title: A systematic review of adult attachment and social anxiety.
abstract: Attachment has been implicated in the development of social anxiety. Our aim was to synthesise the extant literature exploring the role of adult attachment in these disorders.
  
  
  
  Search terms relating to social anxiety and attachment were entered into MEDLINE, PsycINFO and Web of Science. Risk of bias of included studies was assessed using and adapted version of the Agency for Healthcare Research and Quality assessment tool. Eligible studies employed validated social anxiety and attachment assessments in adult clinical and analogue samples. The review included cross sectional, interventional and longitudinal research.
  
  
  
  Of the 30 identified studies, 28 showed a positive association between attachment insecurity and social anxiety. This association was particularly strong when considering attachment anxiety. Cognitive variables and evolutionary behaviours were identified as potential mediators, concordant with psychological theory.
  
  
  
  Due to a lack of longitudinal research, the direction of effect between attachment and social anxiety variables could not be inferred. There was substantial heterogeneity in the way that attachment was conceptualised and assessed across studies.
  
  
  
  The literature indicates that attachment style is associated with social anxiety. Clinicians may wish to consider attachment theory when working clinically with this population. In the future, it may be useful to target the processes that mediate the relationship between attachment and social anxiety.
authors.affiliation: Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Wigan CAMHS, Manchester Road, Higher Ince, Wigan WN2 2JA, United Kingdom. Electronic address: RManning27@gmail.com.
authors.forename: Ray P C
authors.initials: RP
authors.lastname: Manning
authors.affiliation: Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Psychology Department, Edith Cowan University, Australia.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Dickson
authors.affiliation: The Psychosis Research Unit, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom; Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Jasper
authors.initials: J
authors.lastname: Palmier-Claus
authors.affiliation: Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool L69 3GB, United Kingdom.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cunliffe
authors.affiliation: Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taylor
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology; D003430:Cross-Sectional Studies; D006801:Humans; D008016:Life Change Events; D009769:Object Attachment; D010698:Phobic Disorders / Q000523:psychology*; D012307:Risk Factors; D012928:Social Desirability; D012931:Social Environment
keywords: Adults; Attachment; Review; Social anxiety; Social phobia