The Structural Pattern of Anger Expression in Women with Postpartum Depression based on Attachment Styles with the Mediation of Experiential Avoidance and Self-conscious Emotions

Depression is one of the most common postpartum disorders. Also, women with postpartum depression have problems in emotional regulation. The aim of the study was to predict anger expression based on attachment styles with the mediation of experiential avoidance and conscious emotions in women with postpartum depression in 2019.

The research method was descriptive-correlational and the statistical population of this study included all women with a diagnosis of postpartum depression who referred to health centers in Tehran province in 2019, from which 250 people were selected by convenience sampling. Data were collected using demographic questionnaire, “Revised Adult Attachment Scale”, “Multidimensional Experimental Avoidance Questionnaire”, and the “Beck Depression Inventory”, State-Trait Anger Expression Inventory – 2, Kugler and Jones Guilty Feelings Questionnaire and Experience of Shame Scale. The validity of the instruments was confirmed using construct validity by confirmatory factor analysis method and the reliability by internal consistency method was confirmed by calculating Cronbach's alpha coefficient. The data were analyzed in SPSS. 26 and Amos .26.

The pattern of structural equations using statistical indices showed secure attachment style (β = -0.223, P≥0.05), attachment style Ambiguous / anxious (β = 0.506, P≥0.05), avoidant attachment style (β = 0.212, P≥0.01) has a significant relationship with experimental avoidance  Also, the direct coefficients of experimental avoidance for anger expression (β=0.10, P≥0.01) and conscious emotions to the expression of anger, experiential avoidance to the expression of anger (β=0.88, P≥0.001). Also, the results of indirect path coefficients between secure attachment style (β=-0.237, P≥0.001), ambivalent/anxious attachment style (β=0.716, P≥0.001) and avoidant attachment style (0.066) =β, P≥0.01) is significant through experimental avoidance with anger expression. The results of indirect path coefficients between secure attachment style (β=-0.202, P≥0.001), ambivalent/anxious attachment style (β=0.580, P≥0.001) and avoidant attachment style (β=0.158 β, P≥0.01) is significant through self-conscious emotions with the expression of anger.

Experiential avoidance and conscious emotions are mediating variables in the relationship between attachment styles and the experience of negative emotions such as expressing anger in women with postpartum depression. Therefore, ambivalent/anxious attachment style to the perception of threat in disturbing situations along with negative self-view and experience of secondary emotions such as shame and guilt lead to experience of anger in women with postpartum depression. It is suggested that psychological interventions in reducing negative emotions and experiential avoidance in women with postpartum depression should be considered by therapists.