Altuntas Ozturk, Sema
(2025)
The role of attachment, self-compassion, and emotion regulation in survivors of domestic violence: an exploration of psychological mechanisms and compassion-focused self-help intervention.
PhD thesis, University of Nottingham.
Abstract
Background: Domestic violence (DV) is a common worldwide phenomenon. Nearly 1 in 3 women and 1 in 7 men in England and Wales experience DV in their lifetimes. Post-traumatic stress disorder (PTSD) is the most prevalent negative psychological outcome associated with domestic violence. Yet, not all individuals experienced DV develop PTSD symptoms, which suggests that additional factors should be considered to predict the risk of developing PTSD symptoms among this population. As a theory of emotion regulation and interpersonal relationships, attachment theory may be an important framework that helps to explain why some DV survivors develop PTSD while others do not. Although prior research has demonstrated a strong association between adult attachment and PTSD symptoms, the underlying mechanisms driving this relationship remain only partially understood. While some studies have begun to explore potential mediators and moderators, further investigation is needed to clarify these processes, particularly in high-risk populations such as DV. Hence, identifying factors that may either increase risk or protect individuals from developing PTSD symptoms is crucial. Self-compassion, as a protective factor, and emotion regulation strategies are among such mechanisms. Individual differences in attachment styles, self-compassion, and emotion regulation processes, such as rumination, thought suppression, and dissociation may help clarify why some survivors of DV are more prone to developing PTSD symptoms. Furthermore, although research on self-compassion continues to grow in psychological research and clinical practice, little is known about its developmental origins, with the majority of research being predominantly quantitative. Thus, there is an identified gap in the literature that needs to be addressed by using the more nuanced advantages of qualitative research to understand the development of self-compassion alongside the associated construct of emotion regulation in the context of early attachment relationships. Understanding these mechanisms better help to inform relevant psychological interventions, given that self-compassion is amenable to change through a broad array of interventions, while attachment bonds might be less malleable.
Aims: This PhD project aims to explore psychological mechanisms among survivors of DV, looking into the role of attachment, self-compassion, and emotion regulation influencing post-trauma reactions and the benefits of the adapted self-help compassion-focused intervention to alleviate the suffering of people affected by DV. Chapter 1 (Literature Review) defines key concepts and relevant theories in the context of trauma and survivors of domestic violence. It provides essential theoretical background on the core study constructs related to the post-traumatic context, positioning them within a broader theoretical framework that supports the focus of this research. The first chapter also reviewed relevant empirical evidence, emphasizing the need to address the limitations of existing studies to advance the understanding of psychological mechanisms of interests in the context of domestic violence and to inform treatment avenues for DV-related outcomes among survivors. Chapter 2 (Study 1) presents a cross-sectional investigation of the interrelationships between adult attachment, self-compassion, specific emotion regulation processes and PTSD symptoms in survivors of DV. It examines the extent to which these factors contribute to the development of PTSD symptoms and whether part of the link between attachment styles and PTSD symptoms might be explained by these predictors; specifically, self-compassion and emotion regulation strategies such as rumination, thought suppression, and dissociation. Chapter 3 (Study 2) presents a qualitative exploration of the impact of early attachment relationships on the development of self-compassion and capacity for emotion regulation, contributing to a deeper understanding of attachment profiles, self-compassion development, the ability to manage difficult emotions. Chapter 4 (Study 3) evaluates the effectiveness, feasibility, and acceptability of a compassion-focused self-help intervention with a guided component to support survivors of DV, using a single-case series design. Finally, the General Discussion of proposed study represented in Chapter 5 integrates the findings from the previous chapters and situates them within the broader literature, aiming to provide a comprehensive perspective that addresses the research questions guiding this PhD project. This chapter also outlines the key strengths and limitations of the study, discusses its broader implications, and proposes future directions, with a focus on enhancing support interventions for DV survivors and advancing trauma-informed clinical practice.
Methods: A cross-sectional design was used in the first study of this PhD project to collect quantitative data on key study variables through validated self-report measures. Anonymous adult survivors of domestic violence (n = 138) completed an online survey hosted on the JISC platform. Hierarchical multiple regression analyses were conducted to test the proposed model for predicting PTSD symptoms, while a series of moderation and mediation analyses were used to examine the role of self-compassion and three emotion regulation processes in the relationship between adult attachment and PTSD symptoms among survivors of DV. Study 2 employed qualitative design to gather data through semi-structured interviews held online via MS Teams. The qualitative data from the interviews (n=20) were considered suitable for reflexive thematic analysis (RTA) using the six-step approach outlined by Braun and Clarke (2006, 2019). Study 3 employed a single-case series with a basic A-B design to assess whether an adapted, four-week guided self-help compassion-focused intervention increased self-compassion and reduced self-blame, alongside secondary outcome measures. Six participants completed the full CFT intervention (n = 6). Self-report measures were administered weekly, while some were administered only at pre-baseline, post-intervention, and follow-up time points. Quantitative data from these measures were analysed through visual inspection of process and outcome data, along with calculations of reliable and clinically significant change indices and effect size estimates (Tau-U A vs. B).
Results: The results from Study 1 showed that lower levels of dissociation, thought suppression, and attachment anxiety predicted greater PTSD symptoms, whereas attachment avoidance, rumination, and lower self-compassion were not significant predictors among survivors of DV. Dissociation moderated the relationship between attachment anxiety and PTSD symptoms but did not moderate the attachment avoidance-PTSD link. Mediation analyses indicated that thought suppression fully mediated the relationship between attachment avoidance and PTSD. In addition, self-compassion and dissociation partially mediated this relationship, while rumination did not. For attachment anxiety, self-compassion, rumination, thought suppression, and dissociation all partially mediated its association with PTSD. The obtained findings from Study 2 provided a deeper understanding of the ways in which early caregiver-child relationships shape individual differences in self-compassion and the capacity for emotion regulation. Identified key themes indicated that survivors' self-compassion has been shaped by parental modelling, the lack of parental guidance, negative parental messages, an emphasis on achievements, and the prioritisation of others over oneself, and treating oneself as caregivers treated them. Similarly, their coping strategies for managing difficult emotions were influenced by parental modelling, insufficient parental guidance, the impact of emotional neglect on self-reliance, and the nature of treatment from caregivers. In Study 3, at post-intervention, five out of six participants demonstrated clinically significant improvements in self-compassion, while three showed similar changes in self-blame. Only one participant experienced no notable change. Tau-U analyses indicated moderate to very large effect sizes for three participants, supported by visual analysis. Two participants consistently benefited across all measures. Most reported reductions in secondary measures and attributed improvements primarily to the intervention, particularly the guided calls. Feedback suggested the intervention was both feasible and acceptable.
Conclusions: The PhD project underscores the importance of identifying mechanisms that may serve as either a buffering or vulnerability factors in the development of PTSD symptoms among survivors of DV. It shed light on some early rearing factors and experiences that support or impede development of self-compassion and emotion regulation, offering valuable insights for both clinical interventions and future research. Specifically, interventions aimed at targeting self-compassion and maladaptive emotion regulation strategies (thought suppression and dissociation) may be particularly beneficial in time-limited therapeutic settings, rather than focusing on modifying one’s attachment orientation. Moreover, low-intensity, compassion-focused self-help interventions also show promise as therapeutic resources for survivors of DV. Future research should continue to evaluate the clinical utility of compassion-focused self-help approaches within trauma-exposed populations.
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