Marotti, Julia; (2023) The role of trauma, attachment, and voice-hearer’s appraisals: a latent profile analysis. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Part One of this thesis presents a conceptual introduction summarising the literature on the psychosocial factors of trauma, attachment styles and appraisals of auditory hallucinations (referred to as voices henceforth) and how this relates to voice hearing related distress. Despite robust evidence of the association between trauma, insecure attachment and voice hearing development, prognosis and outcomes, the complex inter-play between such factors has received little attention. Comment is provided on the type of methodological approaches typical of such research and potential improvements are proposed using person-centred data-driven methodologies such as cluster analyses approaches. In Part Two an empirical study extends the current literature by investigating whether there are statistically distinct subgroups of voice hearers based on their selfreported experiences of trauma, the beliefs about the extent that traumas have thematic links to voices content, the presence of fearful attachment style, and appraisal of voices. The study also considers the associations between identified profiles and demographic factors as well as clinical presentation outcomes (including severity of voices, post-traumatic stress disorder symptoms, emotional distress and social functioning). This is a secondary data analysis project using data from voice hearing individuals who are part of a larger randomised controlled trial called AVATAR2 investigating a novel relational therapy for voice treatment. Part Three presents a critical appraisal of the process of completing this research project. This includes a discussion about the different research stages and the challenges and learning points that occurred. Especially, experience of conducting secondary data-analysis with a complex statistical methodology is considered, alongside choices that had to be made around the inclusion of specific ethnicity categories in this study and involvement of Experts by Experience.

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