title: The role of attachment in recovery after a school-shooting trauma.
abstract: BACKGROUND
  Survivors of life-endangering trauma use varying resources that help them to recover. Attachment system activates in the times of distress, and is expected to associate with stress responses, arousal regulation, and mental health.
  
  
  OBJECTIVE
  We examined the associations of attachment style with posttraumatic stress disorders (PTSD) symptoms and dissociative symptoms, and posttraumatic growth (PTG) among students exposed to a school shooting in Finland in a three-wave follow-up setting.
  
  
  METHODS
  Participants were students (M age=24.9 years; 95% female) who were followed 4 (T1, N=236), 16 (T2, N=180), and 28 months (T3, N=137) after the shooting. The assessments included the Attachment Style Questionnaire, the Impact of Event Scale, part of the Adolescent Dissociative Experiences Scale and the Posttraumatic Growth Inventory.
  
  
  RESULTS
  Securely attached survivors had lower levels of posttraumatic stress and dissociative symptoms than preoccupied at T1 and T2 as hypothesized. At T3 survivors with avoidant attachment style had higher levels of intrusive and hyperarousal symptoms than those with secure style. Concerning PTG, survivors with avoidant attachment style scored lower in PTG at T3 than survivors with both secure and preoccupied style.
  
  
  CONCLUSIONS
  Secure attachment style was beneficial in trauma recovery. A challenge to the health care systems is to acknowledge that survivors with preoccupied and avoidant attachment styles react uniquely to trauma, and thus need help in different doses, modalities, and timings.
authors.affiliation: Hospital District of South Ostrobothnia, Seinäjoki, Finland ; Department of Psychology, School of Social Sciences and Humanities, University of Tampere, Tampere, Finland.
authors.forename: Tuija
authors.initials: T
authors.lastname: Turunen
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland ; Department of Psychiatry, Helsinki University Central Hospital, Peijas, Finland.
authors.forename: Henna
authors.initials: H
authors.lastname: Haravuori
authors.affiliation: Department of Psychology, School of Social Sciences and Humanities, University of Tampere, Tampere, Finland.
authors.forename: Raija-Leena
authors.initials: RL
authors.lastname: Punamäki
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland ; Department of Adolescent Psychiatry, Helsinki University Central Hospital, Espoo, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Suomalainen
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland ; Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Mauri
authors.initials: M
authors.lastname: Marttunen
keywords: Attachment style; dissociation; posttraumatic growth; posttraumatic stress symptoms; school violence