Prediction of Generalized Anxiety Disorder based on Attachment Styles by Mediating Early Maladaptive Schemas in Adolescents

Adolescence is considered an important period of life that is accompanied by considerable biological and psychological changes that may lead to anxiety disorders in some cases. Generalized anxiety disorder (GAD) as one of the most prevalent psychological disorders among adolescents is mainly characterized by heightened levels of anxiety that interferes with performance during life. Clinicians warn that untreated GAD can be harmful and may shift to a more severe disorder such as major depression disorder. Therefore, identifying underlying factors and concomitants of the disease seems pivotal. This study aimed to investigate the prediction of generalized anxiety disorder based on 3 attachment styles as well as examine the mediated role of maladaptive schemas.

The statistical population of the study included students of different levels of high school, ages 13-18 years living in Tehran province, in the autumn and winter of the academic year of 2019 – 2020, from which 297 students were selected by a simple random sampling method. The Pennsylvania Worry Questionnaire (PSWQ), Revised Adult Attachment Scale (RAAS), and Young’s Schema Questionnaire-short form (YSQ-SF) were used for data collection. A statistical analysis of Structural Equation Modeling (SEM) was performed using the SPSS-16 software.

A negative and significant (P<0/01) direct effect was observed for secure attachment and avoidant attachment styles, while no significant direct effects were found for ambivalent attachment style relationship to generalized anxiety disorder. Also, the early maladaptive schemas could significantly mediate the secure attachment style and avoidant attachment style relationship to generalized anxiety disorder, while no mediating role was detected for the ambivalent attachment style. A Bootstrapping analysis also confirmed this finding. All 5 categories of maladaptive attachment schemas significantly were correlated to GAD symptoms.

Based on the findings of the present study, it could be concluded that increased measures of secure and avoidant attachment styles in adolescents are associated with decreased levels of GAD symptoms. Increase indices in each of the 5 categories of maladaptive schemas (The 18 early maladaptive schemas are classified into 5 main areas: Disconnection/Rejection, Impaired Autonomy, and Performance, Other-Directedness, Hypervigilance/ Inhibition, Impaired Limits) are associated with increased GAD severity, so the relationship is significant. Also, early maladaptive schemas could mediate the relationship between secure and avoidant attachment styles with generalized anxiety disorder in adolescents. According to the results of this study, careful consideration of attachment styles and early maladaptive schemas to prevent generalized anxiety disorder in adolescents is recommended.