as a Mediator from Attachment Style to Depression
Limitations
Directions for Future Research
Clinical Implications
Conclusions

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APPENDICES
Appendix A Copy of Study Measures
Appendix B Additional Statistical Models

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REFERENCES

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LIST OF TABLES

Table 1 Correlations and Descriptive Statistics

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LIST OF FIGURES

Figure 1 Hypothesized Model

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Figure 2 Orthogonal Attachment Dimensions and Corresponding Attachment Styles

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Figure 3 Effects of CM, Past IPV, and Current IPV on Depression

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Figure 4 Attachment Insecurity Mediating Effects of CM and IPV on Depression

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Figure 5 Attachment Anxiety and Avoidance Mediating the Effects of CM and IPV on
Depression

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Figure 6 Effects of Attachment Anxiety and Avoidance on Attentional Biases

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Figure 7 Effects of Attachment Insecurity on Interpretation Biases of Self and Other

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Figure 8 Effects of Attachment Anxiety and Avoidance on Interpretation Biases of Self and
Other
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Figure 9 Effects of Attention Biases on Interpretation Biases of Self and Other

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Figure 10 Negative Interpretation Bias Mediating the Effect of Attachment Insecurity on
Depression
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Figure 11 Interpretation Bias of Self and Other Mediating the Effect of Attachment Insecurity on
Depression
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Figure 12 Interpretation Bias of Self and Other Mediating the Effects of Attachment Anxiety and
Avoidance on Depression
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Figure 13 Attachment Insecurity and Negative Interpretation Bias Mediating the Effects of CM
and IPV on Depression
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Figure 14 Attachment Insecurity and Negative Interpretation Bias of Self and Other Mediating
the Effects of CM and IPV on Depression
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Figure 15 Attachment Anxiety and Avoidance and Negative Interpretation Bias of Self and Other
Mediating the Effects of CM and IPV on Depression
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Figure 16 Effects of IPV and Interpersonal Trauma History on Depression

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Figure 17 Effects of CM and IPV on Depression with Covariates

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Figure 18 Attachment Insecurity Mediating Effects of CM and IPV on Depression with
Covariates

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Figure 19 Attachment Anxiety and Avoidance Mediating Effects of CM and IPV on Depression
with Covariates
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Figure 20 Attentional Biases

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Figure 21 Effects of Attachment Insecurity on Attentional Biases

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Figure 22 Effects of Attachment Anxiety and Avoidance on Attentional Biases with Covariates
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Figure 23 Effects of Attachment Insecurity on Interpretation Biases

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Figure 24 Effects of Attachment Insecurity on Interpretation Biases with Covariates

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Figure 25 Effects of Attachment Insecurity on Interpretation Biases of Self and Other with
Covariates
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Figure 26 Effects of Attachment Anxiety and Avoidance on Interpretation Biases of Self and
Other with Covariates
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Figure 27 Effects of Attention Biases on Interpretation Biases of Self and Other with Covariates
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Figure 28 Negative Interpretation Bias Mediating the Effect of Attachment Insecurity on
Depression with Covariates
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Figure 29 Interpretation Bias of Self and Other Mediating the Effect of Attachment Insecurity on
Depression with Covariates
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Figure 30 Interpretation Bias of Self and Other Mediating the Effects of Attachment Anxiety and
Avoidance on Depression with Covariates
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Figure 31 Attention Bias Mediating the Effect of Attachment Insecurity on Depression

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Figure 32 Attachment Insecurity and Negative Interpretation Bias Mediating the Effects of CM
and IPV on Depression with Covariates
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Figure 33 Attachment Insecurity and Negative Interpretation Bias of Self Mediating the Effects
of CM and IPV on Depression with Covariates
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Figure 34 Attachment Anxiety and Negative Interpretation Bias of Self Mediating the Effects of
CM and IPV on Depression with Covariates
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INTRODUCTION
Women experiencing intimate partner violence (IPV; defined here as abuse perpetrated
by a male to a female romantic partner) are at increased risk for exhibiting depressive symptoms.
Attachment insecurity may explain this relationship, as it is highly associated with IPV
victimization (Alexander, 2009; Bookwala, 2002) and often results in depressive symptoms
following stressful interpersonal events (Bifulco, Moran, Ball, & Bernazzani, 2002). The
explanatory mechanisms by which insecure attachment styles relate to depressive symptoms,
however, are not well understood. Attachment styles are believed to guide the way in which
individuals process interpersonal situations, as they “govern how incoming interpersonal
information is attended to and perceived, determines which affects are experienced, [and] selects
the memories that are evoked” (Zeanah & Zeanah, 1989, p. 192). Cognitive theories of
depression suggest that deficits in information processing (e.g., negative biases in attention and
interpretation) are a key mechanism in the development of depression (Beck, 1987). Therefore,
the information a woman selectively attends to in an abusive relationship and the interpretations
she makes about the abuse may explain the link between attachment insecurity and depressive
symptoms. Research has examined information processing biases that are associated with each
attachment style, demonstrating how individuals attend to information and interpret situations in
ways that are consistent with their working models (Dewitte, Koster, De Houwer, & Buysse,
2007; Mikulincer & Shaver, 2001). However, these attachment-related biases have not yet been
examined as a link to depressive symptoms.
IPV is likely to contribute to more insecure attachment styles over time, but women may
also exhibit attachment insecurity prior to experiencing IPV (Henderson, Bartholomew, Trinke,
& Kwong, 2005). Many women in abusive relationships report a history of IPV in previous

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relationships and/or childhood maltreatment (CM), which are both associated with insecure
attachment styles (Cannon, Bonomi, Anderson, Rivara, & Thompson, 2010; Riggs, 2010). A
woman’s attachment style may therefore be a product of previous and current relational
experiences. A history of interpersonal trauma may influence the way in which a woman
processes information from her current abusive relationship. Specifically, when a woman makes
an inference about an event, she draws from mental representations in her long-term memory
that have been shaped by prior experiences (Crick & Dodge, 1994). In making attributions about
current abuse, women with a history of CM or IPV may draw from previous abusive memories
as well as emotions and interpretations associated with that abuse.
The current study examined the information processing components of attachment style
as mechanisms to depressive symptoms for women experiencing IPV. It also investigated the
role of interpersonal trauma history on attachment insecurity and subsequent information
processing biases (see Figure 1 for proposed model). The goal of this study was to improve our
understanding of the cognitive and relational mechanisms by which IPV leads to depressive
symptoms.
Figure 1
Hypothesized Model

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IPV and Depressive Symptoms
IPV in adult women is a significant public health problem, as prevalence rates for women
are as high as 30% for community samples (Beydoun, Beydoun, Kaufman, Lo, & Zonderman,
2012), 55% for clinical samples (Beydoun et al., 2012), and 78% for college samples (Eshelman
& Levendosky, 2012). Women who have experienced IPV are at an increased risk for depressive
symptoms (Fogarty, Fredman, Heeren, & Liebschutz, 2008). One meta-analysis indicated that
women with a history of IPV are two times more likely than non-abused women to report
depressive symptoms and over three times more likely to meet criteria for major depressive
disorder (Beydoun et al., 2012). IPV is consistently associated with depressive symptoms in
cross-sectional studies (Cascardi & O’Leary, 1992; Graham, Bernards, Flynn, Tremblay, &
Wells, 2012; Mechanic, Weaver, & Resick, 2008). Longitudinal work also demonstrates that IPV
predicts higher levels of depressive symptoms for years following the initial assessment of abuse
(La Flair, Bradshaw, & Campbell, 2012). This study showed a stronger longitudinal association
between IPV and depression for women who were not depressed at the initial assessment,
indicating that IPV may play a causal role in the development of depression. Research also
demonstrates the amount of IPV (frequency, severity, and/or duration) is positively associated
with severity of depressive symptoms (Bogat, Levendosky, Theran, von Eye, & Davidson, 2003;
Koopman et al., 2007; Vaeth, Ramisetty-Mikler, & Caetano, 2010).
While the association between IPV and depressive symptoms is well-established, the
specific mechanisms explaining this relationship are not well understood. A better understanding
of the depressogenic mechanisms for women experiencing IPV can improve prevention and
intervention efforts. A woman’s attachment style may be one such mechanism, as it guides the
information she attends to and the way she interprets situations. Women with insecure

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attachment styles are likely to attend to negative cues and/or avoid positive cues, resulting in
maladaptive interpretations about interpersonal situations, thus making them more likely to
exhibit depressive symptoms.
Attachment
Attachment is a bond that assures one’s proximity to close others (or attachment figures)
in order to create feelings of security and protection (Bowlby, 1980). Attachment figures are
used as a “secure base,” a place of safety and comfort from which the individual can safely
explore her environment, while remaining confident of the attachment figure’s availability
(Waters & Cummings, 2000). Attachment also functions as a “control system,” organizing
emotions and behaviors exhibited in close relationships (Bowlby, 1958; Waters & Cummings,
2000). The attachment system operates during ordinary circumstances, but demonstrates
heightened activation during periods of stress (Bowlby, 1980).
An individual’s attachment style first develops during infancy, and the quality of early
care giving influences the attachment style a child develops. A child with a sensitive and
emotionally available caregiver is likely to develop a secure attachment (i.e., able to explore
freely the environment and rely on the caregiver for support when needed). A child with an
insensitive or unavailable caregiver, on the other hand, is likely to exhibit an insecure attachment
style (Bowlby, 1988). Given the lack of sensitive care giving they experience, these children are
forced to develop alternate strategies to cope with their attachment needs. For example, some
children may engage in hyper-activation of their attachment systems, intensifying proximity to
the attachment figure and frequently attending to potential threats to the attachment relationship.
Other children may downregulate their attachment systems, keeping a distance from their
attachment figures and minimizing attention to attachment-related threats (Dewitte et al., 2007).

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Based on repeated experiences of caregiver responsivity, children’s expectations about
the availability of their attachment figures are internalized as working models of attachment that
unconsciously guide subsequent interactions with others (Bowlby, 1988; Zimmermann, 1999).
Specifically, children develop internal working models (IWMs) of self (as worthy of attention
and love) and of others (as reliable and willing to provide care). Children with secure attachment
styles demonstrate predominantly positive IWMs of self and others, while children with insecure
attachment styles exhibit predominantly negative IWMs of self and/or others. Functionally,
IWMs have been compared to cognitive schemas, as they are organized representations of former
experiences that guide cognition and behavior (Bretherton, 1987). Individuals attend to
environmental cues and interpret situations in ways that are congruent with IWMs (Zimmerman,
1999).
Attachment styles. Based on research using the Strange Situation paradigm (Ainsworth
& Bell, 1970), four categories of child attachment have been identified (Ainsworth & Bell, 1970;
Ainsworth, Blehar, Waters, & Walls, 1978; Bowlby, 1988; Main & Cassidy, 1988). Securely
attached children show distress during their mothers’ absence, are comforted by their mothers’
return, and are able to explore freely when no longer distressed. Insecure-resistant (or insecureambivalent) attachment style describes children who display high levels of distress during their
mothers’ absence, seek comfort from their mothers upon their return but are not comforted by
this contact, and remain in close proximity to their mothers for the remainder of the paradigm.
Children with insecure-avoidant attachment styles do not display distress during their mothers’
absence and do not seek proximity with their mothers upon their return, but instead play
independently. A disorganized attachment style describes children who demonstrate high levels

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of distress when separated from their mothers as well as a lack of coherent strategy in coping
with the separation and reunion with their mothers.
While early research on attachment focused solely on childhood, Hazan and Shaver
(1987) argued that attachment relationships are not unique to childhood, but are present
throughout the lifespan. During later childhood and adolescence, individuals may develop
attachment figures outside of the family unit, such as with peers or teachers (Laghi, D’Alessio,
Pallini, & Baiocco, 2009; Waters & Cummings, 2000; Wilkinson, 2010). In late adolescence and
early adulthood, primary attachment figures tend to shift from parents to peers, including close
friends and romantic partners (Fraley & Davis, 1997). In adulthood, an individual may have
multiple attachment figures, including parents or close friends. However, romantic partners are
typically the main attachment figure for adults (Hazan, Campa, & Gur-Yaish, 2006). Hazan and
Shaver (1987) identified categories of adult romantic attachment which correspond to those
observed in children.
A secure attachment style tends to develop when an individual experiences warm,
responsive, and reliable care giving during early childhood (Bowlby, 1988). Individuals
experiencing this type of parenting tend to believe they are worthy of attention and can depend
on others to be there when they need support; therefore, responsive parenting gives rise to mostly
positive IWMs of the self and others. These individuals rely on proximity seeking during times
of distress, but are able to distance from their attachment figures once they have regulated their
distress (Bowlby, 1969). Those with secure attachment styles tend to be comfortable engaging in
intimate relationships as well as in seeking autonomy and demonstrating independence
(Bartholomew, 1990). When needs for safety, love, and exploration are not met during

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childhood, individuals seek alternate strategies to cope with attachment-related insecurity,
including the hyper- and/or hypo-activation of the attachment system.
Individuals with preoccupied attachment styles primarily have negative IWMs of the self
and positive IWMs of others. Experiencing insensitive or inconsistent care giving during early
childhood may lead individuals to believe they are unworthy of receiving affection and should
prioritize the needs of others (Bowlby, 1988). Individuals with this attachment style tend to be
overly dependent and demonstrate an insatiable desire to gain the approval of others (Shaver,
Schachner, & Mikulincer, 2005). They exhibit a hyper-activation of the attachment system, as
they frequently monitor their attachment figures, search for cues regarding attachment figure
availability or rejection, and rely on proximity seeking to regulate distress. Individuals with
preoccupied attachment styles tend to overvalue intimacy while devaluing or experiencing
discomfort with autonomy (Bowlby, 1980).
Another strategy in dealing with attachment insecurity is to deny, suppress, or ignore
one’s attachment needs, resulting in a hypo-activation of the attachment system congruent with a
dismissive attachment style. For these individuals, positive IWMs of the self and negative IWMs
of others are most dominant. As they have experienced rejection from early caregivers, they
distance themselves from others in order to avoid future hurt, as they believe others are not
dependable or trustworthy (Berant & Wald, 2009). These individuals also see themselves as
invulnerable to distress or able to cope without the help of others in order to maintain a positive
self-image (Fraley & Shaver, 1997). Individuals with a dismissive attachment style often show
blunted affect and arousal (denial of attachment needs), tend to passively avoid close
relationships and emotional intimacy, and exhibit preoccupation with achievement (Mikulincer,

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Doley, & Shaver, 2004). As such, they overvalue autonomy and independence, while devaluing
or showing discomfort with intimate relationships.
The fourth type is a fearful attachment style, which describes individuals who exhibit
predominantly negative IWMs of both self and others. This style of attachment often develops
following early experiences of rejecting or unavailable caregivers, as this results in individuals
viewing others as uncaring or undependable and viewing themselves as unlovable or unworthy
of attention. These individuals desire intimacy in relationships, but experience intense distrust
and fear of rejection (Bartholomew, 1990). They tend to be hypersensitive to the approval of
others and avoid close relationships in which they believe they are vulnerable to rejection. This
behavioral pattern undermines the possibility of experiencing satisfying relationships, ultimately
maintaining negative IWMs of the self and others. Individuals with fearful attachment styles
experience simultaneous hyper- and hypo-activation of their attachment systems and do not have
a coherent strategy to help them reduce distress (Bartholomew, 1997). These individuals
experience discomfort with both intimacy and autonomy.
Dimensions of attachment style. While earlier work considered attachment a categorical
construct, more recent research has demonstrated how attachment styles differ along two
orthogonal dimensions: attachment anxiety and attachment avoidance. Attachment anxiety,
which is associated with a woman’s IWMs of self, reflects the extent to which she feels worthy
of care and affection from an attachment figure (Ziv, Oppenheim, & Sagi-Schwartz, 2004).
Women with negative models of self (e.g., I am unworthy of love) often worry their lack of selfworth will lead to their needs for nurturance not being met in a predictable manner, resulting in a
fear of abandonment (Surcinelli, Rossi, Montebarocci, & Baldaro, 2010). Attachment anxiety is
associated with a discomfort with autonomy as well as frequent monitoring for the availability

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and accessibility of attachment figures (Fraley, Hudson, Heffernan, & Segal, 2015). Attachment
avoidance, which corresponds to IWMs of others, is the degree to which a woman believes
others are available, accepting, and responsive if she needs support (Ziv et al., 2004). Women
with negative models of others (e.g., others are undependable) tend to feel uncomfortable with
intimacy and therefore avoid becoming close to others for fear that they will be rejected
(Bartholomew, 1990).
The four categorical attachment styles can be conceptualized in terms of variability on
these two orthogonal dimensions (see Figure 2; Bartholomew, 1990; Fraley & Spieker, 2003).
Individuals with secure attachment styles demonstrate low levels of both attachment anxiety and
avoidance, as they are comfortable seeking intimacy or closeness with attachment figures when
needed, as well as being independent when it feels safe to do so. A preoccupied attachment style
is characterized by high levels of attachment anxiety and low levels of attachment avoidance, as
individuals with this style demonstrate an over-reliance on attachment figures for fear of
abandonment, as well as discomfort with autonomy and independence. Individuals with a
dismissive attachment style demonstrate high levels of attachment avoidance and low levels of
attachment anxiety, as they rely solely on themselves and downplay the importance of intimate
relationships. Lastly, fearful attachment style is associated with high levels of both attachment
anxiety and avoidance, as it is characterized by simultaneous hyper- and hypo-activation of the
attachment system as well as fear of both intimacy and autonomy.

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Figure 2
Orthogonal Attachment Dimensions and Corresponding Attachment Styles

Measurement of attachment styles. There is debate in the attachment literature
regarding whether attachment styles are best conceptualized as qualitatively distinct categories or
as orthogonal dimensions. Given this debate, attachment styles have been measured differently
across studies. For example, some research has used a prototype measure of attachment, in which
the four attachment categories are described in brief paragraphs, and participants select which
style best describes them (Carnelley, Pietromonaco, & Jaffe, 1994; Hazan & Shaver, 1987;
Murphy & Bates, 1997; Surcinelli et al., 2010). This methodology is limited in its ability to
assess variability in dimensions of attachment and has high face validity. Other studies have
measured continuous dimensions of attachment anxiety and avoidance, but created attachment

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categories based on high and low levels of these dimensions (Bifulco et al., 2002; Conradi & de
Jonge, 2009; Cooper et al., 2009). While this method is an improvement in that it assesses
multiple items related to attachment style, creating such attachment categories is often based on
arbitrary cut-offs. Still other research uses continuous measures of both attachment dimensions
(Davis et al., 2014; Dewitte, 2011; Edelstein & Gillath, 2008). These three approaches to
measuring attachment show differential associations with correlates of attachment (e.g., Bekker
& Croon, 2010; Bifulco et al., 2002; Surcinelli et al., 2010), suggesting they may not be
measuring the same constructs. These methodological differences limit our understanding of
attachment-related representations, behaviors, and emotions.
Researchers have also conducted taxometric analyses to determine which structure
(categorical or dimensional) best captures the nature of attachment in both child (Fraley &
Spieker, 2003) and adult (Fraley et al., 2015) samples. Results of both studies concluded that
attachment is better represented by continuous dimensions compared to categories. A 2-factor
solution emerged, which resembles the previously described dimensions of attachment anxiety
and avoidance. This suggests that individual differences in attachment style are best understood
as varying levels of attachment anxiety and attachment avoidance.
Measures of attachment must also account for the variability in attachment styles that
individuals exhibit across different relationships (Waters et al., 2002). For example, a woman
may display a preoccupied attachment with her parents, but a more secure attachment with her
friends. Thus, the specific relationship(s) of interest must be clarified in assessing attachmentrelated behaviors and emotions. As a woman’s attachment to her intimate partner is the focus of
the current study, a measure of romantic attachment was used.

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The mode of assessing attachment is also important to consider. Research indicates that
self-report measures of attachment do not always correlate to interview and observational
measures of attachment (Waters et al., 2002). It is argued that these different types of measures
are assessing different levels of attachment styles. For example, self-report measures likely
assess more conscious attachment representations and behaviors, while interview and
observational methods may tap unconscious attachment-related processes (Gawronski, Hofmann,
& Wilbur, 2006; Waters et al., 2002).
Stability of attachment styles across the lifespan. Attachment styles tend to be stable
over time. Several retrospective studies demonstrate moderate stability in attachment styles from
childhood to adulthood (e.g., Bartholomew & Horowitz, 1991; Hazan & Shaver, 1987). A few
prospective studies have followed individuals for 15 to 20 years (ranging from infancy or
childhood to late adolescence or adulthood) and found modest stability in attachment styles
(Aikins, Howes, & Hamilton, 2009; Raby, Cicchetti, Carlson, Egeland, & Collins, 2013;
Roisman & Booth-LaForce, 2014). Waters and colleagues (2000), for example, found that 72%
of individuals were categorized similarly during their 20’s as they were during infancy. Several
other studies have demonstrated modest stability across a number of years throughout childhood
(Bar-Haim, Sutton, Fox, & Marvin, 2000; Main & Cassidy, 1988; NICHD, 2001; Vondra, Shaw,
Swearingen, Cohen, & Owens, 2001), throughout adolescence (Allen, McElhaney, Kuperminc,
& Jodl, 2004), and throughout early and late adulthood (Cozzarelli, Karafa, Collins, & Tagler,
2003; Hiester, Nordstrom, & Swenson, 2009; Scharfe & Bartholomew, 1994; Scharfe & Cole,
2006; Sibley & Liu, 2004; Zhang & Labouvie-Vief, 2004).
While there is moderate stability in individuals’ attachment styles over time (e.g., Raby et
al., 2013), some individuals change attachment styles across time. On average, individuals tend

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to develop more secure attachment styles over time, though some individuals move from secure
to insecure styles (Waters et al., 2002; Waters, Hamilton, & Weinfield, 2000). Studies also show
that high-risk samples tend to exhibit greater attachment insecurity over time (Cozzarelli et al.,
2003; Solomon, Dekel, & Mikulincer, 2008). Significant positive or negative life events are
expected to modify an individual’s IWMs (Iwaniec & Sneddon, 2001; Scharfe & Cole, 2006).
Studies have consistently shown that negative life events and traumatic stressors, including CM
and IPV, contribute to increasingly insecure attachment styles (Aikins et al., 2009; Allen et al.,
2004; Cozzarelli et al., 2003; Levendosky, Bogat, Huth-Bocks, Rosenblum, & von Eye, 2011;
Roisman & Booth-LaForce, 2014; Scharfe & Cole, 2006; Solomon et al., 2008; Vondra et al.,
2001). Further, psychological intervention and significant positive relationships can contribute to
an increasingly secure attachment style over time (Iwaniec & Sneddon, 2001; Kobak, Zajac,
Herres, & Ewing, 2015; Kooyman, Olij, & Storm, 2014).
An individual’s attachment style is thus rooted in childhood experiences and shaped (for
better or worse) across the span of her life based on subsequent relationships and experiences.
For example, an individual with negative childhood experiences and an insecure attachment style
early on may develop a more secure attachment style throughout their lifetime as a result of
psychotherapy and positive social relationships. An individual with positive early care giving
relationships may develop a more insecure attachment style following traumatic events in
adulthood. Another individual with an insecure attachment style from experiencing neglect
during formative years may develop an increasingly insecure attachment style by experiencing
chronic trauma throughout the lifespan.

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IPV and Attachment
Consistent with research showing that traumatic events contribute to greater attachment
insecurity, women who have experienced IPV often demonstrate insecure attachment styles
(Alexander, 2009; Bond & Bond, 2004; Bookwala, 2002; Henderson et al., 2005; Karakurt,
Silver, & Keiley, 2016; Kuijpers, van der Knaap, & Winkel, 2012; Shechory, 2012). One study
found that 88% of women who recently left an abusive relationship exhibited insecure
attachment styles (Henderson, Bartholomew, & Dutton, 1997). While several studies have shown
a cross-sectional association between IPV and attachment insecurity, Weston (2008)
demonstrated that IPV predicted increases in attachment insecurity over the course of a year in a
community sample of low-income women. During a frightening or traumatic event, a woman
would typically seek out her attachment figure for protection. However, in the case of IPV, her
attachment figure is also the perpetrator of the abuse, and so she is unable to receive comfort
from this attachment figure. This betrayal from her partner is likely to alter negatively the
woman’s internal working models, resulting in models of the self as unworthy of love and/or
models of others as harsh, abusive, and unreliable (Levendosky, Lannert, & Yalch, 2012).
While recent IPV is likely to affect a woman’s attachment style, her attachment style is
also shaped in large part by previous relationship experiences (Henderson et al., 2005).
Therefore, a woman’s attachment insecurity could also have preceded the current IPV and
partially be a result of prior interpersonal trauma (Alexander, 2009). A history of child
maltreatment (CM), which is commonly reported in women experiencing IPV (Cannon, et al.,
2010; Daigneault, Hebert, & McDuff, 2009; Whitfield, Anda, Dube, & Felitti, 2003), frequently
results in attachment insecurity into adulthood (Bailey, Moran, & Pederson, 2007; Cort, Toth,
Cerulli, & Rogosch, 2011; Riggs & Kaminski, 2010; Riggs, Cusimano, & Benson, 2011).

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Additionally, women in abusive relationships often report a history of IPV in previous
relationships (Alexander, 2009; Kuijpers et al., 2012; Smith & Stover, 2016). A history of IPV is
associated with insecure attachment styles, even for women who are not currently in abusive
relationships (Henderson et al., 2005). Therefore, CM, prior IPV, and current IPV may all
contribute to women’s attachment insecurity in adulthood. However, no studies examining
attachment styles in women currently experiencing IPV assess for the unique effects of prior
interpersonal trauma. The insecure attachment styles commonly seen in women experiencing
IPV may put them at risk for exhibiting depressive symptoms.
Attachment and Depression
Attachment insecurity puts women at risk for depressive symptoms following
interpersonal stressors (Bifulco et al., 2002; Bowlby, 1980). Women with insecure attachment
styles may develop depressive symptoms when security is disrupted or threatened, such as
following the inability to form a secure attachment or the loss of a previously established
attachment (Wei, Shaffer, Young, & Zakalik, 2005). The IWMs of insecurely attached women
may negatively influence their interpretations of stressful interpersonal events, putting them at
risk for depression (Bowlby, 1980; Scharfe, 2007). In order to maintain a coherent view of the
world and herself, information from new experiences is assimilated to fit a woman’s internal
working models. For example, the information attended to in an interpersonal interaction, how
the information is perceived, and which past experiences are evoked during the situations are
congruent with a woman’s attachment style (Bartholomew, 1990, 1997; Bartholomew &
Horowitz, 1991; Bowlby, 1980). Interpersonal stressors are therefore likely to confirm feelings
of insecurity and negative IWMs, decreasing an individual’s self-esteem and increasing her risk
for depressive symptoms (Strodl & Noller, 2003; West, Rose, Spreng, Verhoef, & Bergman,

15

1999). Research demonstrates that attachment insecurity is associated with depressive symptoms
in both cross-sectional (Bekker & Croon, 2010; Burnette, Davis, Green, Worthington, &
Bradfield, 2009; Craparo, Gori, Petruccelli, Cannella, & Simonelli, 2014; Li, Lin, & Hsiu, 2011;
Roelofs, Lee, Ruijten, & Lobbestael, 2011; Safford, Alloy, Crossfield, Morocco, & Wang, 2004)
and longitudinal studies (Bifulco et al., 2002; Conradi & de Jonge, 2009; Monti & Rudolph,
2014; Scharfe, 2007).
Both dimensions of attachment anxiety and avoidance may predict depressive symptoms
in the face of stress. Attachment anxiety is associated with primarily negative IWMs of the self,
and low self-worth is often associated with depressive symptoms (Scharfe, 2007). Individuals
high in attachment anxiety also tend to demonstrate low self-efficacy and have difficulty
demonstrating autonomy (Bowlby, 1969; Strodl & Noller, 2003). In the face of relational
distress, they may feel abandoned, believe they are unable to cope on their own, and perceive the
situation as indication of their own failure, putting them at risk for depressive symptoms
(Sloman, Gilbert, & Hasey, 2003; Wei, Heppner, Russell, & Young, 2006). Attachment
avoidance is associated with over-reliance on the self and emotional avoidance, making it
difficult to process emotions and cope effectively with stressful situations (Monti & Rudolph,
2014; Sloman et al., 2003; Wei et al., 2006). Experiencing significant levels of stress may
overwhelm the defense mechanisms of highly avoidant individuals. Therefore, when they
encounter a stressful event with which they are unable to cope, their feelings of self-sufficiency
are challenged, making them feel vulnerable and putting them at risk for depression.
Studies demonstrate mixed results regarding which attachment styles are associated with
depressive symptoms. However, attachment style has been assessed differently across studies,
which may explain these inconsistent findings. Studies using prototype measures of attachment

16

categories find higher levels of depressive symptoms in individuals with preoccupied and fearful
attachment styles (Carnelley, Pietromonaco, & Jaffe, 1994; Murphy & Bates, 1997; Surcinelli et
al., 2010). Research that used attachment categories based on high and low levels of attachment
anxiety and avoidance find that individuals with any type of insecure attachment demonstrate
more depressive symptoms than those with secure attachment styles (Bifulco et al., 2002;
Conradi & de Jonge, 2009). Many studies using dimensions of attachment have found that both
attachment anxiety and avoidance are independently associated with depressive symptoms,
although the effect of attachment anxiety is more robust (Bekker & Croon, 2010; Burnette et al.,
2009; Li et al., 2011; Monti & Rudolph, 2014; Roelofs et al., 2011; Scharfe, 2007; Strodl &
Noller, 2003; Woodward et al., 2013).
Attachment and depression in women experiencing IPV. As attachment insecurity is
consistently associated with depressive symptoms following interpersonal stressors, insecure
attachment style may be one mechanism by which IPV leads to depressive symptoms. As
previously mentioned, depression may result following the inability to form a secure attachment
or the loss of a previously established attachment, both of which may occur in abusive
relationships. Many abusers keep their partners at a distance and refrain from disclosing intimate
information about themselves as a way to maintain control over the relationship (Stark, 2007).
Insecurely attached women in these relationships may feel as though they are not good enough to
get their partners to form a close connection. Other abusive individuals express intense affection
or love and appear very open with their partners early in the relationship, often leading the
woman to become attached to the abuser rather quickly (Dutton & Painter, 1993). Then, once the
partner becomes abusive, she may have a difficult time letting go (Walker, 2009). Women with
insecure attachment styles in either of these abusive scenarios are likely to make negative

17

attributions about self (e.g., I’m not good enough) or others (e.g., others cannot be trusted).
These negative perceptions following the abuse put women at risk for depressive symptoms.
While some research demonstrates that cognitive schemas similar to negative working
models (e.g., expectation that others will hurt/abuse, fear of abandonment) mediate the
association between IPV and depressive symptoms (Calvete, Corral, & Estevez, 2007; Calvete,
Estevez, & Corral, 2007), no study has examined attachment style as a mediator from IPV to
depressive symptoms. One study, however, has examined attachment insecurity as a moderator
of this relationship (La Flair et al., 2015). Findings suggest that attachment anxiety strengthened
the association between IPV and depression, while attachment avoidance did not significantly
moderate this relationship (La Flair et al., 2015). Other research has demonstrated that
attachment insecurity mediates the relationship between other types of interpersonal trauma (i.e.,
physical and sexual assault) and depressive symptoms (Elwood & Williams, 2007; Fowler,
Allen, Oldham, & Frueh, 2013).
The mechanism by which insecure attachment styles result in depressive symptoms is not
well understood. It has been theorized that this association is due to IWMs guiding information
processing, as insecurely attached women likely attend to negative cues in the environment and
make more maladaptive interpretations (Beatson & Taryan, 2003; Bowlby, 1980; Scharfe, 2007;
West et al., 1999). Stages of information processing will be reviewed in order to provide a
framework to understand subsequent literature on attention and interpretation biases related to
attachment and depression.
Stages of Information Processing
Information processing includes attending to stimuli in the environment and then making
interpretations or meaning of the stimuli. Cognitive schemas play a top-down role in guiding

18

these stages of information processing (Everaert, Koster, & Derakshan, 2012). Individuals have
limited ability to attend to and process all of the stimuli present in the environment. Through the
process of selective attention, particular cues in the environment are focused on and selected for
further processing (Atkinson et al., 2009; Dodge & Crick, 1990; Everaert et al., 2012). There are
three stages of attentional processing: initially orienting attention toward the cues, engaging
attention with the cues, and then disengaging (or failing to disengage) attention away from the
cues (Petersen & Posner, 2012; Posner, 2012; Posner & Petersen, 1990). The types of
information attended to are guided by cognitive schemas. Individuals typically attend to
information that is consistent with their social schemas, resulting in a confirmation bias
(Joormann & D’Avanzato, 2010; Koster, De Raedt, Leyman, & De Lissnyder, 2010). Biases in
the initial stages of selective attention increase the probability that information will be
transferred to short-term memory (Everaert et al., 2012; Koster et al., 2010; Mogg, Bradley, &
Williams, 1995).
After these cues are encoded, they are mentally represented in long-term memory and
given meaning or interpretation (Joormann et al., 2007; Salemink, Hertel, & Mackintosh, 2010).
An individual’s interpretation of a situation is biased based on the limited proportion of cues
selected for further processing (Dodge & Crick, 1990; Joormann et al., 2007; Koster et al.,
2010). These interpretations are also guided by cognitive schemas, which draw from relevant
knowledge stored in long-term memory (Everaert et al., 2012; Williams et al., 2007). Mental
representations, which are shaped by prior experiences, are used as a guide for interpreting and
understanding the present situation (Crick & Dodge, 1994; Joormann & D’Avanzato, 2010;
Salemink et al., 2010). Social situations are therefore interpreted in ways that are consistent with
an individual’s cognitive schemas, resulting in confirmation bias and strengthening of their

19

original beliefs (Everaert et al., 2012; Salemink et al., 2010). Assigning meaning to a situation
occurs at both conscious and unconscious levels of processing (Dodge & Crick, 1994; Joormann
et al., 2007). Throughout this study, the terms “implicit” and “unconscious” will be used
interchangeably, as will the terms “explicit” and “conscious,” as discussed in prior research
(Dienes & Perner, 1999; Gawronski et al., 2006).
Information Processing Biases and Attachment Styles
The IWMs associated with a woman’s attachment style function like cognitive schemata,
unconsciously guiding the cues she attends to in a situation, what prior attachment experiences
are drawn from to make meaning of the scenario, and ultimately how she interprets the situation
(Zimmermann, 1999; Ziv et al., 2004). As an individual’s IWMs become engrained or automatic,
they play a top-down role in guiding the types of information attended to and selected for further
processing by providing a set of rules for obtaining or limiting access to particular types of
information (Atkinson et al., 2009; Collins, 1996; Collins & Read, 1994; Main, Kaplan, &
Cassidy, 1985). Attachment styles filter incoming information both by directing attention toward
information that is consistent with their IWMs and directing attention away from information
that is inconsistent with their IWMs (Mikulincer & Shaver, 2003). IWMs determine whether
attentional resources are directed toward or away from attachment-relevant cues, biasing
interpretation of the situation in an expectation-consistent manner (Collins & Feeney, 2004; Van
Emmichoven, Van Ijzendoorn, De Ruiter, & Brosschot, 2003).
Attentional biases and attachment styles. Individuals may direct attention toward or
away from attachment-related cues in order to cope with distress (Dewitte & Koster, 2014). For
example, individuals who are high in attachment anxiety frequently monitor the availability of
attachment figures, looking for potential signs of abandonment (Main, 1990). As such, they may

20

have an attentional bias toward attachment-related threats or negative attachment cues. Those
high in attachment avoidance believe they are self-sufficient and downplay the importance of
attachment relationships in order to avoid rejection and cope with unfulfilled needs for intimacy
(Bartholomew, 1990). These individuals are likely to demonstrate attentional bias away from
signs of support or positive attachment cues in order to confirm beliefs they only need to rely on
themselves. Securely attached individuals are able to balance their attention between attachment
cues (need for security) and other cues in their environment (need for exploration) (Atkinson et
al., 2009).
A number of empirical studies have tested whether attentional biases differ across
attachment styles, yet findings have been mixed. A few studies, however, have found results
consistent with predictions. For example, one study found that attachment avoidance was
associated with attentional biases away from positive attachment-related words (Edelstein &
Gillath, 2008). Other research demonstrated that attachment anxiety is associated with attentional
biases toward negative emotion faces (Westphal, Bonanno, & Mancini, 2014) and threatening
words (Bailey, Paret, Battista, & Xue, 2012). This finding is consistent with predictions that
attachment anxiety would be associated with negative stimuli, though these studies did not
include attachment-specific negative cues.
Another way that attachment style may influence attentional bias is through one’s
attentional scope. Attentional breadth encompasses which and how much information will be
attended to and processed simultaneously (Gable & Harmon-Jones, 2010). Dewitte and Koster
(2014) demonstrated that attachment avoidance was associated with a broader attentional scope
(attempts to reduce attention on attachment figure), while attachment anxiety was associated
with a narrower attentional scope, focused particularly on the individual’s romantic partner

21

(attempts to seek proximity or monitor attachment figure’s availability). Attentional scope may
influence selective attention bias, as a narrow scope makes it more likely for a woman to focus
her attention on attachment-related cues, while a broad scope makes it more likely for a woman
to focus her attention away from attachment cues. Therefore, this is consistent with hypotheses
that attachment anxiety is associated with attention toward negative attachment cues (e.g., signs
of rejection), while attachment avoidance is associated with attention away from positive
attachment cues (e.g., signs of support).
While a few studies have supported hypotheses regarding attentional biases associated
with attachment anxiety and avoidance, other studies have found associations in the opposite
direction than expected (Davis et al., 2014; Dewitte, Koster, De Houwer, & Buysse, 2007;
Westphal et al., 2014; Van Emmichoven et al., 2003) or no association between attachment style
and attentional biases (Dewitte, 2011). There are significant differences in methodology used
across these studies, which may account for these inconsistent results. For example, attachment
style was assessed differently across studies. While many studies used dimensional measures of
attachment anxiety and avoidance (Davis et al., 2014; Dewitte, 2011; Dewitte & De Houwer,
2008; Dewitte & Koster, 214; Dewitte, De Houwer, Koster, & Buysse, 2007; Dewitte, Koster,
De Houwer, & Buysse, 2007; Edelstein & Gillath, 2008; Wesphal et al., 2014), others used
categorical measures (Atkinson et al., 2009; Cooper, Rowe, Penton-Voak, & Ludwig, 2009;
Silva, Soares, & Esteves, 2012; Van Emmichoven et al., 2003).
Furthermore, the stimuli used as targets in attentional tasks vary widely across studies.
Only a few studies used attachment-related words (Atkinson et al., 2009; Dewitte, Koster, De
Houwer, & Buysse, 2007; Edelstein & Gillath, 2008) or stimuli related to one’s attachment
figure (Dewitte, De Houwer, Koster, & Buysse, 2007). Several other studies utilized emotions

22

faces (Cooper et al., 2009; Davis et al., 2014; Dewitte, 2011; Dewitte & De Houwer, 2008;
Westphal et al., 2014), emotional images (Silva et al., 2012), or positive/negative emotion words
unrelated to attachment (Bailey et al., 2012; Van Emmichoven et al., 2003). Given that
attachment styles are hypothesized to direct an individual’s attention toward or away from cues
that are consistent with his or her IWMs, attachment-specific stimuli are likely the best test of
attachment-related attentional biases.
The small number of studies using attachment-related stimuli provides mixed results.
Atkinson and colleagues (2009) found that insecurely attached women had greater attentional
bias toward negative attachment cues compared to securely attached women. This study did not
examine dimensions of attachment anxiety and avoidance. Another study found that individuals
high in both attachment anxiety and avoidance demonstrated attentional bias away from negative
cues of attachment threat (Dewitte, Koster, De Houwer, & Buysse, 2007). Lastly, Edelstein and
Gillath (2008) showed that attachment avoidance was associated with attention bias away from
positive and negative attachment-related cues, but found no relationship for attachment anxiety.
Other research that used names of individuals’ attachment figures as stimuli found that
attachment anxiety was associated with attentional bias toward the attachment figure, while
avoidance was unrelated to attention bias (Dewitte, De Houwer, Koster, & Buysse, 2007). The
inconsistent findings may be due to other methodological differences, such as the specific task of
selective attention used.
Several studies used the emotional Stroop task (Atkinson et al., 2009; Bailey et al., 2012;
Edelstein & Gillath, 2008; Van Emmichoven et al., 2003), a modified version of the Stroop task
in which color words are replaced with neutral and emotional words. If individuals take longer to
respond to emotional words compared to neutral words, it is assumed that the individual

23

selectively attended toward the emotional stimuli. However, there is debate regarding the
mechanisms that underlie interference during the Stroop task (Donaldson, Lam, & Mathews,
2007; MacLeod, 2005; Mogg, Millar, & Bradley, 2000; Musa, Lepine, Clark, Mansell, & Ehlers,
2003), and it is unclear whether the task solely measures attention, or whether it also measures
other cognitive processes (e.g., general interference, cognitive avoidance). Therefore, the
emotional Stroop task may not be the most direct measure of selective attention.
Some research has employed a modified dot-probe task (MacLeod, Mathews, & Tata,
1986), using either attachment- or emotion-related stimuli (Davis et al., 2014; Dewitte, De
Houwer, Koster, & Buysse, 2007; Dewitte, Koster, De Houwer, & Buysse, 2007; Westphal et al.,
2014). In this task, two words are presented on a screen for a short period of time (e.g., 500 ms,
1000 ms), one above the other. An emotional word (e.g., attachment-related threat word) is
usually paired with a neutral word. As the word pair disappears, a small dot-probe replaces one
of the two words and remains on the screen until the participant indicates the location of the
probe as quickly and accurately as possible. If participants have faster reaction times to dotprobes that replace emotional stimuli compared to neutral stimuli, they would be considered to
have an attentional bias toward the emotional stimuli, as it is assumed they were already
attending to the stimulus in that location. Some researchers have questioned the reliability of the
dot-probe task, as they have identified low estimates of internal reliability (< .5; Schmukle, 2005;
Waechter, Nelson, Wright, Hyatt, & Oakman, 2014; Waechter & Stolz, 2015). However, these
studies have focused only on anxiety-related threat stimuli, and the reliability of this task for
other types of stimuli (e.g., attachment, depression) is not known.
Research on attention biases related to attachment style is a small, but growing, body of
literature. At this point, inconsistency in methods used across studies make it difficult to draw

24

firm conclusions regarding the specific nature of attention biases associated with attachment
anxiety and avoidance. A few studies, however, lend support for the hypotheses that attachment
anxiety is associated with attention toward negative attachment cues and that attachment
avoidance is associated with attention away from positive attachment cues. These biases in
selective attention may limit the types of information encoded for further processing, thus
biasing the interpretations as congruent with IWMs.
Interpretation biases and attachment styles. During the process of interpretation, the
current situation can evoke memories of similar experiences from the past. Through mental
representations that are shaped over time, these memories trigger expectations for the meaning of
the current situation, expectations which are then checked against the data (information gathered
from the situation) to confirm whether or not the expectations are correct. If a woman selectively
attends to situational information that is consistent with her attachment style, this information is
highly likely to confirm her expectations regarding the meaning of the situation. This
interpretation process can occur at both unconscious (i.e., implicit interpretation bias) and
conscious (i.e., explicit interpretation bias) levels of processing (Main et al., 1985; Zimmermann,
1999). In the current study, implicit or unconscious interpretation bias refers to a lack of
awareness regarding the presence of particular attitudes, beliefs, or cognitions, also called lack of
content awareness. Explicit or conscious interpretations refer to attitudes, beliefs, or cognitions
of which the individual is aware (Gawronski et al., 2006).
The types of interpretation biases associated with attachment anxiety and avoidance are
likely to differ. Attachment avoidance, which limits attention to positive attachment cues, is
likely associated with negative interpretations of others. That is, if a woman does not focus on
support from an attachment figure, she is more likely to make attributions about others as

25

unreliable or unsupportive. Attachment anxiety, associated with attention to negative attachment
cues, is likely associated with negative attributions of the self. For example, if a woman is
focused on cues of abandonment, she is more likely to perceive herself as worthless.
Research supports that women interpret situations in a way that is consistent with their
IWMs. However, the majority of this research has focused on explicit interpretations. In general,
individuals with secure attachment styles tend to explicitly interpret situations positively, while
those with insecure attachment styles interpret situations negatively (Gallo & Smith, 2001; Pereg
& Mikulincer, 2004; Rekart, Mineka, Zinbarg, & Griffith, 2007; Shaver & Mikulincer, 2008;
Whisman & McGarvey, 1995). Consistent with hypotheses, some research finds that attachment
avoidance is associated with explicit negative interpretations of others, such as interpreting the
intention of their behaviors as hostile (Mikulincer, 1998; Vrticka, Sander, & Vuilleumier, 2012).
However, others find that both attachment anxiety and avoidance are associated with negative
attributions of others, including attributions about the behavior of one’s own romantic partner
and other attachment figures (Collins, 2006; Heene, Buysse, & Van Oost, 2005; Pearce &
Halford, 2008; Sumer & Cozzarelli, 2004; Dewitte & De Houwer, 2011). Attachment insecurity
has also been associated with explicit negative attributions of the self. In particular, attachment
anxiety is associated with negative self-appraisals (Mikulincer, 1998; Sumer & Cozzarelli, 2004)
and perceiving oneself as unable to cope with emotional distress (Vrticka et al., 2012).
Fewer studies have examined implicit interpretation biases in insecurely attached
individuals. Insecurely attached individuals are more likely to interpret ambiguous situations as
threatening compared to securely attached individuals (Meyer, Pilkonis, & Beevers, 2004;
Mikulincer & Florian, 1995; Mikulincer & Shaver, 2001; Radecki-Bush, Farrell, & Bush, 1993;
Sheinbaum et al., 2105; Wang, King, & Debernardi, 2012). Maier and colleagues (2004) used

26

narrative interview techniques designed to capture unconscious attachment representations and
found that women implicitly interpret their experiences in a manner consistent with their IWMs.
Overall, research demonstrates that individuals make interpretations that are congruent
with their IWMs, which insecurely-attached individuals make more negative attributions. The
majority of these studies, however, have examined explicit interpretations of interpersonal
situations. As IWMs are considered unconscious representations of attachment experiences
(Maier et al., 2004), it is important for more studies to examine how these mental representations
guide implicit interpretations of social situations. These beliefs may be especially important to
examine as a risk factor for depression, as they likely represent beliefs that are most painful and
have been suppressed from conscious awareness.
Summary. Evidence suggests that insecure attachment styles may lead to attention and
interpretation biases that are congruent with IWMs. These information processing biases likely
put insecurely attached individuals at risk for depressive symptoms, as they are more likely to
attend to negative information and interpret stressful situations in a maladaptive way. Research
has demonstrated that explicit interpretations consistent with IWMs mediate the relationship
between attachment insecurity and depressive symptoms (Elwood & Williams, 2007;
Marganska, Gallagher, & Miranda, 2013; Whisman & McGarvey, 1995). Thus far, no studies to
date have examined how attention and implicit interpretation bias may play a role. Research
unrelated to attachment, however, has demonstrated how these negative information processing
deficits are important factors in the development and maintenance of depression.

27

Information Processing Biases and Depression
Cognitive theories of depression are based on an information processing model and
suggest that depressive symptoms are caused and maintained by deficits in attention and
interpretation (Beck, 1987; Bower, 1981; Ingram, 1984; Teasdale, 1983). Beck (1964) proposed
that depressed individuals have a negative schema that distorts an individual’s thought process.
A depressive schema leads an individual to attend to negative information in the environment
and interpret situations in a negative way that results in depressive affect (Beck, 1964, 1987).
Depressed individuals focus on negative information at the expense of positive or neutral cues
(Dozois & Beck, 2008), leading to a confirmation of previous negative expectations. These
maladaptive cognitive processes are more likely to result in depression in the context of stressful
life events (Dozois & Beck, 2008).
Attentional biases in depression. Consistent with cognitive theories, a number of
studies have found that depressed individuals show a greater attentional bias toward negative
stimuli than positive or neutral stimuli, as well as a greater bias toward negative stimuli when
compared to non-depressed individuals (Dai & Feng, 2011; Ellenbogen & Schwartzman, 2009;
Fritzsche et al., 2010; Joormann & Gotlib, 2007; Karparova, Kersting, & Suslow, 2007;
Kellough, Beevers, Ellis, & Wells, 2008; Sears, Newman, Ference, & Thomas, 2011; Shane &
Peterson, 2007). While cognitive theories of depression suggest that attentional biases may be
one etiological mechanism for the development of depression (Beck, 1987; Ingram, 1984), many
of these studies examined attentional biases in already depressed patients (e.g., Gotlib et al.,
2004; Taylor & John, 2004; Shane & Peterson, 2007), making it difficult to conclude whether it
was a cause and/or result of the depression.

28

A few prospective studies have shown that negative attentional biases predict subsequent
depressive symptoms following the occurrence of life stressors (Beevers & Carver, 2003; De
Raedt & Koster, 2010; Price et al., 2016), suggesting it may be a causal mechanism. Others have
shown that attention bias may be related to the maintenance of depressive symptoms.
Specifically, negative attentional biases were associated with slower mood recovery following a
sad mood induction (Clasen et al., 2013; Sanchez, Vazquez, Marker, LeMoult, & Joormann,
2013). Together, these studies suggest attentional biases may cause and maintain depressive
symptoms.
While several studies support a negative attentional bias in depressed individuals, other
research did not find evidence of this negative bias (Clasen, Wells, Ellis, & Beevers, 2013;
Ellenbogen, Schwartzman, Stewart, & Walker, 2002; Koster, Leyman, De Raedt, & Crombez,
2006; Sass et al., 2014). Methodological differences across studies may partially explain these
inconsistencies. For example, results differed depending on the length of time participants were
exposed to stimuli. Studies with longer exposure times (e.g., greater than 1000 ms) were more
likely to find a negative attentional bias in depressed individuals than studies with shorter
exposure times (e.g., 14 ms, 500-700 ms; Bradley, Mogg, & Lee, 1997; Donaldson et al., 2007;
Gotlib et al., 2004; Joorman & Gotlib, 2007; Koster, De Raedt, Goeleven, Franck, & Crombez,
2005). Other studies have found a negative attentional bias in depressed participants during later,
controlled stages of attention, and not during early, automatic stages of processing (Duque &
Vazquez, 2015; Koster et al., 2005; Lee Pe, Vandekerckhove, & Kuppens, 2013). This suggests
that depressed individuals are likely to excessively elaborate on negative material (Donaldson et
al., 2007; Sanchez et al., 2013).

29

The type of stimuli used also differed across studies. For example, many studies used
general negative stimuli (e.g., angry faces, words related to physical threat; Joormann & Gotlib,
2007; Karparova, Kersting, & Suslow, 2005; Mathews, Ridgeway, & Williamson, 1996). These
stimuli are not necessarily relevant to depression and thus biases toward these words would not
be expected in depressed individuals (e.g., Donaldson et al., 2007; McCabe & Gotlib, 1995).
Studies that have used words more specific to depression (e.g., sad, lonely, rejection) more
consistently find a negative attentional bias in depressed individuals (e.g., Bradley et al., 1997;
Ellenbogen & Schwartzman, 2009; Hill & Knowles, 1991; Shane & Peterson, 2007). Schlosser
and colleagues (2011) found a greater attentional bias for negative stimuli that participants rated
more personally relevant to them than for negative stimuli they rated as irrelevant to them.
Another important difference in methodology that may explain mixed findings in the
literature is the selective attention task used. Studies that have used more than one task of
selective attention found mixed results across tasks, suggesting attention bias tasks are not all
measuring the same construct (Fritzsche et al., 2010; Joorman et al., 2006). Further, a metaanalysis demonstrated that the association between attentional biases and depression depended
on the task used; a moderate, significant association was observed for studies using the dot-probe
task (d = 0.52), while the relationship was not significant for studies using the emotional Stroop
task (Peckham, McHugh, & Otto, 2010), the limitations of which were discussed earlier
(MacLeod, 2005; Mogg et al., 2000; Musa et al., 2003; Donaldson et al., 2007). Studies that have
used the exogenous cueing task have also shown mixed results (Baert, De Raedt, & Koster,
2010; Clasen et al., 2013; Ellenbogen & Schwartzmn, 2009; Everaert, Tierens, Uzieblo, &
Koster, 2013; Koster et al., 2006). The dot-probe task, the most widely used measure of attention
bias (Rodebaugh et al., 2016), is a more consistent predictor of attention biases associated with

30

depression (Bradley et al., 1997; Fritzsche et al., 2010; Gotlib et al., 2004; Hill & Dutton, 1989;
Joormann & Gotlib, 2007; Mathews et al., 1996; Mogg et al., 1995; Shane & Peterson, 2007;
Taylor & John, 2004).
While findings have been mixed, the majority of research demonstrates an attentional
bias toward depression-related stimuli in depressed individuals. This finding is especially strong
for studies using the dot-probe task, stimuli presented for longer periods of time, and tasks using
depression-relevant stimuli. Given depressed individuals are likely to attend to depressive cues,
they are also likely to interpret situations based on these negative cues.
Interpretation biases in depression. Given that an individual’s schema guides the way
they process information, individuals with depressive schemata interpret events in a negative
way. Individuals draw from similar events in their memory store in order to make attributions.
Given depressed individuals are more likely to attend to negative information and interpret
information in a negative way, they are also more likely to remember negative information (e.g.,
De Raedt & Koster, 2010; Rinck & Becker, 2005). Therefore, when interpreting current
situational cues, they are likely to have a greater proportion of negative memories from which to
draw.
Much research has demonstrated a negative bias in the explicit interpretations depressed
individuals make. While several cross-sectional studies show an association between negative
attributions and depressive symptoms (Abela, 2002; Alloy & Clements, 1998; Gibb et al., 2001;
Gonzalo, Kleim, Donaldson, Moorey, & Ehlers, 2012; Haeffel, 2011; Metalsky, Joiner, Hardin,
& Abramson, 1993; Metalsky & Joiner, 1992), there are also prospective studies that
demonstrate negative attributions following a stressful event predict symptoms days and weeks
later (Abela, 2002; Abela, Aydin, & Auerbach, 2006; Haeffel, 2011; Hankin, 2010; Kwon &

31

Laurenceau, 2002; Metalsky, Halberstadt, & Abramson, 1987; Metalsky et al., 1993; Swendsen,
1998). Depressive symptoms are more likely to result when individuals blame themselves for the
occurrence of a negative event, view themselves negatively as a result of the event (e.g.,
worthlessness), and expect catastrophic consequences to result (Alloy, Abramson, Metalsky, &
Hartlage, 1988). Furthermore, the more stable (likely to persist over time) and global (affecting
many areas of one’s life) the attributions are, the more likely they are to result in depressive
symptoms (Metalsky et al., 1987).
Not only do depressed individuals exhibit explicit biases in interpreting information in a
negative way, but they demonstrate similar biases on an implicit, unconscious level. Several
studies have used the Scrambled Sentences Test (Wenzlaff & Bates, 1998), which requires
participants to unscramble words in order to create a sentence that must be positive or negative.
For example, participants are presented with the scrambled words “looks the future bright very
dismal,” forcing them to create a positive (“the future looks very bright”) or negative (“the future
looks very dismal”) sentence. Studies using this task have repeatedly found that depressed
individuals generate a greater proportion of negative sentences, suggesting that depression is
associated with a tendency to interpret ambiguous information in a negative way (Brockmeyer et
al., 2012; Everaert et al., 2013; Everaert, Duyck, & Koster, 2014; Rude, Covich, Jarrold,
Hedlund, & Zentner, 2001; Rude, Durham-Fowler, Baum, Rooney, & Maestas, 2010; Rude,
Valdez, Odom, & Ebrahimi, 2003; Rude, Wenzlaff, Gibbs, Vane, & Whitney, 2002; Van der
Does, 2005; Wells, Vanderlind, Selby, & Beevers, 2014).
Summary. Overall, a robust association has been found between depression and negative
interpretation biases. These biases occur at both conscious and unconscious levels of processing.
The cognitive model suggests that negative interpretation biases are influenced by attention

32

biases, as interpretations are based on the cues attended to in the environment. Everaert and
colleagues (2013, 2014) demonstrated this link, showing that negative attentional biases in
depressed individuals predict depressive interpretation biases. These stages of information
processing are guided by depressive cognitive schemas.
Information Processing Biases in Attachment and Depression
As information processing biases are associated with insecure attachment styles as well
as depressive symptoms, such information processing deficits may explain the association
between attachment style and depressive symptoms. In particular, attachment avoidance may be
associated with attentional biases away from positive attachment cues, leading women to make
negative interpretations about others (e.g., they are unreliable, unsupportive), which could result
in depressive symptoms. Conversely, attachment anxiety may lead to attentional biases toward
negative attachment cues, biasing women’s interpretations about themselves (e.g., I am
worthless, it’s my fault). These negative self-attributions may increase a woman’s risk for
developing depressive symptoms. Some research has demonstrated that explicit interpretations of
self and other that are consistent with IWMs partially mediate the relationship between
attachment insecurity and depressive symptoms (Elwood & Williams, 2007; Marganska et al.,
2013; Whisman & McGarvey, 1995). Attention and implicit interpretation biases, however, have
not yet been examined as mechanisms from attachment style to depression.
Theory and methods from the information processing literature related to both depression
and attachment allow for an easy integration of this research. Both theories describe an
overarching cognitive schema or working model that guide information processing biases.
Further, there is significant overlap in the themes represented in depressive cognitive schemas
and insecure attachment styles, thus resulting in significant overlap in the content of stimuli used

33

in attention and interpretation bias tasks. For example, themes related to loss, separation, failure,
worthlessness, and rejection are common among depressive schema and insecure attachment
styles. As such, there is overlap between negative stimuli used in studies of depression and
research on attachment (e.g., rejected, ignored, abandon; Dewitte, Koster, De Houwer, &
Buysse, 2007; Hill & Dutton, 1989; Hill & Knowles, 1991; Edelstein & Gillath, 2008). As
previously mentioned, individuals tend to show a bias toward depression-related words that are
personally relevant to them (Schlosser et al., 2011), which may be similar to individuals
demonstrating biases toward stimuli congruent with their IWMs.
While the literature on attention biases in depression has focused on which stages of
attentional processing are most relevant for depressive risk, the attachment literature has focused
less on this issue. Studies using either the dot-probe or exogenous cueing paradigms have
presented stimuli for either 500 ms (Davis et al., 2014; Dewitte et al., 2007; Dewitte & De
Houwer, 2008) or 1000 ms (Cooper et al., 2009; Dewitte et al., 2007; Westphal et al., 2014).
However, studies using these two exposure times have not shown a clear pattern of differing
results, suggesting attachment-related attention biases may occur at both early and late stages of
processing. However, attention biases in depression are only observed in later stages of
processing (e.g., 1000 ms or later). Overall, these studies suggest that information processing
deficits associated with insecure attachment styles may be a mechanism by which attachment
insecurity leads to depressive symptoms in the face of stressful interpersonal events.
Attachment Style as a Mechanism from IPV to Depression
Information processing deficits are therefore likely to explain why insecure attachment
styles result in depressive symptoms for survivors of IPV. Women who have developed insecure
attachment styles (in part from the IPV) are likely to process information related to the abuse

34

more negatively than women with secure attachment styles. In particular, women high in
attachment anxiety may direct their attention toward negative attachment cues (e.g., rejection
from their partners), making it more likely that they will make negative interpretations about
themselves (e.g., I deserved the abuse). Women high in attachment avoidance may direct
attention away from positive attachment cues (e.g., partner’s attempts to make amends, social
support offered by friends), making it likely they will make negative interpretations about others
(e.g., nobody is there when I really need them, even the people you love will eventually hurt
you). These negative attributions about self and others following the experience of IPV
ultimately make women vulnerable for depressive symptoms.
Attention biases in women experiencing IPV. A few studies unrelated to attachment
have examined attentional biases in women with a history of IPV. Findings indicate that
survivors demonstrate a greater attentional bias toward dysphoric words and fearful faces than
women who have not experienced IPV (Lee & Lee, 2012, 2014). More research has examined
attentional biases in other types of trauma. Studies consistently demonstrate that trauma
survivors demonstrate a specific attentional bias towards words that are related to their trauma,
such as words related to sexual violence or the body in survivors of sexual trauma (DePierro,
D’Andrea, & Pole, 2013; Fleurkens, Rinck, & van Minnen, 2011; Witthoft, Borgmann, White, &
Dyer, 2015). These trauma-related attentional biases are associated with depressive symptoms in
trauma-exposed samples (Ashley, Honzel, Larsen, Justus, & Swick, 2013; Hauschildt, Wittekind,
Moritz, Kellner, & Jelinek, 2013; Iacoviello et al., 2014), supporting the notion that attentional
biases may contribute to depression for women experiencing IPV.
Interpretation biases in women experiencing IPV. Research on interpretations of
women experiencing IPV has primarily focused on explicit interpretations. Causal attributions

35

for the abuse (i.e., attributions of blame) are most commonly studied. Some studies show that
women blame themselves for the abuse (Babcock & DePrince, 2012; Barnett, 2000; Beck et al.,
2015; Hassija & Gray, 2012; Hebenstreit, Maguen, Koo, & DePrince, 2015; Lim, Valdez, &
Lilly, 2015; Reich et al., 2015; Towns & Adams, 2016; Walker, 2009). Some examples of this
include women attributing the cause of the abuse to their own assertiveness or disagreeing with
their partner (O’Leary, Curley, Rosenbaum, & Clarke, 1985), or believing they should be able to
change their partner’s abusive behavior through unconditional love (Towns & Adams, 2000).
These causal attributions may reflect negative perceptions of self. Other studies find that women
primarily blame their partners for the abuse (Holtzworth-Munroe, 1988; O’Leary et al., 1985;
Pape & Arias, 2000).
Other research has identified negative explicit perceptions of self in women experiencing
IPV (Beck et al., 2015). For example, IPV is associated with low self-worth (Clements,
Sabourin, & Spiby, 2004; Valdez & Lilly, 2015), feelings of powerlessness (Valdez, Lim, &
Lilly, 2013), and being over critical of oneself (Taskale & Soygut, 2017). One study found that
some women choose to “subordinate the self,” or act in accordance to the abuser’s desires, in an
attempt to de-escalate the violence (Campbell, Kub, Belknap, & Templin, 1997). Frequently
subordinating the self may lead women to make negative attributions about the self, as it may
result in beliefs that women deserve to be silenced or are unable to exert autonomy (Ferraro &
Johnson, 1983). Studies also demonstrate negative explicit beliefs about others associated with
IPV victimization. For example, women experiencing IPV often believe others will not protect
them (Lim et al., 2015) or be able to meet their needs (Atmaca & Gencoz, 2016; Taskale &
Soygut, 2017; Valdez et al., 2013). IPV is also associated with difficulty trusting others due to

36

feelings of betrayal (Valdez et al., 2013) and general beliefs that the world is malevolent (Valdez
& Lilly, 2015).
Research on implicit interpretation biases in IPV-exposed women is limited. Using
projective assessment, one study examined implicit beliefs regarding self and others in women
with and without a history of IPV (Pallini, Alfani, Marech, & Laghi, 2017). These authors found
that women who experienced IPV were more likely to describe characters as having less agency
and capability and used more themes of danger and failed protection compared to women who
have not experienced IPV. These results suggest women with IPV may demonstrate implicit
negative perceptions of self (as incapable and powerless) and others (as unsafe and unable to
protect).
Another study found that IPV was associated with negative interpretations of ambiguous
situations (Lambert, Benight, Wong, & Johnson, 2013). Specifically, the authors assessed
women’s likelihood to interpret physiological arousal as an indication of low self-efficacy.
Women were provided with ambiguous scenarios related to physical sensations (e.g., “You feel
short of breath”) and were given three potential explanations for the scenario. Two of the
explanations were neutral or related to physical health, and one explanation was negative related
to the self (e.g., “You can’t deal with what’s going on in your life”). Women experiencing IPV
were more likely to attribute the symptoms to low self-efficacy than were non-abused women,
and this negative interpretation bias was associated with depressive symptoms. While this study
provides some evidence for a negative implicit interpretation bias in women experiencing IPV, it
focuses only on interpretations about the self and is not focused on interpersonal situations.
Some research has examined implicit interpretations related to other types of trauma and
found that individuals exposed to trauma were more likely to interpret ambiguous situations as

37

negative or risky compared to individuals not exposed to trauma (Elwood, Williams, Olatunji, &
Lohr, 2007). DePrince and colleagues (2009) found that interpersonal trauma is associated with
implicit negative interpretations about others, including the belief that relationships are harmful.
While there is some evidence to suggest women experiencing IPV have negative unconscious
interpretation biases, research to date is limited.
Summary. These studies demonstrate attention and interpretation biases found in
trauma-exposed individuals. However, no studies have examined attachment-specific
information processing biases in women experiencing IPV. Differences in attachment style,
which result in part from IPV, may explain the different findings across studies. For example,
research suggests that some women blame themselves for the abuse, while others blame their
partners or may even blame both themselves and their partners. This variability in causal
attributions may be explained by individual differences in attachment style; attachment anxiety
may be positively associated with self-blame, while attachment avoidance may relate to partnerblame. These information processing biases that are congruent with IWMs put women at risk for
developing depressive symptoms. Examining these findings through the lens of attachment style
can provide a greater understanding of information processing that occurs following traumatic
events.
The Role of Interpersonal Trauma History in Information Processing Biases and
Depression
A woman’s history of interpersonal trauma may also play a significant role in her risk for
depression. As previously discussed, adult attachment styles are a product of relational
experiences across childhood and adulthood. Given this, a woman’s history of CM or prior IPV
may have contributed to a woman’s attachment style. These previous experiences of

38

interpersonal trauma may increase a woman’s risk for depressive symptoms, as attachment
representations that are shaped from prior experiences guide how she processes information from
her current abusive relationship.
As previously described, a woman’s IWMs (and resulting interpretations) are influenced
by experiences from her past. During the stage of interpretation, a woman recalls relevant
knowledge from memory, gained through prior attachment experiences, and uses this as a guide
for interpreting and understanding her present situation (Crick & Dodge, 1994). When an abused
woman makes attributions for the IPV she has experienced, she draws on mental representations
she has developed from prior relationships. For a woman with a history of CM or prior IPV, the
IPV she is currently experiencing may trigger memories of her previous abuse (Briere, 2004),
along with relevant interpretations (e.g., “I never do anything right”) and emotions (e.g., sadness,
loneliness). The recollection of these prior abusive experiences might increase the likelihood she
makes negative interpretations about her abuse (e.g., “It is my fault”), putting her at greater risk
for developing depressive symptoms. A woman without a history of CM or past IPV, whose
attachment insecurity is mainly a result of IPV in her current relationship, may be more likely to
have positive relational experiences from which to draw. The recollection of more loving
attachment representations might decrease the likelihood that she makes negative attributions
about the IPV, decreasing her depressive symptom risk.
Research on whether childhood trauma influences the interpretation of traumatic events
in adulthood is limited. One study found that women with a history of CM were more likely to
engage in self-blame for IPV they experienced in adulthood (Babcock & DePrince, 2012). Some
research, however, has examined information processing biases in women with histories of CM
or IPV. For example, a history of CM is associated with attentional biases toward negative

39

emotion faces (de Silva Ferreira et al., 2014; Gibb, Schofield, & Coles, 2009; Gunther,
Dannlowski, Kersting, & Suslow, 2015; Pollak, Cicchetti, Hornung, & Reed, 2000) and away
from happy faces (Davis et al., 2014). Fewer studies have examined interpretation biases in adult
survivors of CM. Survivors of CM have a tendency to make negative implicit interpretations
about ambiguous information (Luke & Banerjee, 2013). For example, a history of CM is
associated with interpreting neutral faces as angry (Gibb et al., 2009) and making hostile
attributions about the intent of others’ behavior (Kay & Green, 2015). Wells and colleagues
(2013) found that adults who experienced maltreatment in childhood were more likely to make
negative implicit interpretations on the Scrambled Sentence Test and exhibit negative explicit
attributions about self and others. While no study has compared the concurrent role of prior and
current IPV on information processing biases, previously described studies demonstrate attention
and interpretation biases associated with a history of IPV, even for women not currently in
abusive relationships (e.g., Lee & Lee, 2014; Pallini et al., 2017; Valdez & Lilly, 2015).
This research suggests that women with a history of interpersonal trauma may attend to
negative information and interpret situations in maladaptive ways. These information processing
biases may be associated with insecure attachment styles that resulted from CM and prior IPV
and may influence the way that women perceive current interpersonal situations. It is especially
likely to influence the processing of ongoing IPV, as the abuse may bring up memories of
childhood abuse or previous IPV and confirm prior negative expectations about the self or
others. These elicited memories are therefore likely to increase the negative interpretations a
woman makes about her abuse, confirming her IWMs and increasing her risk for depression.

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Summary of Current Study
Women who experience IPV are at risk for depressive symptoms, and attachment style
may account for this relationship. The more frequent IPV a woman experiences, the more
insecurely attached she is likely to become, as frequent abuse strengthens her negative IWMs.
Furthermore, attachment insecurity is associated with depressive symptoms following stressful
interpersonal events. However, the mechanism for why attachment insecurity results in
depressive symptoms is poorly understood. Information processing deficits associated with
insecure attachment styles may be one such mechanism. An individual’s attachment-related
IWMs of self and other unconsciously guide how the individual processes social information,
influencing what aspects of a situation are extracted and how the situation is appraised (Atkinson
et al., 2009). Information is processed in a way that is congruent with a woman’s IWMs. For
insecurely attached women, interpersonal stressors are likely to be perceived negatively, putting
a woman at risk for depression. While empirical studies have demonstrated attention and implicit
interpretation biases associated with insecure attachment styles (e.g., Dewitte & De Houwer,
2008; Westphal et al., 2014), these attachment-related information processing deficits have not
been associated with depression in the empirical literature. Research unrelated to attachment,
however, demonstrates that negative attention and implicit interpretation biases are important
mechanisms in the development of depressive symptoms (e.g., Gotlib et al., 2004). Therefore,
the information processing deficits associated with insecure attachment styles are likely to put
women who experience IPV at risk for depressive symptoms.
Both attachment anxiety and avoidance are likely associated with depressive risk, but
through different information processing pathways. Attachment anxiety is associated with
greater attention toward negative attachment-related cues, increasing the likelihood of making

41

negative attributions about the self as worthless or deserving of abuse. Attachment avoidance, on
the other hand, is related to attending away from positive attachment-related cues, increasing the
likelihood of making negative attributions about others as unreliable, untrustworthy, or harmful.
Both negative interpretations of the self and others are likely to put women at risk for developing
depressive symptoms.
A history of CM or prior IPV is also likely to influence a woman’s risk of developing
depressive symptoms. Specifically, women pull from mental representations shaped by past
abuse when interpreting current experiences of IPV, increasing the likelihood of making negative
attributions about the IPV. Women without a history of CM or past IPV, with positive
attachment experiences from which to draw, may be less likely to make consistently negative
attributions about the IPV.
The current study tested the following hypotheses:
1) Frequency of IPV would be positively associated with attachment insecurity, depressive
symptoms, negative attention and interpretation biases, and CM.
2) IPV and a history of interpersonal trauma would each have positive associations with
depressive symptoms.
3) Attachment insecurity would mediate the association between IPV and depressive
symptoms. Interpersonal trauma history would also be positively associated with
attachment insecurity.
a. Both attachment anxiety and avoidance would significantly mediate this
relationship.
4) Attachment insecurity would predict negative attention and implicit interpretation biases.

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a. Attachment anxiety would be associated with attentional bias toward negative
attachment stimuli. Attachment avoidance would be associated with attentional
bias away from positive attachment stimuli.
b. Attachment anxiety would be positively associated with negative implicit
interpretations of self, and attachment avoidance would be positively associated
with negative implicit interpretations of others.
5) Negative attention biases would predict negative implicit interpretation biases.
a. Attention biases toward negative attachment cues would predict negative
interpretations about self. Attention biases away from positive attachment cues
would be associated with negative interpretations about others.
6) Negative attention and implicit interpretation biases would mediate the association
between attachment insecurity and depressive symptoms.
7) Attachment insecurity and information processing biases would mediate the association
between IPV and depressive symptoms. A history of interpersonal trauma would also be
positively associated with attachment insecurity and resulting information processing
biases.

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METHOD
Participants
Participants were 301 undergraduate women recruited through the Michigan State
University human subject pool. Eligibility criteria included women who were at least 18 years
old, fluent in English, and currently in a heterosexual dating relationship that constituted an
attachment relationship for at least one month. A modified version of the WHOTO scale (Fraley
& Davis, 1997) was used to screen whether women were in attachment dating relationships. This
6-item measure assessed the 3 basic characteristics of an attachment relationship: proximity
seeking (“Is it hard for you to be away from your partner?” “Is your partner the person you most
like to spend time with?”), safe haven (“Is your partner the person you want to talk to when you
are worried about something?” “Is your partner the person you turn to when you are feeling upset
or down?”), and secure base (“Is your partner someone you know will always be there for you?”
“Is your partner the person you want to share your successes/accomplishments with?”).
Consistent with prior research (Heffernan et al., 2012; Mikulincer, Shaver, Gillath, & Nitzberg,
2005), women were included in the current study if they endorsed items from 2 of the 3
attachment characteristics.
Seventy-five percent of women were White/Caucasian, 11% Black/African American,
6% multiracial, 5% Asian American, and 3% Hispanic, Latina, Chicana, or Mexican American.
The average relationship length was 20.10 months (SD = 16.12). Only 7% of women were
cohabiting with their partners. The average age of women was 19.52 (SD = 1.24). Fourteen
percent of women reported their family’s annual income was greater than $200,000, 12.6%
reported between $150,000 and $200,000, 23.6% reported between $100,000 and $150,000,
30.2% reported between $50,000 and $100,000, and 19.6% reported less than $50,000.

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Measures
Intimate partner violence. The Severity of Violence against Women Scale assessed
threats of violence, physical violence, and sexual abuse a woman might experience from her
dating partners (SVAWS; Marshall, 1992). Respondents noted the frequency with which each of
the 46 events have occurred in their dating relationships on a 4-point scale ranging from “never”
to “many times.” Sample items include “threatened to hurt you,” “pushed or shoved you,” and
“physically forced you to have sex.”
The Psychological Maltreatment of Women Inventory (PMWI; Tolman, 1989) is a 14item measure that assessed psychological abuse. Women reported the frequency with which each
of the events have occurred in their dating relationships on a 5-point scale ranging from “never”
to “very frequently.” Sample items include “monitored my time and made me account for my
whereabouts” and “treated me like an inferior.”
Women completed both the SVAWS and PMWI twice: once regarding their current
dating relationships, and once regarding all previous dating relationships. Cronbach’s alpha was
high for each measure in the current sample (.88 for current SVAWS, .86 for current PMWI, .93
for prior SVAWS, and .95 for prior PMWI).
Attachment style. Women’s romantic attachment style dimensions were assessed using
the Experiences in Close Relationships Questionnaire (ECRQ; Brennan, Clark, & Shaver, 1998).
The ECRQ is a 36-item self-report questionnaire with a 7-point scale ranging from “strongly
disagree” to “strongly agree.” The measure provides 2 subscales: attachment anxiety
(Cronbach’s alpha in the current sample = .92) and attachment avoidance (α = .93). Sample items
from each scale include “I’m afraid I will lose my partner’s love” and “I don’t feel comfortable
opening up to romantic partners,” respectively.

45

Depressive symptoms. Women’s depressive symptoms were assessed using the Center
for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). Women noted the
frequency at which they experienced 20 depressive symptoms in the past week on a 4-point scale
ranging from “rarely or none of the time (less than 1 day)” to “all of the time (5-7 days).”
Cronbach’s alpha was high in the current study (.91).
Childhood maltreatment. The Childhood Trauma Questionnaire (CTQ; Bernstein et al.,
1994) was used to measure CM. Women reported the frequency with which they experienced
each of the 28 items on a 5-point scale ranging from “never true” to “very often true.” The CTQ
includes 5 subscales: emotional abuse, emotional neglect, sexual abuse, physical abuse, and
physical neglect. The majority of scales demonstrated adequate reliability (α in the present study
ranged from .63 to .93) with the exception of physical neglect (α = .18). Therefore, the physical
neglect scale was dropped from analyses. Emotional abuse and neglect were summed to create
an overall emotional maltreatment scale, an approach that has been used in prior CM research
(e.g., Hankin, 2006; Theran & Han, 2013).
Attentional biases. The modified dot-probe task (MacLeod et al., 1986) was used to
assess women’s attentional biases. Women’s attentional biases toward both attachment-related
and general words were assessed in order to test whether attachment style predicted attachmentspecific biases. Stimulus material for the task included 20 negative attachment-related words
(e.g., separation, rejection, ignored), 20 positive attachment-related words (e.g., close, secure,
support), 20 general negative words (e.g., misery, tragic, gloom), 20 general positive words (e.g.,
happy, peace, cheer), and 20 neutral words (furniture-related; e.g., clock, table, bowl). These
stimuli have been used in prior studies (Atkinson et al., 2009; Dewitte, Koster, De Houwer, &

46

Buysse, 2007; Donaldson et al., 2007; Edelstein & Gillath, 2008). Each stimulus word was
paired with a neutral word matched on word length (Hermans & De Houwer, 1994).
Each trial started with a fixation cross presented for 1000 ms in the middle of the screen.
Then, a word pair appeared and remained visible for 1000 ms. Words in each pair were presented
one above the other. As the words disappeared, a letter probe (E or F) replaced one of the two
words and remained on the screen until participants responded. Participants indicated whether
the letter was an “E” or an “F” by pressing the corresponding button on the computer mouse (left
or right, respectively) as quickly and accurately as possible. Participants completed 10 practice
trials of neutral word pairs, followed by 200 experimental trials (each word pair was presented
twice). Word pairs were presented in randomized order across trials and participants. The words
and the letter probe were presented equally often at the top or bottom position of the screen, and
the letter probe replaced either an emotional word or a neutral word equally. The inter-trial
interval was 500 ms.
Reaction times (RTs) on trials where a probe was presented at the same location as an
emotional word (attachment or general positive/negative) was subtracted from RTs on trials
where a probe was presented at the opposite location from the emotional word (Davis et al.,
2014; Fani, Bradley-Davino, Ressler, & McClure-Tone, 2011; Mogg & Bradley, 1999. The
average of these difference scores were calculated separately for positive attachment, negative
attachment, general positive, and general negative trials. If individuals demonstrated an
attentional bias toward emotional words, their responses would be faster when the probe follows
at the location previously occupied by the emotional word. Higher scores indicated greater
attentional bias toward the emotional word.

47

Only trials in which participants correctly responded to the probe were included in
analyses. Trials were excluded if participants responded too quickly (less than 200 ms) or too
slowly (greater than 2000 ms), which constituted less than 1% of the total trials. Lastly, data
were imputed for participants who demonstrated poor accuracy (less than 75% correct trials) on
the task (n = 12).
Implicit interpretation bias. Women’s implicit interpretation biases were assessed using
a modified version of the Scrambled Sentences Test (SST; Wenzlaff & Bates, 1998). The SST
required participants to create grammatically correct, meaningful sentences out of 6 scrambled
words (e.g., “winner born I am loser a”) using only 5 words. The task forced participants to
create a positive or negative sentence related to the self (e.g., “I am a born winner” or “I am a
born loser”) or related to others (e.g., “I tell my friends everything” or “I tell my friends
nothing”).
The task included a practice and test phase. The practice phase included 3 trials of neutral
scrambled sentences (e.g., “shoe dog the my homework ate”) to familiarize participants with the
task. The test phase included 40 trials broken into 2 blocks; each block contained 10 self and 10
other stimuli presented in a fixed order. Participants were given 150 seconds to complete each
block. As in prior studies using the SST (Brockmeyer et al., 2012; Everaert et al., 2013; Everaert
et al., 2014; Rude et al., 2010), a cognitive load procedure was employed in order to reduce
socially desirable responding and ensure implicit biases are being measured. Participants were
given a 6-digit number to remember while completing each block and asked to write the number
at the bottom of their answer sheet at the end of each block.
Negative interpretation bias was defined as the ratio of negatively unscrambled sentences
over the total number of sentences correctly completed (Wenzlaff & Bates, 1998). This ratio was

48

calculated separately for self and other interpretation biases. The interpretation biases measured
with the SST are considered implicit in that individuals are unaware that they hold such beliefs.
Covariates. Symptoms of anxiety and post-traumatic stress were controlled for, given
their comorbidity with depressive symptoms in women experiencing IPV (Nixon, Resick, &
Nishith, 2004) as well as their association with information processing deficits (Lee & Lee,
2014; Sass et al., 2014). Post-traumatic stress symptoms were assessed using the PTSD Checklist
for DSM-5 (PCL-5; Weathers et al., 2013). The PCL-5 is a 20-item self-report questionnaire that
required respondents to rate how much they have been bothered by each symptom in the last
month on a scale from 0 (“not at all”) to 4 (“extremely”). Cronbach’s alpha was high in the
current sample (.93).
Anxiety symptoms were assessed using the Patient-Reported Outcomes Measurement
Information System (PROMIS) Adult Anxiety Short Form (Cella et al., 2010; Pilkonis et al.,
2011). This 7-item measure required participants to rate the frequency at which they experienced
each symptom during the last week on a scale ranging from 1 (“never”) to 5 (“always”). Items
include a range of physical (e.g., “I felt tense”), cognitive (e.g., “I felt worried”), and affective
(e.g., “I felt fearful”) symptoms. The PROMIS demonstrated high reliability in the current
sample (α = .92).
Relationship satisfaction was also controlled for, as it is associated with relationship
attributions and depressive symptoms in non-violent couples (Fincham & Bradbury, 1992;
Kouros, Papp, & Cummings, 2008). The Revised Dyadic Adjustment Scale (RDAS) was used to
assess relationship satisfaction (Busby, Christensen, Crane, & Larson, 1995). The RDAS is a 14item self-report questionnaire, in which participants report the extent to which they agree with
each item on a 6-point scale ranging from “never” to “all the time.” This measure has been used

49

to assess relationship satisfaction in dating relationships of college students (e.g., Riggs et al.,
2011). Cronbach’s alpha in the current sample was adequate (.81). Copies of all study measures
are included in Appendix A.
Analyses also controlled for demographic variables, including age, socioeconomic status,
and race. As 75% of the sample was Caucasian, it was not possible to examine each racial group
separately. Therefore, analyses examined differences between racial minority and Caucasian
women.
Procedure
Women completed screening questions (e.g., age, relationship status, English fluency)
online and completed the full study in lab offices if they were eligible to participate. The
behavioral tasks were administered before self-report measures. Women received 2 research
credits for their participation in the study. Participants were provided with resources for mental
health and dating violence.
Data Analysis
Hypothesis 1 was tested by examining the correlations between IPV and the variables of
interest (CM, attachment insecurity, attentional biases, interpretation biases, and depressive
symptoms). The remaining hypotheses were tested using structural equation modeling (SEM)
and path analysis in MPlus (version 6; Muthén & Muthén, 2010). Latent variables were created
for the following construct: IPV (2 indicators: SVAWS and PMWI), CM (3 indicators: emotional
abuse/neglect, physical abuse, and sexual abuse), attachment insecurity (2 indicators: anxiety and
avoidance), negative interpretation bias (2 indicators: self and other), and attention bias (2
indicators: negative and positive cues). A single indicator latent variable was used for depressive
symptoms.

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RESULTS
Data Preparation and Descriptive Statistics
For participants with poor dot-probe task accuracy, attention bias data were imputed
using maximum likelihood estimation. Maximum likelihood estimation procedures produce the
most efficient and least biased estimates when data are missing completely at random (Graham,
Hofer, & MacKinnon, 1996; von Hippel, 2013). Data in the current sample were missing
completely at random (MCAR statistic = 12.91, df = 7, p = n.s.), and less than 1% of the data
were missing. No significant differences emerged between participants with and without missing
data on any study variables.
The normality of variables was examined. Kurtosis was acceptable. Several measures of
CM and IPV were positively skewed (skewness for current SVAWS = 4.54, current PMWI =
2.09, past SVAWS = 4.32, CTQ physical abuse = 3.47, CTQ sexual abuse = 5.55). Each of these
variables was log transformed prior to running analyses, which reduced the skewness (skewness
for current SVAWS = 0.88, current PMWI = -0.02, past SVAWS = 0.99, CTQ physical abuse =
1.78, CTQ sexual abuse = 1.28).
Correlations among variables and descriptive statistics are presented in Table 1. Eightynine percent of women reported at least one type of IPV in their current relationship.
Specifically, 26% reported physical abuse, 7% reported sexual abuse, and 88% reported
emotional abuse in their current dating relationship. Sixty-four percent of participants endorsed
experiencing IPV in previous relationships (27% reported physical abuse, 17% reported sexual
abuse,63% reported emotional abuse). Overall, 94% of participants reported experiencing IPV at
some point in time. On the CTQ, 88% of women reported experiencing some form of CM.
Twenty-seven percent reported physical abuse, 10% reported sexual abuse, and 71% reported

51

emotional abuse or neglect during childhood. On the CES-D, 28% of women endorsed
depressive symptoms in the clinically significant range (Radloff, 1977).
Each of the covariates was associated with study variables and therefore was examined in
all analyses. In all of the following models, both anxiety and PTSD symptoms were positively
associated with CM, IPV, attachment insecurity, interpretation biases, and depression. To
increase statistical power, a latent variable of mental health (2 indicators: anxiety and PTSD) was
used throughout analyses. All pathways remained statistically significant when covariates were
added to the models. Therefore, models without covariates will be presented in the text. Models
including covariates are presented in Appendix B. Before covariates were added to the models,
non-significant pathways were trimmed from the model in order to increase statistical power.
Age and family income were not significantly associated with any variables in the models and
thus were not presented in the models.

52

Table 1
Correlations and Descriptive Statistics
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16 17
1. Current IPV (SVAWS)
2. Current IPV (PMWI)
0.66 *
3. Prior IPV (SVAWS)
0.10 0.03
4. Prior IPV (PMWI)
0.07 0.16 * 0.77 *
5. Childhood Maltreatment
0.06 0.08 0.15 * 0.19 *
6. Attachment Anxiety
0.20 * 0.31 * 0.16 * 0.24 * 0.32 *
7. Attachment Avoidance
0.25 * 0.26 * 0.15 * 0.16 * 0.33 * 0.46 *
8. Depression
0.28 * 0.33 * 0.16 * 0.19 * 0.31 * 0.47 * 0.32 *
9. Neg. Interpretation - Self
0.12 * 0.16 * 0.01
0.01
0.13 * 0.23 * 0.16 * 0.42 *
10. Neg. Interpretation - Other
0.33 * 0.30 * 0.05
0.11
0.21 * 0.33 * 0.27 * 0.45 * 0.57 *
11. Attn. Bias to Neg. Attach.
0.02 0.08 0.02 -0.03 -0.08
0.04 -0.08 -0.02 -0.06 -0.04
12. Attn. Bias to Pos. Attach.
-0.03 0.00 -0.02
0.04 -0.03
0.07 -0.01 -0.02 -0.16 * -0.06
0.10
13. PTSD
0.30 * 0.37 * 0.28 * 0.32 * 0.44 * 0.44 * 0.32 * 0.68 * 0.28 * 0.44 *
-0.01
0.02
14. Anxiety
0.34 * 0.38 * 0.21 * 0.21 * 0.22 * 0.42 * 0.28 * 0.64 * 0.28 * 0.36 *
-0.04
0.01 0.68 *
15. Relationship Satisfaction
-0.38 * -0.46 * 0.11
0.03 -0.05 -0.33 * -0.34 * -0.35 * -0.24 * -0.35 *
0.03
0.01 -0.31 * -0.29 *
16. Age
0.08 0.08 0.07
0.14 * 0.05 -0.01
0.12 * -0.01 0.03 0.03
0.00
-0.08 0.03 0.08
-0.01
17. Race
0.11 0.06 0.03 -0.03
0.19 * 0.12 * 0.09
0.12 * 0.10 0.08
-0.04
-0.07 0.07 0.08
-0.04 0.01
18. Income
0.00 0.01 0.07
0.06 -0.13 * -0.03
0.06 -0.02 -0.08 -0.08
0.01
-0.02 -0.03 0.06
0.05 -0.05 -0.20 *
Minimum
0
0
0
0
0
18
18
0 0.00 0.00 -170.94 -290.12
0
0
27
18
Maximum
50
38
92
52
56
107
102
45 1.00 0.92
151.55 236.31
69
28
68
23
Mean
2.95 5.26 4.41
8.37
7.28 47.12 39.29 13.05 0.19 0.33
-1.01
-0.69 17.54 8.59 51.32 19.52
Standard Deviation
5.75 5.87 9.32 11.61
9.41 20.41 16.72
9.66 0.20 0.20
42.25 47.59 14.48 6.49
8.09 1.24
Note . * p < .05. SVAWS = Severity of Violence Against Women Scales. PMWI = Psychological Maltreatment of Women Inventory. Race 1 = Racial minority, 0 = Caucasian.

53

Hypothesis 1
Hypothesis 1 predicted that IPV would be positively associated with CM, attachment
insecurity, depressive symptoms, negative interpretation biases, and attentional biases. This
hypothesis was tested using bivariate correlations (see Table 1). Current IPV was positively
associated with attachment anxiety and avoidance, depression, and negative interpretation of self
and other. Prior IPV was positively associated with attachment anxiety and avoidance as well as
depression. Childhood maltreatment was positively associated with attachment anxiety and
avoidance, depression, and negative interpretations of self and other. Neither CM nor IPV were
significantly associated with attentional biases.
Hypothesis 2
Hypothesis 2 predicted that current IPV and a history of interpersonal trauma would each
have unique effects on depressive symptoms. Model fit was poor (see Appendix B), and CM had
a low factor loading (.20) on the interpersonal trauma latent variable. Therefore, the effects of
current IPV, past IPV, and CM on depression were examined separately (see Figure 3). Model fit
was good (RMSEA = .10, CFI = .93, SRMR = .04). Results indicate that IPV in the current
relationship and CM were positively associated with depressive symptoms, while past IPV was
not significantly associated with depression. Note that standard coefficients are presented in
Figure 3 and all subsequent models.

54

Figure 3
Effects of CM, Past IPV, and Current IPV on Depression

Hypothesis 3
Attachment insecurity was tested as a mediator between CM and IPV and depressive
symptoms (see Figure 4). The model showed good fit (RMSEA = .08, CFI = .94, SRMR = .04).
Notably, attachment insecurity fully mediated the effects of CM and current IPV on depression.
Prior IPV was not associated with attachment insecurity or depressive symptoms. As such, prior
IPV was removed from subsequent analyses.

55

Figure 4
Attachment Insecurity Mediating Effects of CM and IPV on Depression

Next, separate dimensions of attachment anxiety and avoidance were examined within
the model (see Figure 5). Model fit was acceptable (RMSEA = .12, CFI = .90, SRMR = .05).
IPV and CM were positively associated with both attachment anxiety and avoidance. Further,
attachment anxiety positively predicted depression, while attachment avoidance did not.

56

Figure 5
Attachment Anxiety and Avoidance Mediating the Effects of CM and IPV on Depression

Hypothesis 4
Hypothesis 4 proposed that attachment insecurity would predict negative attention and
interpretation biases. Attention biases were examined first. Overall attention biases modeled as a
latent variable had poor model fit (see Appendix B, so this latent variable was not used in
subsequent models. Instead, attachment insecurity was examined as a predictor of separate
general and attachment-related attention biases (see Appendix B). However, attachment
insecurity was not significantly associated with attentional bias toward positive or negative
general or attachment-related cues.
This model was then run separating attachment into dimensions of anxiety and avoidance
to test the hypothesis that attachment anxiety would be associated with attentional bias toward
negative attachment cues and attachment avoidance would be associated with attentional bias
away from positive attachment cues (see Figure 6). The model demonstrated good fit (RMSEA =
57

.00, CFI = 1.00, SRMR = .00). Contrary to hypothesis, attachment avoidance was associated
with attentional bias away from negative attachment-related stimuli. Attachment anxiety was not
associated with attentional biases.
Figure 6
Effects of Attachment Anxiety and Avoidance on Attentional Biases

Attachment insecurity was then examined as a predictor of negative interpretation biases
(see Appendix B). Findings indicated that attachment insecurity was positively associated with
negative interpretation biases. The model was then examined with separate interpretation biases
toward self and other (see Figure 7). Model fit was good (RMSEA = .00, CFI = 1.00, SRMR =
.01). Attachment insecurity positively predicted negative interpretation biases regarding both self
and others.
Figure 7
Effects of Attachment Insecurity on Interpretation Biases of Self and Other

Next, attachment was separated into dimensions of anxiety and avoidance to test the
hypothesis that attachment anxiety would be associated with negative interpretations about self,

58

and attachment avoidance would be associated with negative interpretations about others (see
Figure 8). The model had good fit (RMSEA = .00, CFI = 1.00, SRMR = .00). Consistent with
hypotheses, attachment avoidance was positively associated with negative interpretations of
others. Attachment anxiety was positively associated with negative interpretations of both self
and others.
Figure 8
Effects of Attachment Anxiety and Avoidance on Interpretation Biases of Self and Other

Hypothesis 5
Hypothesis 5 posited that attention biases would predict interpretation biases.
Specifically, it was hypothesized that attention bias toward negative attachment cues would
predict negative interpretation bias toward self, and attention bias away from positive attachment
cues would predict negative interpretation bias toward others (see Figure 9). Model fit was good
(RMSEA = .00, CFI = 1.00, SRMR = .00). Contrary to hypotheses, attention biases to positive
attachment cues were negatively associated with negative interpretation bias toward self.
Attention bias to negative attachment cues was not significantly associated with interpretation
biases.
Figure 9
Effects of Attention Biases on Interpretation Biases of Self and Other

59

Hypothesis 6
Hypothesis 6 examined whether attention and interpretation biases mediated the
association between attachment insecurity and depressive symptoms. First, attention and
interpretation biases were examined separately. The model testing negative interpretation bias as
a mediator between attachment insecurity and depressive symptoms demonstrated good fit (see
Figure 10; RMSEA = .04, CFI = 1.00, SRMR = .02). Findings indicate negative interpretation
bias partially mediated the relationship between attachment insecurity and depressive symptoms.
Figure 10
Negative Interpretation Bias Mediating the Effect of Attachment Insecurity on Depression

Negative interpretation bias was then separated into bias regarding self and other (see
Figure 11). Model fit was good (RMSEA = .00, CFI = 1.00, SRMR = .01). Findings indicate that
interpretation biases toward both self and other partially mediated the relationship between
attachment insecurity and depressive symptoms.

60

Figure 11
Interpretation Bias of Self and Other Mediating the Effect of Attachment Insecurity on
Depression

The dimensions of attachment anxiety and avoidance were then examined (see Figure
12). Model fit was good (RMSEA = .00, CFI = 1.00, SRMR = .00). Findings indicated that
attachment avoidance and anxiety predicted negative interpretation bias toward others, and
attachment anxiety predicted negative interpretation bias toward self. Attachment anxiety had a
direct effect on depressive symptoms. Negative interpretation bias toward both self and other
were positively associated with depressive symptoms, suggesting they partially mediated the
effects of attachment dimensions on depression.

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Figure 12
Interpretation Bias of Self and Other Mediating the Effects of Attachment Anxiety and Avoidance
on Depression

Attention bias was next examined as a mediator from attachment insecurity to depressive
symptoms (see Appendix B). Attention bias toward negative or positive attachment cues was not
associated with attachment insecurity or depressive symptoms, and thus did not significantly
mediate this association. Attention bias was therefore removed from subsequent analyses.
Hypothesis 7
Hypothesis 7 examined whether attachment insecurity and subsequent interpretation
biases mediated the effect of CM and IPV on depressive symptoms. The model demonstrated
good fit (see Figure 13; RMSEA = .08, CFI = .94, SRMR = .05). Findings indicate that
attachment insecurity and negative interpretation biases fully mediated the effects of CM and
IPV on depressive symptoms. Further, IPV was positively associated negative interpretation
biases.

62

Figure 13
Attachment Insecurity and Negative Interpretation Bias Mediating the Effects of CM and IPV on
Depression

The model was run separately with negative interpretation bias toward self and other (see
Figure 14). Model fit was good (RMSEA = .07, CFI = .95, SRMR = .05). While attachment
insecurity was associated with negative interpretation bias toward self and other, only negative
interpretations of self were positively associated with depressive symptoms. Thus, attachment
insecurity and negative interpretations about self fully mediated the effects of CM and IPV on
depressive symptoms. Further, IPV was positively associated with negative interpretations about
others.

63

Figure 14
Attachment Insecurity and Negative Interpretation Bias of Self and Other Mediating the Effects
of CM and IPV on Depression

Next, the model was run with separate dimensions of attachment anxiety and avoidance.
Model fit was acceptable (see Figure 15; RMSEA = .10, CFI = .92, SRMR = .05). The results
demonstrated that attachment anxiety significantly predicted negative interpretations of self and
other as well as depressive symptoms. Attachment avoidance, on the other hand, did not
significantly predict negative interpretation bias or depression. Further, negative interpretations
of self predicted depressive symptoms, while negative interpretations of others did not.
Therefore, attachment anxiety and negative interpretation bias about self partially mediated the
effects of CM and IPV on depressive symptoms.

64

Figure 15
Attachment Anxiety and Avoidance and Negative Interpretation Bias of Self and Other Mediating
the Effects of CM and IPV on Depression

65

DISCUSSION
This study increases our understanding of mechanisms that lead to depressive symptoms
for women experiencing IPV. Results indicated that insecure attachment style fully mediated the
effects of CM and IPV on depressive symptoms. This relationship was largely driven by the
effects of attachment anxiety, and implicit negative beliefs about self partially accounted for the
relationship between attachment anxiety and depressive symptoms. Attentional bias to
attachment-related cues did not mediate this relationship. Findings suggest interpersonal violence
leads to negative alterations in women’s attachment styles, and that unconscious information
processing partially explains how attachment insecurity leads to the development of depressive
symptoms.
Attachment Style Mediates the Relationship between IPV and Depression
Insecure attachment style fully mediated the effects of CM and IPV on depressive
symptoms, confirming hypotheses that attachment insecurity is a significant pathway through
which women experiencing interpersonal trauma develop depression. Findings further highlight
that insecure attachment styles lead to depressive symptoms because they guide women to
process interpersonal information in maladaptive ways (Bifulco, Moran, Ball, & Lillie, 2002).
Subsequent analyses revealed that attachment anxiety, in particular, and resulting implicit
negative interpretations about the self mediated the relationship between IPV and depressive
symptoms. This finding suggests that a history of interpersonal trauma may lead a woman to fear
she will be abandoned, which reinforces her unconscious belief that she is worthless or deserving
of abuse. Other research has shown that women high in attachment anxiety exhibit implicit
negative beliefs about themselves even when thinking about times they felt loved or cared for
(Peterson, 2014), suggesting attachment relationships are persistently associated with perceptions

66

of their unworthiness. Research also demonstrates that anxiously attached women have difficulty
suppressing negative affect, memories, and thoughts (Mikulincer, Dolev, & Shaver, 2004;
Mikulincer & Orbach, 1995), making it likely they are frequently focusing on this material, in
effect, continuously reinforcing their negative self-perceptions. This unconscious belief about
self eventually results in the development of depressive symptoms. Women with more secure
attachment styles are less likely to interpret the IPV as an indication that they are a failure or
incapable of maintaining relationships, ultimately protecting them from developing depression.
Findings from the current research confirm that IWMs are an unconscious internalization
of attachment experiences (Bartholomew, 1990) leading women to interpret unconsciously their
experiences in a manner consistent with their IWMs (e.g., Dewitte & De Houwer, 2011; Maier et
al., 2004). Beliefs are often suppressed to an unconscious level as a defense mechanism to deal
with thoughts, memories, and emotions that seem too painful to acknowledge (Dentale,
Vecchione, De Coro, & Barbaranelli, 2012). Therefore, an individual’s implicit and explicit
beliefs about self and others do not always align (Dentale et al., 2012; Mikulincer, Shaver, BarOn, & Ein-Dor, 2010). While prior research has shown that explicit beliefs mediate the
relationship between attachment insecurity and depressive symptoms (Elwood & Williams,
2007; Marganska et al., 2013), this is the first study to demonstrate that unconscious attachmentrelated perceptions are associated with depressive symptoms. This suggests that negative beliefs
about self, even when they are out of a woman’s conscious awareness, can play a significant role
in the development of depressive symptoms (Gawronski et al., 2006). Implicit beliefs may be
especially important to examine as a risk factor for depression, as they probably represent the
beliefs that are most painful and that have been suppressed from conscious awareness. Defense

67

mechanisms that are used to keep these beliefs at an unconscious level are not effective at
protecting women from depression.
Dimensions of Attachment Associated with Depression
In the present research, CM and IPV were associated with both dimensions of attachment
insecurity; however, only attachment anxiety mediated the relationship between interpersonal
trauma and depression. While several studies have shown that both attachment anxiety and
avoidance are associated with depressive symptoms (e.g., Burnette et al., 2009; Monti &
Rudolph, 2014; Roelofs et al., 2010), attachment anxiety is a more robust predictor than
attachment avoidance (Bekker & Croon, 2010; Li et al., 2011). This may be a function of the
defense mechanisms that are common in avoidantly attached individuals.
Attachment avoidance is associated with an overreliance on the self, distancing from
intimate relationships, and downplaying attachment-related needs (Bartholomew, 1990; Dewitte
& De Houwer, 2008). However, this overreliance on self and denial of needs for support are
defense mechanisms to cope with unfulfilled intimacy needs and masks a vulnerable self-image
(Mikulincer et al., 2004; Strodl & Noller, 2003). In order to deactivate the attachment system,
individuals who are high in attachment avoidance ignore and suppress distressing thoughts and
memories (Fraley & Brumbaugh, 2007; Leyh, Heinisch, Kungl, & Spangler, 2016; Zheng,
Zhang, & Zheng, 2015). However, studies have demonstrated that this ability to suppress
distressing content is attenuated under high cognitive load (Chun, Shaver, Gillath, Mathews, &
Jorgensen, 2015; Edelstein & Gillath, 2008; Kohn, Rholes, & Schmeichel, 2012), suggesting the
suppression is effortful and ineffective when individuals become overwhelmed.
Further, Mikulincer and colleagues (2004) found that, for individuals high in attachment
avoidance, high cognitive load activated implicit (but not explicit) negative perceptions of the

68

self. They describe this as the “hidden vulnerabilities” of attachment avoidance, in which
suppressing negative material increases vulnerability to emotional stimuli when environmental
demands take up cognitive resources, as the individual has fewer resources dedicated to
suppressing painful thoughts (Mikulincer et al., 2004). High levels of stress may therefore
overwhelm the defense mechanisms of avoidantly attached individuals, removing the armor used
to protect against negative beliefs about self, putting them at risk for depressive symptoms
during these periods. However, when stress levels are normal or low, emotional suppression
likely protects against symptoms of depression. This could explain the mixed findings in the
literature on the association between attachment avoidance and depressive symptoms, as this
relationship may depend on the stress level or cognitive load placed on participants at the time of
data collection.
IPV may be one such stressor that can overwhelm the defense mechanisms of avoidantly
attached individuals. However, avoidant attachment likely only results in depression in the midst
of ongoing stressors or cognitive load (e.g., Chun et al., 2015; Kohn et al., 2012). Therefore,
individuals high in attachment avoidance may display depressive symptoms during current IPV
or following recent incidents of IPV. Women who previously experienced IPV in their current
relationship, but have not experienced abuse in some time, may have had sufficient time for their
defense mechanisms (i.e., emotional suppression) to be reestablished. Unfortunately, the present
study did not assess whether IPV experienced in the current relationship was recent or further in
the past, though this hypothesis is important to examine in future research.

69

Interpretation Biases Associated with Depression
Implicit beliefs about others did not significantly mediate the relationship between
attachment insecurity and depressive symptoms once covariates were added to the model. This
suggests that a woman’s view of herself in relation to others is more significant than her
perceptions of others in the development of depressive symptoms. For anxiously attached
individuals, even memories of positive attachment experiences activate negative unconscious
perceptions of self (Peterson, 2014). This indicates a hyper-focus on negative views of self,
regardless of the other person’s behavior, which is likely to put women at risk for depressive
symptoms.
While interpretations of others are not associated with depression, they may be important
for other mental health outcomes, such as anxiety or PTSD. Indeed, in the current study, negative
implicit interpretations of others were significantly related to the latent variable including PTSD
and anxiety. Anxiety and trauma-related disorders are related to mistrust for others and a sense of
danger in one’s environment (Ali, Dunmore, Clark, & Ehlers, 2002; Christensen, Stein, &
Means-Christensen, 2003; Dunmore, Clark, & Ehlers, 2001; Mohlman, Carmin, & Price, 2007),
especially for female survivors of interpersonal trauma (Cox, Resnick, & Kilpatrick, 2014).
Findings from the current study indicate these negative beliefs about others may be implicit, and
the relationship between these explicit and implicit beliefs should be examined further in future
research.
Relationship between Attachment Dimensions and Interpretation Biases
The types of implicit interpretation bias demonstrated in the current study differed for
attachment anxiety and avoidance. Attachment anxiety was associated with negative implicit
perceptions of both self and other. For anxiously attached women, they are likely to have

70

negative expectations of others (e.g., assume they will be abandoned) due to their negative
perceptions of self – that they are unworthy of love and affection. These women have difficulty
trusting that others will not leave them due to beliefs of their own worthiness, not beliefs about
the esteem of others (Rodriguez, DiBello, Overup, & Neighbors, 2015). Attachment avoidance,
on the other hand, was only associated with negative implicit beliefs about others. This is
consistent with the idea that individuals who are high in attachment avoidance devalue and
distance themselves from intimate relationships in order to protect themselves from possible
rejection (Bartholomew, 1990). Attachment avoidance was not, however, associated with
unconscious perceptions of self. While at a conscious level, we might expect attachment
avoidance to be associated with positive perceptions of self, defense mechanisms may work to
suppress unconscious negative views about self.
Only one prior study has found negative implicit beliefs about self emerge in individuals
who are high in attachment avoidance under conditions of high cognitive load (Mikulincer et al.,
2004). The cognitive load procedure used by Mikulincer and colleagues placed greater cognitive
demands on participants than the procedure used in the current study. They tasked participants to
remember a 7-digit number and rehearse it aloud during 192 trials of the implicit interpretation
task. In the current study, participants were asked to remember a 6-digit number and to recall the
number after 20 trials of the implicit interpretation task. This suggests that greater cognitive load
may be required in order to elicit unconscious negative beliefs about self in individuals who are
high in attachment avoidance. However, the cognitive load procedure used in the current study
was effective in eliciting other unconscious biases in the expected directions.

71

Other Pathways Linking Attachment Insecurity and Depression
Implicit negative interpretations only partially mediated the relationship between
attachment insecurity and depression symptoms. This suggests that, in addition to implicit
negative interpretations, there are likely other pathways that explain the association between
insecure attachment styles and depressive symptoms. Explicit negative cognitions about self and
other have previously been shown to mediate this relationship (Elwood & Williams, 2007;
Marganska et al., 2013). Poor affect regulation is another potential mechanism. Individuals with
insecure attachment styles either rely too heavily on others (attachment anxiety) or themselves
(attachment avoidance) in order to cope with stressors (Sloman et al., 2003). Research
demonstrates that ineffective coping strategies (Burnette et al., 2009; Wei et al., 2006) mediate
the association between attachment insecurity and depressive symptoms.
Interpersonal behaviors that result from attachment insecurity may also play a role.
Attachment anxiety involves a persistent fear of losing attachment security or an attachment
figure (Bowlby, 1988). A result of this anxiety includes seeking proximity to the attachment
figure and engaging in excessive reassurance-seeking in order to ensure security (Evraire,
Ludmer, & Dozois, 2014; West et al., 1999). Research on the interpersonal theory of depression
(Coyne, 1976) highlights how excessive reassurance seeking often elicits rejection, alienating
others and reducing social support, reinforcing negative perceptions of self and others, and
ultimately maintaining depressive symptoms (Birgenheir, Pepper, & Johns, 2010; Starr &
Davila, 2008; Stewart & Harkness, 2015). Thus, interpersonal behaviors associated with IWMs
may be an additional pathway to depression. Conversely, securely attached women are more
likely to engage their support network in adaptive ways, increasing the social support they

72

receive, and protecting them against depression (Shurman & Rodriguez, 2006; Mburia-Mwalili,
Clements-Nolle, Lee, Shadley, & Yang, 2010).
Effects of Trauma on Information Processing
Findings also highlight the importance of an individual’s relational context in shaping
implicit beliefs, as IPV had a direct effect on negative interpretation bias. Specifically, IPV was
positively associated with an unconscious negative bias regarding others. Women who are
currently in an abusive relationship may implicitly believe that they cannot trust others, as their
trust was betrayed by an attachment figure perpetrating abuse against them. IPV may also lead to
beliefs that others are not safe and that relationships will eventually lead to hurt, whether
emotional and/or physical. These women may develop fear of becoming close to others,
particularly in romantic relationships. Lastly, women experiencing IPV may fear what their
partner may try to do if they were to leave the relationship, as violence often escalates at this
time (Campbell et al., 2003; Elisha, Idisis, Timor, & Addad, 2010; McFarlane, Campbell, &
Watson, 2002).
In addition, CM influenced implicit interpretations via insecure attachment style. This
suggests that CM influences the interpretations a woman makes through her IWMs or mental
representations of relationships. A history of CM significantly shapes an individual’s IWMs, the
schemas they use to navigate and make sense of the world (Cannon et al., 2010; Riggs, 2010).
When a woman is making interpretations in her current abusive relationship, she is guided by
internal models of how she perceives self and others that were originally shaped by her abuse
during childhood. These mental representations are a product of interpersonal trauma
experienced during both childhood and adulthood.

73

The current study also demonstrates how attachment style and depressive symptoms are
significantly influenced by trauma experienced in both childhood and adulthood. While
experiencing CM sets a foundation for negative IWMs, IPV is likely to maintain this attachment
insecurity in adulthood. Positive and negative relational experiences across the lifespan shape an
individual’s attachment style, for better or for worse (Scharfe & Cole, 2006). Therefore, women
who developed insecure attachment styles from CM may develop more secure attachment styles
over time if they have significant positive relationships. However, women with a history of CM
who then experience IPV in adulthood are likely to maintain attachment insecurity and remain at
risk for the development of depression.
Attention Bias as a Mediator from Attachment Style to Depression
While interpretation bias emerged as a significant mediator between attachment
insecurity and depression, attention bias did not. A few small associations with attention bias did
emerge. First, attachment avoidance was associated with an attention bias away from negative
attachment-related cues, a finding that is consistent with prior research (Edelstein & Gillath,
2008). Individuals high in avoidance tend to overvalue themselves and devalue the importance of
relationships in order to protect themselves from potential harm (Hazan & Shaver, 1987). This
finding indicates that this may occur by individuals avoiding cues of potential hurt, rejection, or
abandonment. Second, attention bias toward positive attachment-related cues was associated
with implicit negative interpretations of the self. Attention toward positive attachment cues may
be related to hypervigilance to the presence of attachment figures and/or excessive reassurance
seeking. This behavior may reflect unconscious insecurities and negative beliefs about whether
one is worthy and loveable. It is also consistent with a study that found thinking about feeling
loved or cared about elicited unconscious negative self-perceptions (Peterson, 2014). While these

74

findings may shed light on the mechanisms of insecure attachment styles, these interpretations
should be considered tentative at this point, given the small size of these relationships.
Attention bias did not significantly mediate the relationship between attachment
insecurity and depressive symptoms. This suggests that it is largely negative implicit
interpretation biases that guide the information processing of internal working models and result
in depression. It is possible that attachment insecurity does not guide where individuals allocate
their attention in interpersonal situations. Instead, IWMs may guide a woman to interpret most
situations in a similar manner, regardless of the situation or what cues are in the environment.
These negative interpretations then result in depression, as they reinforce perceptions that the
woman is not good enough for love and/or that others are not reliable or trustworthy. While it is
possible that attachment-related attention bias is not a significant mechanism in the development
of depressive symptoms, several studies unrelated to attachment have demonstrated a
relationship between negative attentional bias and depression (e.g., Dai & Feng, 2011;
Ellenbogen & Schwartzman, 2009; Fritzsche et al., 2010; Joormann & Gotlib, 2007; Sears et al.,
2011). Therefore, this null finding may be related to the attention bias methodology used in the
current study.
For example, other aspects of attentional processing, which were not assessed in the
current study, may be important for the development of depression. Specifically, some research
indicates that depression may not be related to the initial allocation of attention (examined in the
present study), but rather is associated with difficulty disengaging attention from negative cues in
the environment (De Raedt & Koster, 2010; Mogg & Bradley, 2005; Wisco, 2009). This can lead
to rumination and excessive elaboration on negative content, resulting in negative interpretation
biases and ultimately maintaining symptoms of depression (Blaut, Paulewicz, Szastok,

75

Prochwicz, & Koster, 2013; Koster, De Lissnyder, & De Raedt, 2013; Smith & Alloy, 2009;
Wisco, 2014).
Issues with the attention bias task used in the current study may also explain the findings.
Reliability of the dot-probe task was poor in the current study. In recent years, the reliability of
the dot-probe task in studies of anxiety disorders has been questioned. Most studies using the
dot-probe task do not report on task reliability (Rodebaugh et al., 2016), and those that do show
poor reliability, including internal consistency, test-retest reliability, and split-half reliability
(e.g., Kappenman, Farrens, Luck, & Hajcak, 2014; Price et al., 2015; Waechter & Stolz, 2015).
The majority of papers addressing reliability of the dot-probe task have focused on anxiety
disorders and threat-related attention biases. Therefore, even less is known about the reliability
of attention bias measures as they relate to depression and attachment style. However, one study
examining attentional bias in depression using the dot-probe task reported poor split-half
reliability (Zvielli, Vrijsen, Koster, & Bernstein, 2016).'
Given concern over the reliability of the dot-probe task, several calls have been made to
improve methodology in the study of attention bias (e.g., Kappenman et al., 2014; Rodebaugh et
al., 2016; Waechter & Stolz, 2015). Specifically, researchers have turned to other attention bias
paradigms, such as tracking eye movements, in order to obtain more accurate measurements
(e.g., Amir, Zvielli, & Bernstein, 2016; Duque & Vazquez, 2015; Newman & Sears, 2015). This
method has shown improved reliability compared to the dot-probe task, though reliability
estimates are still not ideal (Rodebaugh et al., 2016). Others have called for the development of
new attention bias paradigms, as well as changes in how scores from current paradigms are
calculated (Waechter & Stolz, 2015).

76

Regardless of the attention bias task used, the most common score of attention bias is an
average of attention bias across the duration of the task (Rodebaugh et al., 2016). This score
assumes that attention bias is fixed, stable, or trait-like. However, data suggest that attentional
bias may be a dynamic process that changes during the course of the task and occurs in phases or
bursts (Zvielli, Bernstein, & Koster, 2015). Newly proposed methods that account for attention
bias as a dynamic process and include multiple indices (e.g., average reaction time, peak reaction
time, overall variability in reaction time) show greater reliability and more consistent
associations with psychopathology compared with aggregate scores of attentional biases (Amir et
al., 2016; Zvielli et al., 2015; Zvielli et al., 2016). Continued research is critical to understand the
best measures and scoring of attentional bias in order to continue developing our understanding
of how this process functions as a mechanism for depression and other forms of
psychopathology.
Limitations
While this study examined the influence of interpersonal trauma from both childhood and
adulthood, cross-sectional data was used. Given this, the directionality among variables cannot
be known with certainty. For example, attachment insecurity and/or depressive symptoms
resulting from CM may also make it more likely for women to enter a relationship in which IPV
occurs (Godbout, Dutton, Lussier, & Sabourin, 2009). More prospective studies are needed to
better understand the relationship between interpersonal violence, attachment style, and
psychopathology across the lifespan.
Participants in the current sample had relatively low levels of depression. As previously
reported, only 28% of women reported depressive symptoms in the clinically significant range. It
is therefore unclear whether findings from the present study would generalize to clinical samples

77

with more severely depressed women. It is expected that the depressive mechanisms observed in
this study would apply to women with severe levels of depression, but it is important for future
research to examine this hypothesis.
Directions for Future Research
Despite this limitation, this study provides important implications for future research.
This is the first study to demonstrate that unconscious beliefs about self partially explain why
attachment insecurity results in depressive symptoms for women who have experienced
interpersonal trauma. While explicit interpretations are easier to assess given they are in an
individual’s conscious awareness, current findings highlight the importance of assessing implicit
interpretations in understanding risk for depression. Unconscious beliefs may be especially
important to examine as they are so difficult to acknowledge that they have been suppressed
from conscious awareness. Given the important role of implicit biases, research should continue
to examine the role that implicit beliefs play in the maintenance of mental health symptoms for
women experiencing IPV. Unconscious beliefs about self and others may also play in a role in
women’s selection of romantic partners. Future research should examine whether these
underlying attachment-related beliefs influence a woman’s risk for experiencing IPV.
Negative implicit beliefs about self only partially mediated the relationship between
attachment anxiety and depression, suggesting other mechanisms may also be operating. As
previously discussed, emotion regulation, excessive reassurance seeking, and explicit negative
beliefs are additional pathways that may explain this relationship. To date, these pathways have
only been examined separately (e.g., Evriare et al., 2014; Marganska et al., 2013; Sloman et al.,
2003). Future research should examine multiple pathways simultaneously to develop a more
comprehensive understanding of how coping strategies, implicit and explicit cognitions, and

78

behavior relate to one another. For example, negative unconscious beliefs about self may result
in excessive reassurance seeking behaviors, which may reinforce negative perceptions of self and
others.
Attachment insecurity and implicit negative interpretations remained significant
predictors of depression when controlling for symptoms of anxiety and PTSD. However, these
mechanisms were also significantly associated with anxiety and PTSD, suggesting these
pathways may not be entirely unique to depression, though the association with depression was
stronger than with anxiety and PTSD. This is consistent with prior research that shows anxiety
and PTSD symptoms are associated with insecure attachment styles and negative self-cognitions
(Arikan, Stopa, Carnelley, & Karl, 2016; Beckers, Roepke, Michael, Renneberg, & Knaevelsrud,
2016; Jinyao et al., 2012; Lindgren, Kaysen, Werntz, Gasser, & Teachman, 2013; Marganska et
al., 2013; Ogle, Rubin, & Siegler, 2016; Sasaki, Iwanaga, Kanai, & Seiwa, 2010; Woodhouse,
Ayers, & Field, 2015). There is significant comorbidity between symptoms of depression,
anxiety, and PTSD, including in survivors of interpersonal violence (Nixon et al., 2004;
O’Campo, Woods, Jones, Dienemann, & Campbell, 2006; Pigeon, Cerulli, Richards, Perlis, &
Caine, 2011). It would be beneficial for future studies to examine how dimensions of attachment
and interpretation biases relate to patterns of comorbid symptoms in trauma survivors.
Findings highlight the effects of both childhood and adult interpersonal trauma on adult
depressive symptoms. It may therefore be erroneous to assume that mental health problems
observed in adults who have recently experienced IPV are solely due to recent events. Instead, it
is important to measure both childhood and adulthood traumatic events in order to understand the
unique contributions of both. As not all individuals respond similarly to the same types of

79

traumatic events, it is important for researchers to consider individual traits or prior experiences
that may influence a psychological reaction to present-day trauma.
Clinical Implications
This study also highlights important areas for clinical intervention in women who have
experienced interpersonal violence. For example, it is critical for therapists to address
unconscious attachment representations or interpersonal schemas resulting from trauma in both
childhood and adulthood. Common beliefs in women who experienced interpersonal trauma may
include seeing the self as worthless or not good enough, prioritizing the needs of others, lack of
perceived agency or control, or viewing others as inherently harmful or abusive (Atmaca &
Gencoz, 2016; Taskale & Soygut, 2017; Valdez & Lilly, 2015; Valdez et al., 2013). Women with
negative unconscious beliefs may present in treatment as not understanding why they are
depressed, as they may be unaware or in denial of these negative implicit views. One goal of
treatment may be for the patient to gain awareness of these implicit beliefs, as well as how her
trauma history contributed to these perceptions.
Negative implicit beliefs may be addressed using psychodynamic or cognitive-behavioral
interventions, treatments that both address implicit beliefs using disparate techniques. For
example, insight-oriented strategies can help women bring these unconscious beliefs into
conscious awareness and develop insight into how these beliefs developed and how they may be
perpetuating their depressive symptoms (Busch, 2017; Levenson, 2008). From a cognitivebehavioral perspective, cognitive restructuring can be used to modify negative automatic
thoughts. It would then be beneficial to identify negative core beliefs (often implicit beliefs)
about self that may be underlying such automatic thoughts and contributing to the maintenance
of depressive symptoms (Beck, 2011; Greenberger & Padesky, 1995).

80

This study also demonstrates potential for integrating insight-oriented and cognitivebehavioral perspectives. There are similarities between these theoretical perspectives, as internal
working models and cognitive schemas are conceptualized in similar ways. This common
overlap in conceptualization allows one to “translate” ideas from both theoretical orientations.
Further, clinicians can draw from the unique aspects of relational and cognitive-behavioral
treatments in order to develop a more comprehensive approach to working with trauma
survivors. Specifically, therapists working from a relational perspective could integrate a
conceptualization of IWMs as guiding how a woman processes interpersonal information. This
could include helping a patient gain insight regarding information they may be more likely to
attend to in their environments and how this may affect the way they unconsciously interpret the
situation. For example, a woman experiencing IPV may focus on signs of neglect or rejection in
her relationship and unconsciously interpret these cues to mean she is worthless or deserving of
the abuse. This information processing would then confirm her already negative IWMs and
contribute to symptoms of depression.
Therapists working from a cognitive-behavioral perspective can include greater use of the
therapeutic relationship as an intervention, as this is an important tool for helping individuals
develop more secure attachment styles over time. A patient’s attachment representations are
often projected onto and reenacted within the therapeutic dyad, making them accessible to
address in the here and now (Blizard & Bluhm, 1994). For women with histories of interpersonal
trauma, this may include expectations that the therapist will eventually harm or abandon them or
beliefs that the needs of the therapist are more important than the needs of the patient. From a
cognitive-behavioral perspective, interpersonal patterns arising in the therapeutic relationship can
be used to identify automatic thoughts and underlying core beliefs (e.g., I am not good enough).

81

From a psychodynamic perspective, the empathy and acceptance that is experienced in the
therapeutic relationship may facilitate the individual establishing a secure base with the therapist
(Mikulincer, Shaver, & Berant, 2013; Pallini et al., 2017). This positive relationship allows the
patient to internalize positive representations of self and others that can eventually counter
negative working models that developed from prior trauma (Bettmann, 2006; Levendosky et al.,
2012). For example, a woman who experienced CM or IPV may learn that becoming close to
others can be safe or that her own needs are important. In other words, the therapeutic
relationship can serve as a corrective relational experience which can ultimately reduce
depressive symptoms.
Another use of the therapeutic relationship as an intervention tool for insecure attachment
is for the therapist to adjust his or her interpersonal “distance” throughout treatment (Daly &
Mallinckrodt, 2009). It can be beneficial to initially meet a patient where they are regarding
relational distance (e.g., close for anxious attachment, more distant for avoidant attachment) in
order to increase patient comfort and increase the likelihood they will engage in treatment. Over
the course of treatment, the therapist can begin to adjust their distance in order to allow for the
client to create change (Thomas, Hopwood, Woody, Ethier, & Sadler, 2014). With a patient high
in attachment anxiety, the therapist may distance to encourage greater autonomy and control for
the patient. This distance allows the patient to process feelings of frustration related to
abandonment and develop greater comfort with independence. With a patient high in attachment
avoidance, the therapist can move “closer” to the patient in order to help her develop greater
comfort with closeness and emotional intimacy.

82

Conclusions
In summary, the current study is the first to identify unconscious attachment
representations as a mechanism by which women experiencing IPV develop depressive
symptoms. This indicates that self-perceptions can affect mental health for trauma survivors even
when these beliefs are outside of an individual’s conscious awareness or are not easily observed
by others. A history of trauma in childhood also contributed to greater attachment insecurity and
subsequent interpretation bias and depressive symptoms, highlighting the potency of CM on
mental health in adulthood. This finding demonstrates how information processing is guided by
beliefs that initially developed during childhood and have been shaped over time. These implicit
attachment representations, a product of experiences across the lifespan, can contribute to or
maintain symptoms of depression. Future research should continue to examine pathways by
which interpersonal violence results in mental health problems in order to improve intervention
and prevention efforts.

83

APPENDICES

84

Appendix A
Copy of Study Measures
Severity of Violence against Women Scale
You and your current (or previous) partner have probably experienced anger or conflict. Below
is a list of behaviors he may have done. Describe how often he has done each behavior to you
(not including horseplay or joking around) by choosing a number from the following scale.
0 = never, 1 = once, 2 = a few times, 3 = many times
1. Hit or kicked a wall, door, or furniture
2. Threw, smashed, or broke an object
3. Driven dangerously with you in the car
4. Threw an object at you
5. Shook a finger at you
6. Made threatening gestures or faces at you
7. Shook a fist at you
8. Acted like a bully toward you
9. Destroyed something belonging to you
10. Threatened to harm or damage things you care about
11. Threatened to destroy property
12. Threatened someone you care about
13. Threatened to hurt you
14. Threatened to kill himself
15. Threatened you with a club-like object
16. Threatened you with a knife or gun
17. Threatened to kill you
18. Threatened you with a weapon
19. Acted like he wanted to kill you
20. Held you down, pinning you in place
21. Pushed or shoved you
22. Shook or roughly handled you
23. Grabbed you suddenly or forcefully
24. Scratched you
25. Pulled your hair
26. Twisted your arm
27. Spanked you
28. Bit you
29. Slapped you with the palm of his hand
30. Slapped you with the back of his hand
31. Slapped you around your face and head
32. Kicked you
33. Hit you with an object
34. Stomped on you
35. Choked you
36. Punched you
85

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

37. Burned you with something
38. Used a club-like object on you
39. Beat you up
40. Used a knife or gun on you
41. Demanded sex whether you wanted to or not
42. Made you have oral sex against your will
43. Made you have sexual intercourse against your will
44. Physically forced you to have sex
45. Made you have anal sex against your will
46. Used an object on you in a sexual way

86

0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3

Psychological Maltreatment of Women Inventory
This questionnaire asks about actions you may have experienced in your current (or previous)
relationship with your partner. Answer each item as carefully as you can by circling a number
beside each one as follows:
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Very Frequently

1
2
3
4
5
6
7
8
9
10
11
12
13
14

My partner called me names.
My partner swore at me.
My partner yelled and screamed at me.
My partner treated me like an inferior.
My partner told me my feelings were irrational or
crazy.
My partner blamed me for his problems.
My partner tried to make me feel crazy.
My partner monitored my time and made me account
for my whereabouts.
My partner used our money or made important
financial decisions without talking to me about it.
My partner was jealous or suspicious of my friends.
My partner accused me of having an affair.
My partner interfered in my relationships with other
family members.
My partner tried to keep me from doing things to
help myself.
My partner restricted my use of the telephone.

87

0
0
0
0

1
1
1
1

2
2
2
2

3
3
3
3

4
4
4
4

0

1

2

3

4

0
0

1
1

2
2

3
3

4
4

0

1

2

3

4

0

1

2

3

4

0
0

1
1

2
2

3
3

4
4

0

1

2

3

4

0

1

2

3

4

0

1

2

3

4

Experiences in Close Relationships Questionnaire
The statements below concern how you feel in your current dating relationship. Respond to each
statement by selecting a number to indicate how much you agree or disagree with the statement.
1
Strongly
Disagree

2

3

4

5

88

6

7
Strongly
Agree

_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____

1. I'm afraid that I will lose my partner's love.
2. I often worry that my partner will not want to stay with me.
3. I often worry that my partner doesn't really love me.
4. I worry that romantic partners won’t care about me as much as I care about
them.
5. I often wish that my partner's feelings for me were as strong as my feelings for
him or her.
6. I worry a lot about my relationships.
7. When my partner is out of sight, I worry that he or she might become interested
in someone else.
8. When I show my feelings for romantic partners, I'm afraid they will not feel the
same about me.
9. I rarely worry about my partner leaving me.
10. My romantic partner makes me doubt myself.
11. I do not often worry about being abandoned.
12. I find that my partner(s) don't want to get as close as I would like.
13. Sometimes romantic partners change their feelings about me for no apparent
reason.
14. My desire to be very close sometimes scares people away.
15. I'm afraid that once a romantic partner gets to know me, he or she won't like
who I really am.
16. It makes me mad that I don't get the affection and support I need from my
partner.
17. I worry that I won't measure up to other people.
18. My partner only seems to notice me when I’m angry.
19. I prefer not to show a partner how I feel deep down.
20. I feel comfortable sharing my private thoughts and feelings with my partner.
21. I find it difficult to allow myself to depend on romantic partners.
22. I am very comfortable being close to romantic partners.
23. I don't feel comfortable opening up to romantic partners.
24. I prefer not to be too close to romantic partners.
25. I get uncomfortable when a romantic partner wants to be very close.
26. I find it relatively easy to get close to my partner.
27. It's not difficult for me to get close to my partner.
28. I usually discuss my problems and concerns with my partner.
29. It helps to turn to my romantic partner in times of need.
30. I tell my partner just about everything.
31. I talk things over with my partner.
32. I am nervous when partners get too close to me.
33. I feel comfortable depending on romantic partners.
34. I find it easy to depend on romantic partners.
35. It's easy for me to be affectionate with my partner.
36. My partner really understands me and my needs.

89

Center for Epidemiologic Studies Depression Scale
Below is a list of some of the ways you may have felt or behaved. Please indicate how often you
have felt this way during the past week:

0 = Rarely or none of the time (less than 1 day)
1 = Some or a little of the time (1-2 days)
2 = Occasionally or a moderate amount of time (3-4 days)
3 = All of the time (5-7 days)

_____ 1. I was bothered by things that usually don’t bother me.
_____ 2. I did not feel like eating; my appetite was poor.
_____ 3. I felt that I could not shake off the blues even with help from my family.
_____ 4. I felt that I was just as good as other people.
_____ 5. I had trouble keeping my mind on what I was doing.
_____ 6. I felt depressed.
_____ 7. I felt that everything I did was an effort.
_____ 8. I felt hopeful about the future.
_____ 9. I thought my life had been a failure.
_____ 10. I felt fearful.
_____ 11. My sleep was restless.
_____ 12. I was happy.
_____ 13. I talked less than usual.
_____ 14. I felt lonely.
_____ 15. People were unfriendly.
_____ 16. I enjoyed life.
_____ 17. I had crying spells.
_____ 18. I felt sad.
_____ 19. I felt that people disliked me.
_____ 20. I could not “get going.”
90

Childhood Trauma Questionnaire
These questions ask about some of your experiences growing up as a child and a teenager.
Although these questions are of a personal nature, please try to answer as honestly as you can.
For each question, select the response that best describes how you feel.
0 = Never True, 1 = Rarely True, 2 = Sometimes True, 3 = Often True, 4 = Very Often True
WHEN I WAS GROWING UP…
1. I didn’t have enough to eat.
2. I knew that there was someone to take care of
me and protect me.
3. People in my family called me things like
“stupid,” “lazy,” or “ugly.”
4. My parent(s) were too drunk or high to take
care of the family.
5. There was someone in my family who helped
me feel that I was important or special.
6. I had to wear dirty clothes.
7. I felt loved.
8. I thought that my parent(s) wished I had never
been born.
9. I got hit so hard by someone in my family that I
had to see a doctor or go to the hospital.
10. There was nothing I wanted to change about
my family.
11. People in my family hit me so hard that it left
me with bruises or marks.
12. I was punished with a belt, a board, a cord,
or some other hard object.
13. People in my family looked out for each other.
14. People in my family said hurtful or insulting
things to me.
15. I believe that I was physically abused.
16. I had the perfect childhood.
17. I got hit or beaten so badly that it was noticed by
someone like a teacher, neighbor, or doctor.
18. I felt that someone in my family hated me.
19. People in my family felt close to each other.
20. Someone tried to touch me in a sexual way, or
tried to make me touch them.
21. Someone threatened to hurt me or tell lies about
me unless I did something sexual with them.
22. I had the best family in the world.
23. Someone tried to make me do sexual things
or watch sexual things.
24. Someone molested me.
91

0
0

1
1

2
2

3
3

4
4

0

1

2

3

4

0

1

2

3

4

0

1

2

3

4

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

0

1

2

3

4

0

1

2

3

4

0

1

2

3

4

0

1

2

3

4

0
0

1
1

2
2

3
3

4
4

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

0

1

2

3

4

0
0

1
1

2
2

3
3

4
4

0

1

2

3

4

25. I believe that I was emotionally abused.
26. There was someone to take me to the doctor if I
needed it.
27. I believe that I was sexually abused.
28. My family was a source of strength and support.

92

0
0

1
1

2
2

3
3

4
4

0
0

1
1

2
2

3
3

4
4

PTSD Checklist for DSM-5
Instructions: Below is a list of problems that people sometimes have in response to very stressful
experiences. Please read each problem carefully and then select one of the numbers to indicate
how much you have been bothered by that problem in the past month.
0 = Not at all, 1 = A little bit, 2 = Moderately, 3 = Quite a bit, 4 = Extremely
In the past month, how much were you bothered by:
_____ 1. Repeated, disturbing, and unwanted memories of the stressful experience(s)?
_____ 2. Repeated, disturbing dreams of the stressful experience(s)?
_____ 3. Suddenly feeling or acting as if the stressful experience(s) were actually happening
again (as if you were actually back there reliving it)?
_____ 4. Feeling very upset when something reminded you of the stressful experience(s)?
_____ 5. Having strong physical reactions when something reminded you of the stressful
experience(s) (for example, heart pounding, trouble breathing, sweating)?
_____ 6. Avoiding memories, thoughts, or feelings related to the stressful experience(s)?
_____ 7. Avoiding external reminders of the stressful experience(s) (for example, people,
places, conversations, activities, objects, or situations)?
_____ 8. Trouble remembering important parts of the stressful experience(s)?
_____ 9. Having strong negative beliefs about yourself, other people, or the world (for example,
having thoughts such as: I am bad, there is something seriously wrong with me, no one
can be trusted, the world is completely dangerous)?
_____ 10. Blaming yourself or someone else for the stressful experience(s) or what happened
after it?
_____ 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
_____ 12. Loss of interest in activities that you used to enjoy?
_____ 13. Feeling distant or cut off from other people?
_____ 14. Trouble experiencing positive feelings (for example, being unable to feel happiness
or have loving feelings for people close to you)?
_____ 15. Irritable behavior, angry outbursts, or acting aggressively?
_____ 16. Taking too many risks or doing things that could cause you harm?
_____ 17. Being “super alert” or watchful or on guard?
_____ 18. Feeling jumpy or easily startled?
_____ 19. Having difficulty concentrating?
_____ 20. Trouble falling or staying asleep?

93

Patient-Reported Outcomes Measurement Information System Adult Anxiety Short Form
The questions below ask about how often you have been bothered by a list of symptoms during
the past 7 days. Please respond to each item using the following scale:
1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always
In the past SEVEN DAYS…
1. I felt fearful.
2. I felt anxious.
3. I felt worried.
4. I found it hard to focus on anything other than my anxiety.
5. I felt nervous.
6. I felt uneasy.
7. I felt tense.

94

Revised Dyadic Adjustment Scale
Most persons have disagreements in their relationships. Please indicate below the approximate
extent of agreement or disagreement between you and your partner for each item below.

0 = Always disagree
1 = Almost always disagree
_____
_____
_____
_____
_____
_____

2 = Frequently disagree
3 = Occasionally agree

4 = Almost always agree
5 = Always agree

1. Religious matters
2. Demonstrations of affection
3. Making major decisions
4. Sex relations
5. Conventionality (correct or proper behavior)
6. Career decisions

0 = All the time
1 = Most of the time

2 = More often than not
3 = Occasionally

4 = Rarely
5 = Never

_____ 7. How often do you discuss or have you considered separation or terminating your
relationship?
_____ 8. How often do you and your partner quarrel or argue?
_____ 9. Do you ever regret dating your partner?
_____ 10. How often do you and your partner “get on each other’s nerves”?
0 = Never
1 = Rarely

2 = Occasionally
3 = Almost every day

4 = Every day

_____ 11. Do you and your partner engage in outside interests together?

0 = Never
1 = Less than once a month

2 = Once or twice a month
3 = Once or twice a week

_____ 12. Have a stimulating exchange of ideas
_____ 13. Work together on a project
_____ 14. Calmly discuss something

95

4 = Once a day
5 = More often

Appendix B
Additional Statistical Models
Figure 16
Effects of IPV and Interpersonal Trauma History on Depression

Note. RMSEA = .14, CFI = .92, SRMR = .06

96

Figure 17
Effects of CM and IPV on Depression with Covariates

Note. RMSEA = .08, CFI = .94, SRMR = .06

97

Figure 18
Attachment Insecurity Mediating Effects of CM and IPV on Depression with Covariates

Note. RMSEA = .07, CFI = .94, SRMR = .05

98

Figure 19
Attachment Anxiety and Avoidance Mediating Effects of CM and IPV on Depression with
Covariates

Note. RMSEA = .08, CFI = .94, SRMR = .05

Figure 20
Attentional Biases

Note. RMSEA = .00, CFI = .47, SRMR = .00

99

Figure 21
Effects of Attachment Insecurity on Attentional Biases

Note. RMSEA = .03, CFI = .99, SRMR = .02

Figure 22
Effects of Attachment Anxiety and Avoidance on Attentional Biases with Covariates

Note. RMSEA = .00, CFI = 1.00, SRMR = .02

100

Figure 23
Effects of Attachment Insecurity on Interpretation Biases

Note. RMSEA = .00, CFI = 1.00, SRMR = .01

Figure 24
Effects of Attachment Insecurity on Interpretation Biases with Covariates

Note. RMSEA = .00, CFI = 1.00, SRMR = .01

101

Figure 25
Effects of Attachment Insecurity on Interpretation Biases of Self and Other with Covariates

Note. RMSEA = .04, CFI = .99, SRMR = .03
Figure 26
Effects of Attachment Anxiety and Avoidance on Interpretation Biases of Self and Other with
Covariates

Note. RMSEA = .09, CFI = .97, SRMR = .05

102

Figure 27
Effects of Attention Biases on Interpretation Biases of Self and Other with Covariates

Note. RMSEA = .00, CFI = 1.00, SRMR = .00

Figure 28
Negative Interpretation Bias Mediating the Effect of Attachment Insecurity on Depression with
Covariates

Note. RMSEA = .06, CFI = .99, SRMR = .03

103

Figure 29
Interpretation Bias of Self and Other Mediating the Effect of Attachment Insecurity on
Depression with Covariates

Note. RMSEA = .04, CFI = 1.00, SRMR = .03

104

Figure 30
Interpretation Bias of Self and Other Mediating the Effects of Attachment Anxiety and Avoidance
on Depression with Covariates

Note. RMSEA = .08, CFI = .98, SRMR = .05

Figure 31
Attention Bias Mediating the Effect of Attachment Insecurity on Depression

Note. RMSEA = .00, CFI = 1.00, SRMR = .01

105

Figure 32
Attachment Insecurity and Negative Interpretation Bias Mediating the Effects of CM and IPV on
Depression with Covariates

Note. RMSEA = .07, CFI = .94, SRMR = .05

106

Figure 33
Attachment Insecurity and Negative Interpretation Bias of Self Mediating the Effects of CM and
IPV on Depression with Covariates

Note. RMSEA = .07, CFI = .94, SRMR = .05

107

Figure 34
Attachment Anxiety and Negative Interpretation Bias of Self Mediating the Effects of CM and
IPV on Depression with Covariates

Note. RMSEA = .08, CFI = .94, SRMR = .06

108

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