The Effect of Insecure Attachment Style on the Severity of Perceived Stress through the Mediating Role of Mindfulness in Patients with Psychodermatological Disorders Attending Counseling Centers in Tehran

Abstract

Introduction and Aim: Psychodermatological disorders are influenced by complex interactions between biological, psychological, and emotional factors, and the severity of symptoms is often associated with patients’ perceived stress. The present study aimed to investigate the effect of insecure attachment style on the severity of perceived stress through the mediating role of mindfulness in patients with psychodermatological disorders attending counseling centers in Tehran.

Methodology: This study was applied in terms of purpose and quantitative with a descriptive-correlational design. The statistical population consisted of all patients with psychodermatological disorders attending counseling centers in Tehran in 2025. A total of 220 participants were selected using convenience sampling, and after excluding incomplete questionnaires, 213 cases were included in the final analysis. Data collection instruments included Brennan et al.’s Insecure Attachment Scale, Cohen et al.’s Perceived Stress Scale, and Baer et al.’s Five Facet Mindfulness Questionnaire. Validity was confirmed through content and construct validity, while reliability was verified using Cronbach’s alpha, composite reliability, and McDonald’s omega coefficients. Data were analyzed using SPSS-27 and SmartPLS-3 through Pearson correlation analysis, confirmatory factor analysis, and structural equation modeling.

Findings: The findings indicated that insecure attachment style had a significant positive effect on perceived stress (β=0.738, p<0.01). Mindfulness showed a significant negative effect on perceived stress (β=-0.751, p<0.01). In addition, insecure attachment style had a significant negative effect on mindfulness (β=-0.762, p<0.01). Mediation analysis further revealed that mindfulness significantly mediated the relationship between insecure attachment style and perceived stress, with a total effect of β=1.31. The goodness-of-fit indices, including GOF=0.532 and NFI=0.983, confirmed the acceptable fit of the structural model.

Conclusion: The results demonstrated that insecure attachment style may increase the severity of perceived stress in patients with psychodermatological disorders through reducing mindfulness capacity. Therefore, enhancing mindfulness skills and addressing maladaptive attachment patterns can be considered effective components of psychological interventions aimed at reducing stress and improving psychological well-being in this population.