<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.152223.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Research Article</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Attachment and object 
                    <italic>relation maturity</italic>: Splitting&#x2019;s relationship with mental distress is not mediated by attachment anxiety or avoidance</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: awaiting peer review]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Frings</surname>
                        <given-names>Daniel</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-0183-9516</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Division of Psychology, London South Bank University, London, England, UK</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:fringsd@lsbu.ac.uk">fringsd@lsbu.ac.uk</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>4</day>
                <month>7</month>
                <year>2024</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2024</year>
            </pub-date>
            <volume>13</volume>
            <elocation-id>743</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>21</day>
                    <month>6</month>
                    <year>2024</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2024 Frings D</copyright-statement>
                <copyright-year>2024</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/13-743/pdf"/>
            <abstract>
                <title>Abstract*</title>
                <sec>
                    <title>Background</title>
                    <p>Attachment style and object relation maturity have been linked to patterns of relating to others and mental health outcomes. However, little research has tested how these processes relate or the level of unique variance they each account for in outcomes. This study aimed to explore these issues.</p>
                </sec>
                <sec>
                    <title>Methods</title>
                    <p>A sample of n = 77 adults completed self-report scales of attachment style, splitting and dyadic splitting tendencies and mental distress (measured via the General Anxiety Disorder (GAD7) and the Patient Health Questionnaire (PHQ8) scales). Questionnaires were completed online.</p>
                </sec>
                <sec>
                    <title>Results</title>
                    <p>The results suggested that anxious attachment and tendency towards splitting were related to higher levels of mental distress. Splitting was positively related to attachment anxiety and avoidance. However, a series of mediation models (testing the relationship between splitting and mental health, mediated by attachment avoidance and anxiety) suggested that anxious attachment did not predict unique variance in distress. Splitting remained related to mental distress but was not mediated by anxious or avoidant attachment styles.</p>
                </sec>
                <sec>
                    <title>Conclusions</title>
                    <p>The findings point towards potential links between two distinct aspects of systems that influence relating and psychological wellbeing. They also suggested that addressing both aspects will be beneficial in helping clients improve their relationships and well-being.</p>
                </sec>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>Attachment</kwd>
                <kwd>Object relations</kwd>
                <kwd>splitting</kwd>
                <kwd>mental health</kwd>
                <kwd>relationships</kwd>
                <kwd>anxiety</kwd>
            </kwd-group>
            <funding-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec5" sec-type="intro">
            <title>Introduction</title>
            <p>The psychodynamic approach to healthy psychological functioning and well-being includes perspectives based on 
                <italic toggle="yes">attachment</italic> (how secure we feel in our relationship with others) and on 
                <italic toggle="yes">object relations maturity</italic> (how we are able to hold complex views of others and our relationships with them). Despite being a well-recognized clinical perspective on psychosocial function, little research has explored how functional systems may be interrelated. This is important, as understanding such relationships offers different opportunities for conceptual clarity and integration, as well as optimizing practical clinical techniques. The current study explores this by examining the relationship between attachment style and splitting (the separation of a social object into distinct parts, often wholly good or wholly bad), and their relative relationships with mental distress.</p>
            <sec id="sec6">
                <title>Attachment perspectives</title>
                <p>Attachment approaches, initially developed by 
                    <xref ref-type="bibr" rid="ref1">Bowlby (1969</xref>, 
                    <xref ref-type="bibr" rid="ref2">1973</xref>, 
                    <xref ref-type="bibr" rid="ref3">1980</xref>, 
                    <xref ref-type="bibr" rid="ref4">1988)</xref> provide a model of how we form links with other people. In these works, Bowlby argues that from birth, we have an innate drive to form a psychological bond with others (in the case of neonates and infants, we usually seek attachment with adults, as the latter can protect the former). The quality of our early attachments (for instance, how sensitive the caregiver is to needs, and how responsive they are to needs once recognized) influences the development of an internal working model of how relationships function &#x2013; for instance, how/if others can be trusted and relied upon. This model is then carried into adult life, affecting how we relate to others.</p>
                <p>More recent perspectives based on this approach have been advanced by 
                    <xref ref-type="bibr" rid="ref6">Fraley et al. (2000)</xref> and 
                    <xref ref-type="bibr" rid="ref26">Rholes &amp; Simpson, (2004)</xref>. These perspectives argue that attachment can be broadly separated into two dimensions: attachment anxiety and attachment avoidance. 
                    <xref ref-type="bibr" rid="ref26">Rholes and Simpson (2004)</xref> argued that attachment anxiety is characterized by a high need for attention, but coupled by a distrust that the caregiver has the will or ability to deliver it. In contrast, avoidance anxiety is a difficulty with intimacy and over-reliance on self-sufficiency and independence. These dimensions can be combined to create a taxonomy of four categories of attachment: 
                    <italic toggle="yes">secure</italic> (low on both dimensions), 
                    <italic toggle="yes">preoccupied</italic> (high anxiety, low avoidance), 
                    <italic toggle="yes">dismissive</italic> (low anxiety, high avoidance), and 
                    <italic toggle="yes">fearful</italic> (high on both dimensions). These influence how we seek out/avoid closeness in relationships, rely on others, allow ourselves to have others rely on us, and judge ourselves in contrast (or not) to others&#x2019; perceived evaluations. Once established, attachment models are traditionally considered to be relatively fixed for life, although secure attachment can be &#x2018;earnt&#x2019; &#x2013; which can involve an ongoing process of consciously challenging the established internal working model (see e.g. 
                    <xref ref-type="bibr" rid="ref27">Saunders et al., 2011</xref>).</p>
                <p>Child attachment patterns have been shown to longitudinally predict the number and quality of later adult relationships (
                    <xref ref-type="bibr" rid="ref18">Lyons-Ruth et al., 2013</xref>). Attachment styles have also been linked to mental well-being (e.g. 
                    <xref ref-type="bibr" rid="ref25">Raque-Bogdan et al., 2011</xref>), the ability to function in therapeutic groups (
                    <xref ref-type="bibr" rid="ref19">Marshall et al., 2018</xref>) and offspring attachment styles (
                    <xref ref-type="bibr" rid="ref11">Harper, 2005</xref>; 
                    <xref ref-type="bibr" rid="ref21">Moullin et al., 2018</xref>). Parental attachment also appears to influence mental health (
                    <xref ref-type="bibr" rid="ref9">Galbally et al., 2020</xref>). While the outcomes and emotional/behavioural markers associated with each style are well established, the relationship between attachment and another major process in relation to object relation maturity is relatively unexplored.</p>
            </sec>
            <sec id="sec7">
                <title>Object relation maturity perspectives</title>
                <p>Object relation maturity perspectives focus on the complexity of representations of and relationships between the self and other social objects (traditionally defined as people) (
                    <xref ref-type="bibr" rid="ref22">Ogden, 1983</xref>). Such approaches argue that as we psychosocially mature we develop more complicated representations of these objects, which allow both positive and negative elements and evaluations of others to be held simultaneously. This allows more nuanced relationships (including navigation of need and reliance on others, being available to others, etc.) to be managed successfully (
                    <xref ref-type="bibr" rid="ref14">Klein, 1952</xref>; 
                    <xref ref-type="bibr" rid="ref23">Ogden, 1986</xref>). While object relation maturity and attachment overlap conceptually (as models of how we relate and some features such as self/other reliance, etc.) and arguably in practice therapeutically, they are also generally considered in isolation in terms of theory and practice (likely for historical reasons in the development of the field).</p>
                <p>The precursor of object relation maturity is characterized by psychological splitting, which is the focus of this study. Splitting involves the separation of objects into distinct elements (part-objects), which are individually all good or bad, and/or the reduction of complex objects into simple, &#x2018;good&#x2019; or &#x2018;bad&#x2019; ones. We may feel ambivalent towards dichotomous evaluations of good or bad. For instance, a partner may in turn be completely idolized and vilified. Splitting can include the splitting of the self, with aspects of the self that cannot be self-managed or accepted projected onto others or repressed. Psychosocially, we begin operating solely in this manner by splitting all objects, including the self (in Kleinen terms, operating from a paranoid-schizoid position; 
                    <xref ref-type="bibr" rid="ref14">Klein, (1952)</xref>). Under normal circumstances, we can manage a more complex set of representations (more mature object relations, Klein&#x2019;s depressive position) at around 6 months of age. While both positions are available across the lifespan, failure to move beyond reliance on splitting in early childhood is seen as a causative factor in borderline personality disorders and other mental health challenges (
                    <xref ref-type="bibr" rid="ref13">Huprich et al., 2017</xref>), as well as impacting day-to-day relationships.</p>
                <p>In both clinical and non-clinical populations, splitting is argued to be functional as a defense mechanism, as it removes potentially distressing ambivalence around the nature of significant others and our relationships with them (which, many argue, are inherently ambiguous; 
                    <xref ref-type="bibr" rid="ref10">Gerson, 1984</xref>; 
                    <xref ref-type="bibr" rid="ref29">Siegel &amp; Spellman, 2002</xref>). However, when splits are within the self and/or involve projecting or introjecting elements of the self or others, they also provide cognitive distortions that may impact functional relationships with others. In addition to being seen as essential to understanding the pathology of many mental health conditions from the object relations perspective, splitting is observed among nonclinical populations, especially when individuals are exposed to stress (
                    <xref ref-type="bibr" rid="ref17">Lopez et al., 1997</xref>).</p>
                <p>Alongside splitting operating at an individual level, within close relationships, dyadic splitting is characterized by co-dependence and dramatic shifts between threats to destroy and urgent need to reconcile with the relationship partner, both driven by split object relationships (
                    <xref ref-type="bibr" rid="ref30">Solomon, 1985</xref>). 
                    <xref ref-type="bibr" rid="ref28">Siegel (2006)</xref> argues that this dyadic splitting is a constellation of behaviors and defenses such as splitting, denial, and projective identification (inducing another person to experience emotions that the individual cannot tolerate experiencing themselves). Functionally, couples experiencing dyadic splitting may learn to avoid potential conflicts &#x2013; this eliminates the possibility of growth and leads to exaggerated and destructive responses when the &#x2018;all bad&#x2019; version of the self, the other, or the relationship emerges. As both sides of the dyad experience this separately, finding a common shared meaning for events is difficult until they achieve more mature object relations. In contrast to attachment, which has an established evidence base, object relations maturity (and the phenomenon of splitting specifically) has relatively limited empirical evidence (detailed below). This lacuna is both in terms of the genesis and developmental trajectory of object relation maturity and the more observable outcomes (i.e., the act of splitting, projection, etc.). This study begins to expand on the latter aspect (outcomes).</p>
            </sec>
            <sec id="sec8">
                <title>Linking attachment and object relations maturity perspectives</title>
                <p>The attachment and object relations maturity approaches both posit that affective and cognitive systems associated with relationships with others guide the function and success of our psychosocial lives. One open question is the extent to which these processes overlap and/or are distinct systems, and how they are conceptually related. The current study explores the relationship between the two major dimensions of attachment (anxiety and avoidance) and the defense mechanism of splitting (an indicator of object relation maturity experienced both at an intra-aethicnd interpersonal level, i.e., splitting and dyadic splitting).</p>
                <p>While both broadly object-relation approaches (in that they focus on the relationship between psychosocial objects), attachment style and object-relation maturity perspectives differ in emphasis. Key differences in the approaches focus on the etiology of developmental goals, with attachment theories highlighting the external world (i.e., parental responsiveness and the importance of early social interactions with primary caregivers) vs. an (arguably inaccurate) perception that object relation maturity focuses overly on the child&#x2019;s internal phantasy world (see 
                    <xref ref-type="bibr" rid="ref23">Ogden, 1986</xref> for a discussion as to whether this perception of an exclusive focus on the internal world of the child is an oversimplification or not).</p>
                <p>Previous empirical studies have linked object relation maturity (in general) with attachment style. 
                    <xref ref-type="bibr" rid="ref24">Priel and Besser (2001)</xref> demonstrated that securely attached women (in their third trimester of pregnancy) have more complex, integrated object relations than those with less secure styles. Structural equation modelling also suggested that the constructs were related but distinct (
                    <xref ref-type="bibr" rid="ref32">Westen, 1991</xref>). Similarly, 
                    <xref ref-type="bibr" rid="ref16">Levy et al. (1998)</xref> showed that more securely attached individuals demonstrated more complex integration in their object relations (although fearful attached participants also demonstrated high levels of object relation complexity). Similarly, 
                    <xref ref-type="bibr" rid="ref5">Calabrese et al. (2005)</xref> showed that those who experienced others as providing a secure emotional base and connection also had more complex representations of both self and others.</p>
                <p>Specific to splitting, 
                    <xref ref-type="bibr" rid="ref17">Lopez et al. (1997)</xref> showed that both securely attached and dismissive participants had lower splitting tendencies, linking them to lower levels of parental care. 
                    <xref ref-type="bibr" rid="ref20">Mikulincer and Orbach (1995)</xref> highlighted an increase in object relation-related defense mechanisms surrounding perception among individuals with insecure attachment (
                    <xref ref-type="bibr" rid="ref29">Siegel &amp; Spellman, 2002</xref>). Looking at intimate relationships, 
                    <xref ref-type="bibr" rid="ref28">Siegel (2006)</xref> observed that links between levels of within-relational problems such as blame, devaluing, conflict, and contempt were all linked to higher levels of dyadic splitting. The same pattern of results was observed in domestic abuse (both in terms of perpetrators and victims; see 
                    <xref ref-type="bibr" rid="ref29">Siegel and Spellman (2002)</xref>.</p>
                <p>Thus, there is a small but growing evidence base that links attachment security to (i) object relations maturity and (ii) specifically to the use of splitting as a defense. Both impact the quality (and indeed safety) of individual relationships with others in both broad and intimate relationship contexts. However, their relationship remains unknown.</p>
                <p>One limitation of the above works is that they categorized participants into attachment types (losing sample variance in the process), relied on narrative-based measures of object relation maturity, and/or focused on relatively narrow populations. By contrast, attachment can be seen as a two-dimensional system based on attachment anxiety and avoidance (
                    <xref ref-type="bibr" rid="ref6">Fraley et al., 2000</xref>), and object relation maturity can be measured quantitatively (reducing potential subjectivity). In addition, while some existing studies look at the covariance between attachment and object relation maturity, they do not consistently look at mental wellbeing/distress as an outcome. Given the importance of splitting and attachment issues as features in a variety of mental health conditions, it is important to understand how these are linked (or not). Finally, the above studies have not looked at the relative impact of attachment and splitting on outcomes; rather, they have assumed (or implied) a causation between attachment style and subsequent object relation maturity.</p>
            </sec>
            <sec id="sec9">
                <title>Aims of current study</title>
                <p>The current study aimed to build upon extant research while also exploring conceptual models that describe relevant relationships. Specifically, the study explored a model in which the effects of splitting are mediated through attachment (i.e., splitting is related to attachment avoidance and/or anxiety, which in turn is linked to mental health) and an alternative in which attachment effects are mediated through splitting. This approach allows an exploration of which processes predict unique variance in outcomes and provides possible models of the interrelationship between these constructs. Given the relative paucity of work in this area, exploratory analyses were undertaken with no a priori hypotheses beyond the expectation that higher splitting, attachment anxiety, and attachment avoidance would be linked with higher mental distress.</p>
            </sec>
        </sec>
        <sec id="sec10" sec-type="methods">
            <title>Methods</title>
            <p>
                <italic toggle="yes">Participants.</italic> A sample of 77 participants was recruited through a combination of social media platforms (i.e., Reddit
                <sup>&#x00ae;</sup>,&#x2122;[r/SampleSize,,r/Psychology, r/CogSci, r/SurveyExchange], Instagram
                <sup>&#x00ae;</sup>,&#x2122;, Snapchat
                <sup>&#x00ae;</sup>,&#x2122;), a survey completion site (Pollpoll
                <sup>&#x00ae;</sup>,&#x2122;), and a psychology undergraduate research participation scheme. The mean age of the sample was 24.93 years (SD = 6.85). In terms of gender, 56 (72.7%) described themselves as female, 15 (19.5%) were male, 4 (5.2%) were non-binary, 1 was an agender (1.3%), and 1 was an androgyne.</p>
            <p>
                <italic toggle="yes">Design.</italic> A cross-sectional design was employed, with variables including demographics, splitting, dyadic splitting, attachment style, and GAD/PHQ scores.</p>
            <sec id="sec11">
                <title>Materials</title>
                <p>All scales can be seen on the OSF site for this project (see 
                    <italic toggle="yes">Extended Data</italic>, below for details).</p>
                <p>
                    <italic toggle="yes">Splitting.</italic> The 
                    <xref ref-type="bibr" rid="ref10">Gerson (1984)</xref> splitting scale was used to measure splitting. This included ten items such as &#x2018;I hate to hear someone close to me being criticized and When I am angry, everyone around me seems rotten.&#x2019;, &#x2018;There are times my partner seems as strong as iron, and at other times as helpless as a baby,&#x2019; which capture the tendency to split objects into good and bad. The anchors were 1 (Strongly Disagree) and 7 (Strongly Agree). The scale author reported good internal reliability (Cronbach&#x2019;s &#x03b1; = 0.70, 
                    <xref ref-type="bibr" rid="ref10">Gerson, 1984</xref>), and later authors reported similar (Cronbach&#x2019;s &#x03b1; 0.68, 
                    <xref ref-type="bibr" rid="ref17">Lopez et al., 1997</xref>). In the current sample, reliability was moderate (Cronbach&#x2019;s &#x03b1; = .66) with 10 items. Internal reliability analysis revealed that dropping one item (&#x2018;It&#x2019;s hard for me to get angry with people I like&#x201d;) increased reliability to 0.74, and this nine-item model was adopted for the current study. Higher scores indicated increased splitting. This scale is not a proprietary research instrument.</p>
                <p>
                    <italic toggle="yes">Dyadic splitting.</italic> For participants who indicated that they were in an intimate relationship (n = 37), the Siegel and Spellman dyadic splitting scale was deployed (
                    <xref ref-type="bibr" rid="ref29">Siegel &amp; Spellman, 2002</xref>). This comprised items anchored at 1 (Strongly Disagree) and 4 (Strongly Agree). Sample items include; &#x201c;We have a roller-coaster relationship. I never know when things are going to fall apart quickly.&#x201d; and &#x201c;I never know whether my partner is going to think I am the best or the worst person in the world.&#x201d; . Reliability was good (Cronbach&#x2019;s &#x03b1; = 0.83). Higher scores indicated increased splitting. This scale is not a proprietary research instrument.</p>
                <p>
                    <italic toggle="yes">Attachment style.</italic> The ECR-R scale was used to measure anxiety and avoidant attachment (
                    <xref ref-type="bibr" rid="ref6">Fraley et al., 2000</xref>). This is a 35-item scale with items anchored at 1 (Strongly Disagree) and 7 (Strongly Agree). For anxious attachment, sample items included I do &#x2018;not often worry about being abandoned&#x2019; and &#x2018;My romantic partner makes me doubt myself.&#x2019;. For avoidance, sample items included &#x2018;I am nervous when partners get too close to me.&#x2019; and &#x2018;I find it easy to depend on romantic partners.&#x2019; For all items, scores were coded such that higher scores were related to more anxiety/avoidance. The anxious attachment reliability was good (Cronbach&#x2019;s &#x03b1; = .93). Avoidant attachment reliability was also good (Cronbach &#x03b1; = .94). This scale is not a proprietary research instrument.</p>
                <p>
                    <italic toggle="yes">Mental distress.</italic> Mental distress was measured using the combined General Anxiety Disorder questionnaire (GAD7, 
                    <xref ref-type="bibr" rid="ref31">Spitzer et al., 2006</xref>) and the Patient Health Questionnaire (PHQ-8, 
                    <xref ref-type="bibr" rid="ref15">Kroenke et al., 2009</xref>). These scales measure frequency of symptomology experienced problematically over the last 2 weeks, including items such as &#x2018;Feeling nervous, anxious, or on edge,&#x2019; &#x2018;Feeling down, depressed, or hopeless,&#x2019; &#x2018;Being so restless that it&#x2019;s hard to sit still&#x2019; and &#x2018;Poor appetite or overeating.&#x2019; In line with 
                    <xref ref-type="bibr" rid="ref33">Kroenke et al. (2016)</xref>, these scales were collapsed to create a single distress score (Cronbach &#x03b1; = .91). These scales are not proprietary research instruments.</p>
                <p>
                    <italic toggle="yes">Procedure.</italic> Participants completed the online measures. First, a participant information sheet was presented. Following this, all participants provided written informed consent via the questionnaire platform (see 
                    <italic toggle="yes">Ethics</italic>, below) participants completed the measures in the order presented above. Finally, they were thanked and debriefed. Please see the 
                    <italic toggle="yes">Extended Data</italic> (below) for details on how to access full versions of these documents.</p>
                <p>
                    <italic toggle="yes">Ethics</italic>: This study received ethical oversight and approval from London South Bank University (reference number ETH2223-0024, granted 14th October 2022). It was conducted in accordance with APA&#x2019;s ethical standards. All the participants provided written informed consent and were debriefed at the end of the study.</p>
            </sec>
        </sec>
        <sec id="sec12" sec-type="results">
            <title>Results</title>
            <p>To test the zero-order relationships between variables, Pearson&#x2019;s correlations were conducted between the study variables (see 
                <xref ref-type="table" rid="T1">Table 1</xref> for these and the descriptive statistics). These results showed positive relationships between splitting and both anxious and avoidant attachment styles and mental distress scores. Dyadic splitting was positively associated with attachment dimensions but not with mental distress scores. Anxious attachment positively correlated with avoidant attachment.</p>
            <table-wrap id="T1" orientation="portrait" position="float">
                <label>Table 1. </label>
                <caption>
                    <title>Means for study variables and zero order relationships.</title>
                </caption>
                <table content-type="article-table" frame="hsides">
                    <thead>
                        <tr>
                            <th align="left" colspan="1" rowspan="1" valign="top"/>
                            <th align="left" colspan="1" rowspan="1" valign="top">M (SD)</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Splitting</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Dyadic splitting</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Anxious attachment</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Avoidant attachment</th>
                            <th align="left" colspan="1" rowspan="1" valign="top">Mental distress</th>
                        </tr>
                    </thead>
                    <tbody>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Splitting</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">3.72 (1.13)</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">--</td>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Dyadic splitting</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">1.82 (0.73</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.43
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">--</td>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Anxious attachment</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">3.36 (1.28)</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.50
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.75
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">--</td>
                            <td colspan="1" rowspan="1"/>
                            <td colspan="1" rowspan="1"/>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Avoidant attachment</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">3.36 (1.24)</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.34
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.51
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.39
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">--</td>
                            <td colspan="1" rowspan="1"/>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">Mental distress</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">18.31 (10.32)</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.43
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.06</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.36
                                <xref ref-type="table-fn" rid="tfn1">**</xref>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">.19</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">--</td>
                        </tr>
                    </tbody>
                </table>
                <table-wrap-foot>
                    <fn-group content-type="footnotes">
                        <fn id="tfn1">
                            <label>**</label>
                            <p>= 
                                <italic toggle="yes">p</italic> &lt;.01.</p>
                        </fn>
                    </fn-group>
                </table-wrap-foot>
            </table-wrap>
            <sec id="sec13">
                <title>Mediation analysis</title>
                <p>To test the proposed direct and indirect relationships, a mediation model was developed using the Hayes PROCESS macro (v4.2, 
                    <xref ref-type="bibr" rid="ref12">Hayes, 2017</xref>). In the first model (n = 69 due to incomplete cases; see 
                    <xref ref-type="fig" rid="f1">Figure 1</xref> for model), splitting was included as the predictor and mental distress as the criterion variable. The 95% confidence intervals were reported from 5000 bootstrap samples
                    <sup>
                        <xref ref-type="fn" rid="fn1">1</xref>
                    </sup>. The overall model was significant (
                    <italic toggle="yes">R</italic>
                    <sup>2</sup> = .23, 
                    <italic toggle="yes">F</italic>(3,65) = 6.76, 
                    <italic toggle="yes">p</italic> &lt;.001. Splitting scores were related to anxious attachment (
                    <italic toggle="yes">a</italic>
                    <sub>1</sub> = 0.61, CIs = 0.35, 0.87) and avoidant attachment (
                    <italic toggle="yes">a</italic>
                    <sub>2</sub> = .40, CIs = 0.14, 0.67). In the full model, splitting was also related to mental distress (
                    <italic toggle="yes">c&#x2019;</italic> = 3.82, CIs = 1.27, 6.36). Anxious attachment was not related to mental distress (
                    <italic toggle="yes">b</italic>
                    <sub>1</sub> = 1.44, CIs = -0.69, 3.57) or avoidant attachment (
                    <italic toggle="yes">b</italic>
                    <sub>2</sub> = -0.12, CIs = 2.15, -1.90). No significant indirect effect of splitting on mental distress via anxious (
                    <italic toggle="yes">a</italic>
                    <sub>1</sub>
                    <italic toggle="yes">b</italic>
                    <sub>1</sub> = 0.88, CIs = -0.92, 2.41) or avoidant (
                    <italic toggle="yes">a</italic>
                    <sub>2</sub>
                    <italic toggle="yes">b</italic>
                    <sub>2</sub> = -.05, CIs = -1.08, 0.74) attachment was observed. Achieved power analysis, calculated using the med function from the pwr2pll R library, revealed the sample was sufficient to detect mediation with a power of 0.80 when &#x03b1; = 0.05.</p>
                <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                    <label>Figure 1. </label>
                    <caption>
                        <title>Meditation analysis.</title>
                        <p>*** = 
                            <italic toggle="yes">p</italic> &lt; .001.</p>
                    </caption>
                    <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/166956/d864e472-86f4-47a7-a499-54fdb08aef5a_figure1.gif"/>
                </fig>
                <p>Although the sample for dyadic splitting was too small to draw conclusions from (n = 37), confirmatory analysis using dyadic splitting as the predictor variable showed the same pattern of results and significance levels.</p>
                <p>In summary, this analysis suggests that the variance in mental distress is related to splitting, but we did not observe mediation via attachment. Moreover, it also suggests that the variance across both splitting and attachment is considered simultaneously, and attachment dimensions do not predict unique variance.</p>
                <p>Two alternative mediations with each dimension of attachment as predictors of mental distress, mediation by splitting, revealed no significant relationship between the attachment dimension and distress (as expected from the previous analysis), direct links between splitting and mental distress (again, as one would expect), and no mediation.</p>
            </sec>
        </sec>
        <sec id="sec14" sec-type="discussion">
            <title>Discussion</title>
            <p>While perspectives associated with attachment and object relation maturity explain difficulties in relationship management, little research has explored the distinctiveness and interrelatedness of these two processes. The current study explored these issues in the context of a non-clinical population (who had self-reported clinical levels of depression and anxiety symptoms on average). Specifically, it examined the unique variance in mental distress associated with attachment styles and the tendency to be involved in psychological splitting.</p>
            <p>The results of the study suggest that when considered individually, both anxious attachment and tendency towards splitting were related to poorer mental health. Splitting was also positively related to both anxious and avoidant attachments. However, when tested using a series of mediation models, anxious attachment was no longer an independent predictor. Splitting remained related to mental health outcomes, but was not mediated by anxious or avoidant attachment styles. Thus, this study provides initial evidence that attachment and splitting are related but distinct processes. This also suggests that the maturity of object relations is likely to be as important as attachment styles (arguably one of the current dominant approaches in psychodynamic therapy) in terms of mental health outcomes.</p>
            <p>From a theoretical perspective, this study builds on previous research that has also generally observed evidence suggesting that object relation maturity is a related but distinct set of processes related to attachment systems (
                <xref ref-type="bibr" rid="ref5">Calabrese et al., 2005</xref>; 
                <xref ref-type="bibr" rid="ref16">Levy et al., 1998</xref>; 
                <xref ref-type="bibr" rid="ref20">Mikulincer &amp; Orbach, 1995</xref>; 
                <xref ref-type="bibr" rid="ref24">Priel &amp; Besser, 2001</xref>; 
                <xref ref-type="bibr" rid="ref28">Siegel, 2006</xref>; 
                <xref ref-type="bibr" rid="ref29">Siegel &amp; Spellman, 2002</xref>, all expanded upon in the 
                <italic toggle="yes">Introduction</italic>, above). While no mediation was observed in the present study, examination of the confidence intervals suggests that object relation maturity may have an indirect effect on mental distress via anxious attachment under some conditions not identified in the present study (indicated by the far smaller lower CI than upper CI). In contrast, no such tendency was indicated by the data for avoidant attachment. This could be used as a basis to speculate that object relation maturity may be more closely linked to attachment than the current study (and others) suggests.</p>
            <p>Regardless of the exact nature of the operation of object relations on mental health and relationships, the current findings suggest the need for a renewed focus on object relation maturity as an important and (perhaps in certain times/contexts) dominant process in everyday social relationships among both clinical and nonclinical populations.</p>
            <p>Despite early exploratory work, this study has a number of potential practical implications. As splitting has a relationship with mental health and remains a unique predictor of variance in mediation models, it is likely that therapeutic work that provides clients with an opportunity to gain insight into their object relation processes, and/or space to mature them, is likely to be beneficial. The unique variance associated with distress, over and above that predicted by attachment, suggests that this work will likely be of benefit alongside more direct attachment-focused approaches &#x2013; perhaps exploring how people produce object relations at different stages of relating in, for example, those with anxious attachment styles. An intriguing possibility is that enhancing object relation maturity may be a way of generating earnt attachment security for clients. This would be profitable for future research utilizing a prospective design.</p>
            <p>The current study has several limitations. The most prominent of these was that the study was cross-sectional. This is notable, as it limits the ability of the study to make causal claims about the relationship between object relations, attachment style, and mental health outcomes. Although the presented mediation models conceptually argue for a linear process, this cannot be inferred from the current findings. Moreover, it is also likely that the systems explored in the current study are reciprocal and that patterns of relationships may change in different contexts. Related to this first limitation, it should be noted that the study was conducted on a non-clinical sample. While this is not unusual in research on either attachment processes or object relations, it is possible that there are step changes in how these systems interact among populations with high levels of attachment insecurity and/or are unable to access more mature object relation systems. It is also noteworthy that the PHQ/GAD scores of the sample were relatively high. Further research with such populations (alongside replication of the current exploratory work in a non-clinical group) would help to test the generalizability of the current findings. A final limitation is the use of scales to capture complex, arguably subconscious, processes. There are a number of well-established attachment scales, one of which was selected for this study. In contrast, scales capturing object relation maturity (including splitting) are less prevalent and have a lower level of related evidence to support their validity and reliability; in the current study, the final scale calculation was altered to address concerns around the latter. The current study adds to this emerging evidence base, and it is worth noting that splitting at both individual and dyadic levels aligned in terms of how they relate to other variables. Further validation research will provide data to strengthen the tools available to researchers in this field.</p>
        </sec>
        <sec id="sec15" sec-type="conclusion">
            <title>Conclusion</title>
            <p>In conclusion, the current study sought to understand the links between splitting and anxious and avoidant attachment. These findings suggest that these are distinct but related processes that relate to mental distress in nonclinical populations. This offers theoretical insight (around the operation of our modes of relating) and practical implications (around the use of both approaches in tandem).</p>
        </sec>
        <sec id="sec16">
            <title>Ethical considerations</title>
            <p>This research received ethical oversight from London South Bank University (reference number ETH2223-0024), granted 14
                <sup>th</sup> October 2022. The research was conducted in accordance with APA&#x2019;s ethical standards. All the participants provided written informed consent.</p>
        </sec>
    </body>
    <back>
        <sec id="sec19" sec-type="data-availability">
            <title>Data availability</title>
            <sec id="sec20">
                <title>Underlying data</title>
                <p>Open Science Framework: Data and syntax. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.17605/OSF.IO/D4TFA">https://doi.org/10.17605/OSF.IO/D4TFA</ext-link> (
                    <xref ref-type="bibr" rid="ref7">Frings, 2024a</xref>).</p>
                <p>This project contains the following underlying data:</p>
                <p>Analysis.sps: Main analysis syntax (SPSS file)</p>
                <p>Data_aggs.sps: Syntax to create aggregate variables</p>
                <p>Medpower syntax.docx: Syntax to reproduce mediation analysis</p>
                <p>
SORA_AGG_BLIND.sav; The SPSS file containing deidentified data</p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode">Creative Commons Attribution 4.0 International license</ext-link> (CC-BY 4.0).</p>
            </sec>
            <sec id="sec21">
                <title>Extended data</title>
                <p>Open Science Framework: Ethics and methods. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.17605/OSF.IO/SZU4B">https://doi.org/10.17605/OSF.IO/SZU4B</ext-link> (
                    <xref ref-type="bibr" rid="ref8">Frings, 2024b</xref>).</p>
                <p>This project contains the following extended data:</p>
                <p>Consent V1.docx: Consent form</p>
                <p>Debrief V1.docx: Debreif form</p>
                <p>Ethics-ETH2223-0024.pdf: Ethics documentation:</p>
                <p>Info V2.docx: Participant information sheet</p>
                <p>Info V2 NON LSBU RECUITMENT.docx: Participant information sheet (for participants who are not LSBU students)</p>
                <p>SORA study 1 questionnaire pack: Scale items</p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode">Creative Commons Attribution 4.0 International license</ext-link> (CC-BY 4.0).</p>
            </sec>
        </sec>
        <ack>
            <title>Acknowledgements</title>
            <p>The authors would like to thank Tiffany Lam for her support in recruiting participants for this study.</p>
        </ack>
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                <p>Achieved power analysis (using the med function, from R package pwr2ppl), indicated to identify joint mediation, the sample would achieve a power of .80 (where &#x03b1; = 0.05) under conditions where correlations between variables were r = 0.44 or greater, i.e. the mediation was sufficiently powered to detect small to medium joint mediation sized effects.</p>
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