An exploration of alcohol use, attachment, and recovery in psychosis

  • Maebh O'Connor

Student thesis: Doctoral ThesisDoctor of Philosophy


Abstract for systematic review:
The aim of this study was to conduct a systematic review to explore how attachment style is related to symptoms and functioning in early psychosis, specifically the At-Risk Mental State and First-episode Psychosis. Methods: A PRISMA-guided systematic search was conducted in PsycInfo, SCOPUS, and Web of Science between 1st January 1995 and 12th July 2019. The search was limited to original research that assessed attachment in participants who presented as At-Risk Mental State or First episode Psychosis.

Nine papers were included. Secure attachment was positively associated with better functioning in early psychosis. Mixed results were observed regarding the relationship between attachment and clinical symptoms in cross-sectional studies. Longitudinal research highlighted a significant association between higher levels of secure attachment and improved clinical outcomes in early psychosis.

Cross-sectionally, the link between attachment and clinical symptoms appears tenuous in At-Risk Mental State and First-episode Psychosis. However, in longitudinal research, there was evidence of a stronger relationship between attachment and recovery from psychotic symptomatology. Clinical recommendations include interventions that enhance the development of secure relational patterns in At-Risk Mental State and First-episode Psychosis to promote long-term recovery. Future research recommendations include the creation of a standardised, reliable and validated measure of attachment in populations with psychosis.

Abstract for large scale research project:
This study sought to investigate whether the experience of childhood trauma increases the likelihood that individuals with psychosis will be motivated to drink alcohol as an avoidant coping strategy and adopt a ‘sealing over’ recovery style.

Seventy-two participants with a diagnosis of a psychotic disorder completed assessments of childhood trauma, drinking motives, recovery style, and alcohol use.

Results: Overall current alcohol use was low but 34.8% of respondents reported a history of alcohol-related problems. Childhood emotional abuse predicted motivation to drink alcohol to cope and a history of alcohol-related problems. The relationship between emotional abuse and history of alcohol-related problems was fully mediated by motivation to drink alcohol to cope. Recovery style was not observed to be related to any key variables.

Conclusions: Findings highlight the need to routinely assess childhood trauma in clinical practice and to consider the impact of emotional abuse upon coping strategies in individuals with psychosis during treatment. Theoretical implications and recommendations for future research are suggested.
Date of AwardJul 2020
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorCiaran Mulholland (Supervisor) & David Curran (Supervisor)


  • Attachment
  • Early psychosis
  • At-risk mental state
  • First-episode psychosis
  • clinical outcomes
  • psychosis
  • childhood emotional abuse
  • drinking motives
  • recovery style
  • alcohol

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