复杂性创伤后应激障碍（Complex Posttraumatic Stress Disorder, 简称CPTSD）被认为是一种不同于创伤后应激障碍（Posttraumatic Stress Disorder, 简称PTSD）的独立诊断，在症状上与PTSD相区分。CPTSD除了包含PTSD核心症状（侵入性症状、回避性症状、高警觉症状），还包含自我组织功能失调（Disturbance in self-organization，简称DSO）的核心症状（情绪调节困难、负性自我认知、人际关系问题）。目前，关于CPTSD概念的适用性及其结构，尚未在中国文化背景下的创伤群体中进行验证。以往的理论观点认为，依恋关系对CPTSD形成有重要影响，且由于CPTSD中还包含了DSO症状，DSO症状与依恋关系也有重要的联系，因此亟需研究从实证角度考察依恋与CPTSD之间的关系。基于依恋的理论框架，可以从关系经验层面对CPTSD症状进行阐释，而依恋对CPTSD产生作用的个体心理过程仍不清楚。有研究者指出，依恋这一关系层面的概念拓展到个体层面，与正念这一概念有许多相通之处。因此，以正念为中介变量考察依恋对CPTSD的影响机制，可以整合关系和个人的视角，更深入地理解CPTSD形成的心理过程。为此，本研究拟探讨三个问题：（1）在中国文化背景下的成年初期创伤群体中，CPTSD能否作为一种独立诊断？（2）依恋是否会影响CPTSD的症状水平？（3）依恋对CPTSD影响的作用机制是怎样的？正念在依恋对CPTSD的影响中是否发挥中介作用？

为了回答以上问题，本研究共进行了三个系列研究（包括8个子研究），研究一对中国文化背景下的CPTSD概念适用性及其结构进行了验证；研究二结合横断研究和实验研究考察依恋对CPTSD的影响，以及反复依恋安全启动能否作为干预CPTSD的方法；研究三则关注依恋影响CPTSD的机制，将研究视角进一步拓展到个人层面的正念，构建CPTSD的关系-个人模型，从横断关系、因果关系到日常情境中，考察正念在依恋对CPTSD影响中的中介作用，以验证CPTSD的关系-个人模型。具体研究如下：

研究一包含两项子研究：研究1a采用潜剖面分析的方法，在1760名有创伤经历的成年初期大学生群体中，支持了CPTSD可以作为一种独立诊断，与PTSD相区分；研究1b在研究1a的基础上，采用网络分析的方法进一步从症状层面支持了CPTSD结构的稳定性，即在成年初期创伤群体中，CPTSD包含PTSD和DSO两个维度，并发现人际关系问题是CPTSD症状网络的核心症状。

研究二包含三项子研究：研究2a从横断关系的视角，在302名有创伤经历的成年初期大学生群体中，验证了依恋焦虑对PTSD、DSO有显著正向预测作用，依恋回避对DSO具有显著正向预测作用；研究2b在126名有创伤经历的大学生中，采用实验研究范式（单因素四水平被试间设计：依恋安全启动组、依恋焦虑启动组、依恋回避启动组、控制组），通过依恋启动考察其对CPTSD的影响，结果发现依恋回避启动会显著提升PTSD症状水平，依恋安全启动会显著降低DSO症状水平；研究2c在连续6天的日常情境下，在102名有创伤经历的大学生中，采用反复启动依恋安全的实验范式考察这一启动范式作为CPTSD干预方法的可能性，结果发现依恋安全的反复启动使得CPTSD症状水平呈下降趋势，但这一趋势并未达到统计上的显著水平。

研究三包含三项子研究：研究3a从横断视角，在230名有创伤经历的大学生中，发现正念在依恋焦虑对CPTSD的影响中起中介作用，在依恋回避对CPTSD的影响中也起中介作用；研究3b采用实验法，通过启动依恋，在374名有创伤经历的大学生中，在因果关系的层面上分别支持了正念在依恋焦虑和依恋回避对CPTSD影响中的中介作用；研究3c通过日记法，在122名有创伤经历的大学生中，发现个体的每日依恋焦虑会通过每日正念影响其每日的CPTSD症状水平，支持了依恋焦虑—正念—CPTSD在每日动态关系中也是成立的。

鉴于本研究共有五项子研究（包括研究二的2项子研究和研究三的3项子研究）包含依恋与CPTSD之间的关系，且采用了不同的研究方法（问卷法、实验法）和不同的被试，为了将所有结果进行汇总，计算总效应量，本研究对五项子研究进行了内部元分析（k = 5, N = 875）。结果支持了依恋焦虑对PTSD、DSO的显著正向预测作用（r = 0.27, p < .001; r = 0.35, p < .001），也支持了依恋回避对PTSD、DSO的显著正向预测作用（r = 0.17, p < .001; r = 0.20, p < .001）。

综合以上结果，本研究指出CPTSD在中国文化背景下可以作为一种独立的诊断，在症状上与PTSD相区分，且其结构是稳定的，即包含PTSD和DSO；另外，依恋焦虑和依恋回避对CPTSD的形成有重要影响，但将反复启动依恋安全作为CPTSD的干预方法仍需更多细节上的考虑；最后，正念在依恋焦虑、依恋回避对CPTSD的影响中发挥着中介作用，本研究在此基础上构建了CPTSD的关系-个人模型，这对于CPTSD的理论建构和未来干预方向有重要的启示。

In the International Classification of Diseases 11th Revision (ICD-11), complex posttraumatic stress disorder (CPTSD) was proposed as a distinct disorder from posttraumatic stress disorder (PTSD). The ICD-11 model of CPTSD is comprised of three core symptoms of PTSD: re-experiencing the trauma here and now(Re), avoidance of traumatic reminders(Av), and persistent perceptions of heightened current threat(Th), as well as three symptom clusters that represent disturbances of self-organization (DSO), namely affective dysregulation (AD), negative self-concept (NSC), and disturbances in relationships (DR). Although a number of studies supported the construct validity of CPTSD in Western culture, less is known about the conclusion among Chinese population. Additionally, previous theoretical perspectives suggest that attachment plays an important role in the development of CPTSD, but lacking empirical study investigate the association between attachment and CPTSD. Moreover, it is not clear about the mechanism underlying attachment and CPTSD. Since attachment is an interpersonal process linked to CPTSD, here we propose that mindfulness can be regarded as an intrapersonal mechanism that helps explain the relationship between attachment and CPTSD.

The present research conducted three studies (including 8 sub-studies) to address these questions. We selected people who experienced at least one traumatic event as our participants. Study 1 examined the construct validity of CPTSD among Chinese young adults. Study 2 investigated the effect of attachment on CPTSD from both cross sectional and casual perspective, and also explored the potential effectiveness of repeated attachment security priming on CPTSD symptoms. Study 3 further demonstrated the mediating role of mindfulness between attachment and CPTSD based on cross-sectional study, experimental study, as well as daily dairy study.

By utilizing latent profile analysis, Study 1a found that CPTSD was a distinct disorder from PTSD among 1760 Chinese young adults. In Study 1b, network analysis was performed and the results supported the ICD-11 model of CPTSD (i.e., includes PTSD and DSO). This analysis also demonstrated an important finding that the disturbance in relationship was the core symptom in CPTSD symptoms network among Chinese population.

Study 2a assessed the cross-sectional relationship between attachment and CPTSD among 302 young adults, and found that attachment anxiety was positively correlated with PTSD and DSO, and attachment avoidance was positively related to DSO. Study 2b conducted an online experiment (attachment security priming group / attachment anxiety priming group / attachment avoidance priming group vs. control group) among 126 young adults.. The results showed that attachment avoidance manipulation increases PTSD symptoms, and attachment security manipulation decreases DSO symptoms. Study 2c explored the potential effectiveness of repeated attachment security priming on the CPTSD symptoms among 102 young adults, and found the effect of repeated attachment security on the CPTSD symptoms was not significant. 

Study 3a found that mindfulness mediated the relations between attachment and CPTSD among 230 young adults using a cross-sectional design. Study 3b further examined the mediating role of mindfulness on the links between attachment and CPTSD among 374 young adults using experimental study. Study 3c used diary study and found that daily attachment anxiety was related to higher daily CPTSD symptoms level through lower daily level of mindfulness.

To summarize the relation between attachment and CPTSD, we conducted an internal meta-analysis. Results revealed that there was significant relations between attachment anxiety and PTSD (r = 0.27, p < .001 ) and DSO (r = 0.35, p < .001), as well as between attachment avoidance and PTSD (r = 0.17, p < .001) and DSO (r = 0.20, p < .001).

To conclude, the present study supported the proposition that ICD-11 CPTSD is a distinct disorder from PTSD and it has a stable structure. Additionally, the current study provided robust empirical evidence for the association between attachment and CPTSD, and showed that attachment anxiety and attachment avoidance played important roles in the development of CPTSD. However, the repetitive attachment security priming method did not show significant effect for the intervention of CPTSD, and clearly this approach needs more improvement in the future. Finally, this study revealed that mindfulness was an important intrapersonal mechanism that helps explain the relationship between attachment and CPTSD. Based on these findings, the present study proposed an interpersonal-intrapersonal model of CPTSD. We believe this evidence-based theoretical model makes an important contribution to the CPTSD literature, and provides valuable implications for future clinical interventions.