A pilot study of attachment relationships, psychological problems and negative automatic thoughts among college students in Pakistan

Introduction

College students experience stress and anxiety due to academic demands, detachment from family, boredom, alienation, and isolation. These emotional states are because of the changes occurring in students’ social, learning, and academic lives in college [1]. In Pakistan, students at the college level are mostly late adolescents who are supposed to make decisions about their careers and their academic and personal lives. The inability to adapt to changes and make appropriate decisions may cause disturbances in their psychological health. Recent studies have revealed that depressive and anxiety symptoms are the most prevalent psychological problems among college [2]. In Asian countries such as Pakistan, depressive and anxiety symptoms among youngsters are increasing at an alarming level [3]. These problems often remain unattended in Pakistan subsequently compromising youngsters’ developmental capacities [4], [5]. This highlights a need to understand the factors contributing to psychological problems of college students in Pakistan.

Literature [6] has reported that most adolescent mental health problems arise from difficulties in attachment relationships. Attachment is an emotional bond between a primary caregiver and an infant that determines the psychosocial adaptation and quality of relationship with other adults and peers in later stages of life specifically during adolescence [7], [8]. Securely attached adolescents use the attachment figure as a safe haven and a secure base through which they can explore the world [7], [8]. In contrast, insecure attachment to significant others leads to the development of psychological problems among youngsters. In line with this notion, Duchesne and Ratelle [9] found that maternal and paternal insecure attachment relationships were significantly associated with the developmental trajectories of depressive symptoms among adolescents. Their study revealed that, for adolescents 11–12 years old, both father and mother influenced the development of depressive symptoms; while, for those older than 12 years old, only secure maternal attachment was a significant predictor. On the contrary, Agerup et al. [10] reported that, as compared to maternal attachment, insecure paternal-adolescent attachment at ages 15–20 resulted in clinical depressive symptoms. In another study, Holt, Mattanah, and Long [11] found that insecure maternal and peer attachment significantly predicted the level of depression of emerging adults transitioning to college.

Moreover, an investigation by Van Eijck et al. [12] indicated that the quality of attachment with the father predicted generalized anxiety disorder (GAD) in early, middle, and late adolescents, particularly among males. Additionally, the correlation between attachment relationships and GAD increased with age, as separation from the family becomes more salient during late adolescence. Another study conducted in India reported negative relationships of secure paternal and maternal attachment with depression and anxiety, with no sex differences [13]. Along with parental attachment, insecure peer attachment becomes an important risk factor for depressive and anxiety symptoms among adolescents [14]. Véronneau, Trempe, and Paiva [15] noted that having an insecure relationship with a best friend may expose adolescents to internalizing problems and social anxiety.

Another important tenet of the attachment theory is the formation of internal working models (IWMs). Bowlby [7], [8] assumed that behavior patterns between child and caregiver during infancy are stored in the IWMs of the child. The attachment theory posits that these IWMs not only support the belief that the world is a safe place to live in and that attachment figures will be available when facing stressors, but they also boost individual confidence and self-worth. In support of this notion, Thompson [16] and Dykas and Cassidy [17] found that individuals with secure attachment may process information positively; whilst individuals with insecure attachment have negatively biased cognitions. Past studies [12], [18], [19] have revealed that insecure attachment relationships with parents and peers were positively related to negative cognitions.

The cognitive theory coined the term maladaptive thinking patterns that guide the interpretation of others’ behaviors and events negatively as negative automatic thoughts (NATs). Beck suggested a three-layered cognitive structure, where NATs are positioned at the outmost surface. NATs are readily available cognitions which an individual can easily use while making decision about experiences and others’ behaviors. The cognitive theory [20] proposed that the presence of NATs leads to the development of psychological problems.

Pössel [21] tested the Beck cognitive model on 518 high school students with a mean age of 15 by examining sequential mediation and bidirectional model among various constructs including dysfunctional attitude, cognitive errors, cognitive triad, and negative automatic thoughts in relation to depression. This longitudinal study revealed that the stimulation of cognitive concepts brought about the development of depressive symptoms, which then reinforced or triggered the already available dysfunctional attitudes. Additionally, Ames, Rawana, Gentile, and Morgan [22] examined the cognitive factors for depressive symptoms and alcohol use through self-esteem and optimism. They found that high self-esteem and optimistic thinking are the major protective factors against depressive symptoms. Moreover, Al-Ghorabaie, Noferesti, Fadaee, and Ganji [23] investigated the response style and cognitive vulnerability in normal and clinical samples of individuals. Findings demonstrated that individuals with GAD displayed more negative beliefs and scored high on uncontrollability and danger. Likewise, Brown et al. [24] investigated the specific content of cognition involved in depression and anxiety across developmental stages such as childhood, adolescence, and early adulthood. The authors found that the physical content was specific to anxiety; whereas, mental and social contents were related to both anxiety and depression. Nevertheless, to date, little evidence has been found on the associations between maternal, paternal, and peer attachment, negative automatic thoughts, depressive and anxiety symptoms in non-Western societies.

Previous studies have noted that the application of Western constructs in non-Western societies may generate different results because of the differences between individualistic and collectivistic societies [25]. It was argued that Western measures were developed according to the western context, therefore the values, norms, and experiences of the context may differ with other culture. There are few studies available on the applicability of Western measures in different cultures. Zulkefly and Wilkinson [25] explored the applicability of Inventory of Parents and Peers Attachment (IPPA; Armsden & Greenberg, 1987) in Malaysia on 2,040 early, middle, and late adolescents residing in various urban and rural areas of Malaysia. The researchers reported that IPPA was not culturally sensitive in assessing adolescents’ attachment relationships in Malaysia. Evidently, cultural specific domains of maternal-child, paternal-child and peer-child relationships need to be studied and interpreted amicably. Supported by Cassidy and colleagues [26] in a review study accentuates to consider specific and unique cultural context while explaining attachment relationships and its consequences. Therefore, it is important to study the applicability of measures originating from Western societies in non-Western contexts.

Based on the literature review, the objectives of this pilot study are to investigate the associations between attachment relationships (maternal, paternal, and peer attachment), negative automatic thoughts, and psychological problems (depressive and anxiety symptoms) among late adolescents in Rawalpindi, Pakistan.

Methodology

Results

Discussion

The present study examined the correlations between the attachment relationships, psychological problems and negative automatic thoughts among Pakistani college students residing in Rawalpindi district. The participants completed a survey booklet within 30–45 min, which is about the same time frame as those reported in a previous study by Kelliher [30]. Therefore, it is suggested that future studies set the average time period for the administration of the questionnaires used in the present research in about 30–45 min as well. Moreover, the response rate was high, in that, 98 out of 100 participants responded to the survey. Participants did not show any ambiguity. Additionally, those with only one living parent or with both parents dead did not respond to the questions related to the corresponding type of parental attachment. No other problems were detected that prevented the participants from completing the survey questionnaires.

Furthermore, in line with previous literature, the findings of the present pilot study showed that most of the participants were securely attached with their respective mother, father and peers [25]. Culturally, children in Pakistan are emotionally dependent on their families and close relationships. On the other hand, the mean scores reported low prevalence of depressive and anxiety symptoms as well as negative thoughts. Consistent with literature [11], [15], the findings of this pilot study indicated that insecure attachment relationships with the mother, father, and peers were positively associated with depressive and anxiety symptoms among college students. Though such associations are well entrenched in empirical literature in Western societies, there is a dearth of related research in the Pakistani setting. Therefore, this study provides baseline information on the risk and protective factors of the psychological problems experienced by Pakistani college students embedded in their quality of attachment with significant others.

Moreover, secure attachment relationships with the father and peers help youngsters to think positively about the self and the world and interpret events in a more positively biased way [12], [17], [18], [19]. Although maternal attachment is important in all stages of life, it had a non-significant association with negative automatic thoughts in this study. Such result is consistent with the concept of hierarchy of attachment espoused by the attachment theory. According to Bowlby [8], during adolescence, a hierarchy of attachment is developed in which adolescents place an attachment figure according to their perceptions of security with that figure. The attachment theory further postulates that adolescents distance themselves from the primary caregiver to develop autonomy [8], [14]. Attachment researchers have pointed out that relationships with peers become more prominent during adolescents. Therefore, the quality of attachment with peers has more influence on the thinking patterns of adolescents. Our findings revealed that maternal and paternal attachment were positively related to peer attachment. These results are in line with the postulation of the attachment theory that the quality of attachment with the primary caregiver facilitates good relationships with other adults and peers in later stage of life [7], [8]. Besides, the results of this study also support a tenet of the cognitive theory suggesting that most internalizing problems arise because of faulty thinking patterns [20], [21], [23], [24].

Taken together, our study provides baseline information about the prominent role of insecure attachment relationships in the development of negative automatic thoughts and psychological problems among college students in Pakistan. The quality of relationship with parents and peers, negative thinking patterns, and other contributing factors for the increasing mental health issues among youngsters of Pakistan need to be addressed in future research. Additionally, developing an indigenous and appropriate prevention and intervention plan for the youth in Pakistan is essential.

The findings of the current study need to be interpreted with caution. However, the limitations of this study include the small sample size, the selection of respondents only from the Rawalpindi district in Pakistan, non-use of multiple sources of information (e. g., respondents’ parents and peers), and collection of data from a non-clinical sample. Therefore, it is recommended that future studies be conducted using a larger and a more diverse sample. Notably, Pakistan is a country where people from diverse backgrounds and cultures live; thus, research data need to be collected from other districts to provide a clearer picture of adolescents’ perceptions about attachment relationships and the prevalence of psychological problems and negative automatic thoughts. Future studies also need to gather information from multiple informants (e. g., parent, peers, and teacher) as well as from a clinical sample for more generalizable results.