1. The Effect of Prolonged
Attachment to Transitional
Object on Anxiety Level and
Sleep Quality in Undergraduate
Students
Presented by
Meng Yie, Si Toh

2. (St. Wenceslaus, n.d.)

3. (a) mother (b) child (1) illusion (2) transitional object
(Winnicott, 1971)

4. (Bandura, 1977)
• Imitation: mimics behaviour of siblings
• Showing the child that he or she are going to sleep
together with the object.
(Markt & Johnson, 1992)

5. Age of TOs Utilization
• the attachment to TO fades away after losing its
comforting role (Winnicott, 1971).
• about half of children in a previous study kept
their TOs until the age of 9 (Sherman, Hertzig,
Austrian, & Shapiro, 1981).
• emotional connection towards an object did not
fade away easily, may even continue until
adulthood (Pappas, 2010).

6. Anxiety
• type of emotion with
– tense feeling
– worried thoughts
– increased blood pressure
(APA, n.d.)

7. TOs and Anxiety
• functions as comforter that helps relieve
anxiety
(Passman & Weisberg, 1975; Passman, 1976;
Passman, 1977; Markt & Johnson, 1992;
Mikulincer, Orbach & Iavnieli, 1998)

8. Sleep Quality
• measurement of sleep:
– total sleep time (TST),
– sleep onset latency (SOL),
– degree of fragmentation,
– total wake time,
– sleep efficiency,
– sleep disruptive events: natural arousals or
apnea
(Buysse, Reynolds III, Monk, Berman, & Kupfer, 1988;
Krystal & Edinger, 2008).

9. TOs and Sleep
• promote sleep
(Boniface & Graham, 1979; Mahalski, 1983; Markt &
Johnson, 1992)
• no research finding - TOs & sleep quality

10. Why?
• research interest - on interventions to
reduce anxiety and improve sleep quality
of students.
• medicines found to be unstable over its
effectiveness (Sleep Health Foundation,
2011).

11. Research Question
• Does the prolonged use of TO until
adulthood with different anxiety level affect
sleep quality?

12. Hypotheses
• Individuals that have higher anxiety level
with current attachment to TOs have better
sleep quality as compared to those without
any attachment to TOs.
• Individuals with or without attachment to
TOs who scores lower in anxiety scale
have better sleep quality as compared to
those who scores higher.

13. Method

14. Study Design
• Online Survey (Qualtrics.com)
– higher reliability for cost and time
effectiveness (Jr. & Schonlau, 2002; Duffy,
Smith, Terhanian, & Bremer, 2005; Evans &
Mathur, 2005)

15. Variables
• IVs:
– The use of TOs (two levels)
– Anxiety level (four levels)
• DV: sleep quality

16. Participants
• 64 participants involved. 12 were omitted.
– 18 to 25 years old
– 14 males and 38 females
– undergraduate students studying in UK

17. Materials
• Demographic sheet
• Pittsburgh Sleep Quality Index (PSQI; Buysse,
Reynolds III, Monk, Berman, & Kupfer, 1988)
– 0 (better) - 21 (worse)
• Beck Anxiety Inventory (BAI; Beck, Epstein,
Brown, & Steer, 1988)
– minimal: 0 - 7, mild: 8 - 15, moderate: 16 - 25,
severe: 26 - 63

18. Procedure
• researcher’s email address was shared on
facebook.
• PIS and PCF were sent to the
respondents which required them to sign
and email it back.
• survey link was then given.
• email back to thank them for their
participation.

19. Analysis
• Between-subject anova (4x2)
• Multiple regression (mediation)

20. Result & Discussion

21. Between-subject Anova
• no significant effect
– anxiety level on sleep quality, F(3, 44) =
1.75, p > .05
–the usage of TO on sleep quality, F(1,
44) = 1.12, p > .05
–interaction effect did not approach
significance as well, F < 1.

22. Figure 1. Means of sleep quality with
anxiety level and the usage of TO.

23. Multiple Regression
• linear regression
– utilization of TO on sleep quality, ignoring the
mediator, was significant, b = -.75, t(50) = -
2.24, p < .05.
• multinomial logistic regression
– use of TO on anxiety level, not significant,
X2(3) = 3.05, p > .05.

24. Discussion
• both hypotheses were not supported.
• small sample size, only 64 participants.
– previous research based on 185
undergraduate students: people with
increased levels of anxiety sleep better with
the aids of inanimate objects (Markt &
Johnson, 1992).

25. Further Implications
• contact with their TOs during sleep.
– the pleasant feelings developed through
contacting with TOs may improve sleep
quality (Markt & Johnson,1992) .
• transform to experimental design, perhaps
with the use a sleep centre or EEG-based
screening.

26. Conclusion
• lack of research about TOs in a variety of
populations.
• the relationship between TOs and mental
health on different populations employing
a variety of mental health measurements.

27. References
American Psychological Association. (n.d.). Anxiety. Retrieved on November 30, 2013 from http://www.apa.org/topics/anxiety/
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Beck, A. T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety psychometric properties. Journal of
Consulting and Clinical Psychology, 56, 893-97.
Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1988). The Pittsburgh Sleep Quality Index: A new instrument for
psychiatric practice and research. Psychiatry Research, 28, 193 – 213. doi:10.1016/0165-1781(89)90047-4
Duffy, B., Smith, K., Terhanian, G., & Bremer, J. (2005). Comparing data from online and
face-to-face surveys. International Journal of Market Research, 47(6), 615 – 639. Retrieved from
http://yjfagnf.m-public.com/Assets/Docs/Archive/Publications/comparing-data.pdf
Evans, J. R., & Mathur, A. (2005). The value of online surveys. Internet Research, 15(2), 195 – 219. doi:10.1108/10662240510590360
Jr., R. D. F., & Schonlau, M. (2002). Advantages and disadvantages of internet research surveys: Evidence from the literature. Field Methods,
14(4). 347 – 367. Retrieved from http://schonlau.net/publication/02fieldmethods.pdf
Krystal, A. D., & Edinger, J. D. (2008). Measuring sleep quality. Sleep Medicine, 9(1), 10 – 17. doi:10.1016/S1389-9457(08)70011-X
Markt, C., & Johnson, M. (1992). Transitional objects, pre-sleep rituals, and psychopathology. Child Psychiatry and Human Development, 23(3),
161 – 173. doi:10.1007/BF00707147
Mikulincer, M., Orbach, I. & Iavnieli, D. (2008). Adult attachment style and affect regulation: Strategic variations in subjective self-other similarity.
Journal of Personality and Social Psychology, 75(2), 436 – 448. doi:10.1037/0022-3514.75.2.420
Pappas, S. (2010). Even grown-ups need security blankets. Retrieved on 23rd October, 2013 from http://www.livescience.com/8737-grown-ups-
security-blankets.html
Passman, R. H. (1976). Arousal reducing properties of attachment objects: Testing the functional limits of the security blanket relative to the
mother. Developmental Psychology, 12(5), 468 – 469. doi:10.1037/0012-1649.12.5.468
Passman, R. H. (1977). Providing attachment objects to facilitate learning and reduce distress: Effects of mothers and security blankets.
Developmental Psychology, 13(1), 25 – 28. doi:10.1037/0012-1649.13.1.25
Passman, R. H., & Weisberg, P. (1975). Mothers and blankets as agents for promoting play and exploration by young children in a novel
environment: The effects of social and nonsocial attachment objects. Developmental Psychology, 11(2), 170 – 177. doi:10.1037/h0076464
Sherman, M., Hertzig, M., Austrian, R., & Shapiro, T. (1981). Treasured objects in school-aged children. Pediatrics, 68(3), 379 – 386. Retrieved
from http://search.ebscohost.com.proxy-lib.anglia.ac.uk/login.aspx?direct=true&db=pbh&AN=4752658&site=ehost-live
Sleep Health Foundation. 2011. Anxiety and sleep. Retrieved from http://sleephealthfoundation.org.au/pdfs/Anxiety%20and%20Sleep.pdf
St. Wenceslaus, (n.d.). Project Linus. Retrieved from http://www.stwenc.org/St_Wenceslaus/Christian_Mothers/Project-Linus.html
Winnicott, D. W. (1971). Playing and reality. London: Routledge.

28. The End~
Thank you! ☺

29. Q & A