Robert G Maunder

Robert G Maunder
Mount Sinai Hospital, Toronto · Department of Psychiatry

MD

About

145
Publications
43,376
Reads
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8,445
Citations
Citations since 2016
41 Research Items
5758 Citations
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Introduction
Please see the Youtube videos that Jon Hunter and I have made introducing the concepts of adult attachment as they relate to physical health... Attachment & Health 1: Intro to Adult Attachment: http://youtu.be/GHHCy1IHTUc + four others: Search "Maunder Hunter Attachment" on Youtube
Additional affiliations
August 1990 - present
University of Toronto
Position
  • Professor (Full)

Publications

Publications (145)
Article
Full-text available
Background The stress response includes appraisal of the threat and one’s resources, coping (including interpersonal interactions), distress, and recovery. Relationships between patterns of adult attachment and stress response have received little study in the context of prolonged, severe occupational stress, limiting knowledge about how attachment...
Article
Childhood adversity alters the relational world of the child and inhibits the development of secure attachment bonds. The purpose of this article is to survey recent evidence that attachment insecurity has the potential to impair physical health throughout the lifespan. It is proposed that attachment insecurity contributes to disease risk through a...
Article
Full-text available
Background: The mental health effects of healthcare work during the COVID-19 pandemic have been substantial, but it is not known how long they will persist. This study aimed to determine if hospital workers' burnout and psychological distress increased monotonically over 1 year, during which waves of case numbers and hospitalizations waxed and wan...
Preprint
Full-text available
Background. The mental health effects of healthcare work during the COVID-19 pandemic have been substantial, but it is not known how long they will persist. This study aimed to determine if hospital workers’ burnout and psychological distress increased monotonically over one year, during which waves of case numbers and hospitalizations waxed and wa...
Article
Background Childhood adversity is associated with somatization, including physical symptom burden and health anxiety. Attachment theory offers a developmental framework to understand adult somatization, as attachment phenomena are theoretically and empirically related to physiological regulation, affect regulation, and childhood adversity, all of w...
Article
Full-text available
Objective The COVID-19 pandemic is expected to have a sustained psychological impact on healthcare workers. We assessed individual characteristics related to changes in emotional exhaustion and psychological distress over time. Methods A survey of diverse hospital staff measured emotional exhaustion (Maslach Burnout Inventory) and psychological di...
Article
The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an ac...
Article
Full-text available
Objective Various models have been used to explain somatization, including attachment theory, which describes how formative experiences influence perceptions of vulnerability and threat. Although attachment insecurity is associated with greater physical symptoms, the mechanisms by which attachment insecurity influences the experience of physical sy...
Article
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Background: Adverse Childhood Experiences (ACEs) are common and associated with many illnesses. Most physicians do not routinely screen for ACEs. We aimed to determine if screening is related to knowledge or medical specialty, and to assess perceived barriers. Methods: Physicians in Ontario, Canada completed an online survey in 2018-2019. Data w...
Article
Full-text available
Purpose: Chemotherapy side effects diminish quality of life and can lead to treatment delay. Nausea and vomiting can occur prior to chemotherapy because of classical conditioning. We studied the effects of 20-minute behavioral interventions, administered by oncology nurses, of higher intensity (mindfulness relaxation-MR) or lower intensity (relaxi...
Article
Full-text available
Background: Adverse childhood experiences (ACEs) are associated with risk of poor adult health, including cardiometabolic diseases. Little is known about the correlates of ACEs for adults who have already developed cardiometabolic diseases, or who are at elevated risk. Methods: Adult primary care patients with cardiometabolic disease (hypertensi...
Article
Full-text available
Over their careers paramedics experience critical incidents that can negatively affect their emotional health, resulting in post-traumatic stress disorder (PTSD) and/or depression. They are at greater risk for PTSD than the general population (10% vs. 1.3%-3.5%) and other rescuer groups, likely due to frequency of exposure, workplace pressure, and...
Article
Full-text available
Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presen...
Article
Introduction and hypothesis Although some psychiatric anxiety questionnaires include overactive bladder (OAB) questions, there are few controlled data to confirm such an association. We tested the association between OAB and anxiety using a control group of women with non-OAB lower urinary tract symptoms (LUTS). Methods Patients referred to a urog...
Article
Cue-induced craving among smokers is a well-documented phenomenon. Conditioning theory is used to explain how stimuli elicit cravings. Attachment theory may explain additional influences on cue-induced craving. This study tested the effects of cigarette cues and attachment figure cues on craving and affect. Cue-reactivity as a function of cue type...
Article
Full-text available
Background and purpose Ambulance workers could benefit from a method for early identification of incidents likely to result in long-term emotional sequelae. There is evidence that persistence of some measures of anxiety beyond the first week after an incident is associated with sequlae. In this study we test the hypothesis that persistence of self-...
Article
Objective: Psychiatry residents train in Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT), evidence-supported treatments used in mental health care that can facilitate clinical reasoning, foster therapeutic alliances, and improve clinical outcomes. However, empirically derived milestones are needed to evaluate competency. This ex...
Chapter
Psychological Care in Severe Obesity - edited by Stephanie Cassin June 2018
Article
Cambridge Core - Health and Clinical Psychology - Psychological Care in Severe Obesity - edited by Stephanie Cassin
Article
Background: Standardized measurement of physical and mental health is useful for identification of health problems. Personalized feedback of the results can influence health behavior, and treatment outcomes can be improved by monitoring feedback over time. However, few resources are available that are free for users, provide feedback from validate...
Conference Paper
p>This paper proposes a compressive sensing (CS) based active user identification scheme over frequency-selective fading channels. Unlike the conventional cyclic prefix (CP) based preamble transmission, our approach does not utilize CP in order to conserve signaling overhead, in turn reducing the system-wide processing latency. Our approach first e...
Article
Full-text available
We sought to estimate the prevalence of childhood adversity and examine its relationship with health outcomes among people living with HIV. Study participants included 1409 adults living with HIV and receiving care in Toronto, Canada. Data on childhood adversity, health behaviors, HIV outcome measures, depression, and health-related quality of life...
Data
Supplemental Table 1: prevalence of individual childhood adverse events by sociodemographic characteristics (N = 1,409).
Article
Background: Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol us...
Chapter
The purpose of this chapter is to discuss an aspect of the psychosocial context of obesity that transcends diagnostic categories and is especially relevant to the management of severely obese patients. In particular, we will describe the relational context of obesity and the importance of insecure attachment and interpersonal trauma. In doing so we...
Article
Morbidity and mortality after deliberate self-harm (DSH) are high, so mental health care shortly after DSH is recommended. Using population-level health data we determined the association between a mental health visit and risk for repeat DSH with or without intensive care unit (ICU) admission or all-cause death. Over two years, 23,140 individuals h...
Article
Objective: An attachment model was used to understand how maternal sensitivity and adverse childhood experiences are related to somatization. Methods: We examined maternal sensitivity at 6 and 18 months and somatization at 5 years in 292 children in a longitudinal cohort study. We next examined attachment insecurity and somatization (health anxi...
Article
Background: Smoking behavior and smoking cessation are complex. Interpersonal factors such as childhood adversity are associated with smoking, especially in women. Identifying how and in whom these individual factors contribute to smoking behavior may support individualized smoking cessation strategies. Attachment insecurity (attachment avoidance a...
Article
Psychosocial adversity in early life increases the likelihood of mental and physical illness, but the underlying mechanisms are poorly understood. Mgat5 is an N-acetylglucosaminyltransferase in the Golgi pathway that remodels the N-glycans of glycoproteins at the cell surface. Mice lacking Mgat5 display conditional phenotypes in behaviour, immunity...
Article
Full-text available
Objectives To develop and assess the validity of measures of patients' attachment-related perceptions of experiences with healthcare providers (HCPs). Setting Online survey. Participants 181 people provided consent and 119 completed the survey (66%). Most participants were women (80%). Primary and secondary outcome measures Questions were developed...
Article
Full-text available
Background: Psychiatric syndromes are complicated by comorbidity and other factors that burden patients, making guideline-informed psychiatric care challenging, and negatively affecting outcome. A comprehensive intake tool could improve the quality of care. Existing tools to quantify these characteristics do not identify specific complications and...
Chapter
In this chapter we draw a heuristic parallel between the characteristics defined by attachment theory as optimal for developmental maturation and processes for teaching clinical competence. We have emphasize that creating a safe learning environment, and in particular a secure supervisory relationship, minimizes fear and anxiety in trainees. This s...
Chapter
In this chapter we utilize our understanding of attachment to describe behaviors and issues that typically arise within hospitals when caring for individuals with attachment insecurity. Prototypic cases are described for each of secure, preoccupied, dismissing and fearful/disorganized individuals, with suggested management strategies directed at bo...
Chapter
We turn now to fruitful areas for further work, as suggested by our author’s contributions. Dr. Kidd has summarized the future efforts required in the physiological realm, emphasizing the need for naturalistic and longitudinal studies that will allow us to understand the relevance of states that have been described within structured laboratory sett...
Chapter
This chapter provides a grounding in the basics of attachment theory, which will be built upon in later chapters in order to explicate the relevance of attachment for healthcare. The fundamentals described include: attachment classifications; the internal working model; the interplay of attachment with gender, culture, and mental illness; how attac...
Chapter
In Chap. 2, we provided a sketch of the internal working model of each attachment style and related patterns of attachment behavior. During a clinical interview or a similar interaction between a health-care provider and a patient, other aspects of communication and interaction can help a clinician acquire a deeper understanding of a patient’s atta...
Book
Can the way in which we relate to others seriously affect our health? Can understanding those attachments help health care providers treat us better? In Love, Fear, and Health, psychiatrists Robert Maunder and Jonathan Hunter draw on evidence from neuroscience, stress physiology, social psychology, and evolutionary biology toexplain how understandi...
Conference Paper
Psychiatry residency training includes clinically supervised evidence-supported treatments of Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT). Teaching and evaluation based on observation of actual therapy sessions provides opportunity to evaluate adherence, competence and learning needs. This exploratory pilot study examines th...
Article
Interpersonal support is protective in heart disease, but sources of support and the quality of support may change over time, especially with aging and disease progression. To determine if support received within an attachment relationship with a spouse is more protective than other types. Subjects were sex- and age-matched cardiac outpatients with...
Article
Full-text available
Effective workplace-based interventions after critical incidents (CIs) are needed for emergency medical technicians (EMT)/paramedics. The evidence for a period out of service post-CI (downtime) is sparse; however it may prevent posttraumatic stress disorder (PTSD) and burnout symptoms. We examined the hypothesis that downtime post-CI is associated...
Article
This study examined attachment style as a moderator of the relationship between childhood abuse and inflammatory bowel disease (IBD)-related outcomes. Study participants were 205 patients with IBD from Mount Sinai Hospital in Toronto. Participants completed self-report questionnaires regarding personal relationships, abuse history, and IBD-related...
Article
Full-text available
Objective Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods Twenty-six family medic...
Article
Models of adult attachment have proven to be useful for understanding illness behavior, stress responses, susceptibility to disease processes, and psychotherapeutic approaches to difficult patients. Two methods of assessing patterns of attachment, using self-report instruments and using techniques such as the Adult Attachment Interview (AAI), are o...
Article
Full-text available
Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their re...
Article
The relationship of psychological stress to relapse in ulcerative colitis (UC) is inconsistent. This may be due to a failure to identify patient characteristics, such as social support, which moderate the transduction of stress from the central nervous system to the immune system. In this study we tested the hypothesis that social support enhances...
Chapter
Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role transitions, and how social roles are central to our sense of identity, how all individuals may hold numerous roles (partner, child, parent, sibling, neighbor, community member, etc.), besides having vocational roles (colleague, employee, employer, or prof...
Article
Several plausible mechanisms explain how stress may increase gut inflammation. There is good evidence that stress contributes to relapse in ulcerative colitis (UC) and that depressive symptoms contribute to inflammation in Crohn's disease (CD). However, the effect size is not consistently large, and it is likely that psychological factors only cont...
Article
Well before the H1N1 influenza, health care organizations worldwide prepared for a pandemic of unpredictable impact. Planners anticipated the possibility of a pandemic involving high mortality, high health care demands, rates of absenteeism rising up to 20-30% among health care workers, rationing of health care, and extraordinary psychological stre...
Article
Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to IPT treatment attrition, dropout, nonresponse, or failure can elucidate its limitations and the opportunities to i...
Article
Full-text available
Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regul...
Article
Full-text available
Mental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure to critical incidents, the prevalence of childhood experiences with abuse and neglect and paramedics' adaptation to critical incidents may be importa...
Article
The techniques of factor analysis are used to investigate a data matrix constructed from magnetic resonance parameters for seventy-five 4-substituted styrenes, α-methylstyrenes, and α-tert-butylstyrenes and 3-substituted styrenes and α-methylstyrenes (with fifteen common substituents for each series). Two substituent factors (parameters) are clearl...
Article
Adult attachment insecurity is associated with many health outcomes and may be associated with sleep disturbance. The purpose of this study was to test the hypothesis that sleep disturbance mediates the relationship between attachment insecurity and three measures of health (perceived general health, physical symptoms and sick days) in a group that...
Article
Full-text available
Ambulance workers could benefit from a method for early identification of incidents likely to result in long-term emotional sequelae. There is evidence that persistence of some measures of anxiety beyond the first week after an incident is associated with sequelae. In this study we test the hypothesis that persistence of self-identifiable component...
Article
Full-text available
Objective: Over the past 25 years, attachment research has extended beyond infant-parent bonds to examine dyadic relationships in children, adolescents, and adults. Attachment has been shown to influence a wide array of biopsychosocial phenomena, including social functioning, coping, stress response, psychological well-being, health behavior, and...
Data
Example of interactive reflective exercise video. Reflective exercises take < 4 min to complete in addition to the time spent viewing the video. The path through the exercise is highly personalized with more than 3000 possible pathways within the program's logic. The goal is not prescriptive, but rather to increase reflection, diminish non-reflecti...
Article
Full-text available
Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior...
Article
We investigated the prevalence of childhood adversity among healthcare workers and if such experiences affect responses to adult life stress. A secondary analysis was conducted of a 2003 study of 176 hospital-based healthcare workers, which surveyed lifetime traumatic events, recent life events, psychological distress, coping, social support, and d...