Well I didn't sleep too well last night.  Catero, my wife, and I went to the cinema yesterday evening and watched "500 Days of Summer" . I enjoyed it and it got me thinking about relationships.  The "Summer" of the title is a woman who doesn't believe in romantic love.  She's kind of charming and maddening and, as I biked away from the cinema, I wondered how I would have approached treating her if she had come to me for therapy!  Interestingly a newspaper reviewer commented that the film is "weirdly incurious about the inner life of its female lead".

I was curious.  Before going to bed I happened to read another chapter of Sharon Begley's book "The plastic mind" (see below for more details).  It was chapter 8 "Blaming mom? Rewired for compassion." which looks at attachment style.  We human beings are very vulnerable and dependent when we're young.  Without a good, protective parent figure we're wide open to all kinds of damage and - in early hunter-gatherer environments where our emotional repertoire developed - without a safe parent figure we would simply have died.  We're the descendants of people who managed to achieve good early protective bonding.  Adult humans are naturally orientated to care for vulnerable young.  Young humans are naturally orientated to look for protection from safe adults, especially when they feel threatened.  Our evolution and survival as a species depended on these inner "programmes".

If this early care-seeking system operates as it should and is reciprocated, then children tend to grow up into adults who feel good about themselves and others.  Begley looks at this through the lens of attachment theory and writes "Those early experiences, as well as experiences throughout life that reinforce them, leave a deep imprint on the personality, attitudes, and behaviour of a child as well as the adult he becomes.  People who are emotionally secure are comfortable with closeness and interdependence, trusting that they will find solace in those to whom they are closest.  From this foundation, they are able to form rewarding relationships.  But the sense of emotional security reverberates beyond personal relationships.  People who are securely attached tend to view life's problems as manageable and, as a result, maintain their sense of optimism ... Because as children they were loved and valued, they view themselves not only as strong and competent - the facet of character from which their optimism springs - but also as valuable, worthy of love, and special.  They believe that their own actions can often reduce their distress and solve their problems but that, when that fails, they can turn to others." 

A sense of "secure attachment", learned from experiences of good early parenting and good subsequent key relationships, affects our sense of ourselves and how we relate to others as adults.  Secure attachment also affects our ability to be empathic and compassionate with others.  It helps to protect us from being prejudiced, defensive, and judgemental.  It profoundly affects the way we see the world we live in, and the world we create around ourselves. 

Very sadly, many of us when young don't receive adequate and consistent loving care from the adults (typically parents) who should be available to look after us.  This may well lead to forms of "insecure attachment".  In broad brush terms, insecure attachment has been viewed as coming in two styles.  In one, "anxious attachment", the individual's response is to "try harder", so they anxiously search for closeness.  They may well "look for trouble", not trusting that other people will be consistently there for them.  They typically don't feel good about themselves, that they are worthy of being loved, or that they will be able to cope adequately on their own.  The world and the problems it throws up may well feel threatening and overwhelming.  In the other classical insecure attachment style "avoidant attachment", the person "gives up" on searching for good, supportive relationships.  They lose trust and go it on their own.  They tend to be emotionally distant, and may well come to find genuinely close relationships threatening.  In the real world, these simplified categories are actually probably better viewed as dimensions.  We can probably pretty much all - in certain situations - feel secure, anxious or avoidant.  However we will tend towards one attachment category more than the others.  Research (see Bakermans-Kranenburg et al below) found that in North American "non-clinical" mothers, 58% were classified as securely attached, 23% as dismissing (avoidant), and 19% as preoccupied (anxious).  In groups of people attending psychotherapy, it's very likely that the proportion suffering from insecure (particularly anxious) attachment is likely to be higher than 19% - and in any case it is more accurate to think of this as scoring high on the dimension of anxious attachment in certain situations or relationships rather than simply being in a particular category all the time.       

Reading Begley's chapter "Blaming mom?" reminded me of the importance of the attachment literature.  Most excitingly Begley wrote particularly about the work of Professor Phil Shaver of University of California, Davis.  Shaver is a world expert on adult attachment and he has a particular interest in the interaction between attachment style, relationships and compassion.  He and colleagues have found that we can reverse many of the damaging effects of avoidant and anxious attachment styles using a variety of methods, including various forms of imagery.  In a recent paper (see Omri et al below) reported on "Altering a person's sense of security in the short run in the laboratory", saying "Several methods have been used to create short-term changes in people's sense of security in the laboratory.  These methods involve: (a) exposing people (subliminally or supraliminally) to security-related words (e.g., love, hug, affection, and support) or the names of an individual's security-providing attachment figures; (b) exposing people (subliminally or supraliminally) to pictures representing attachment security; and (c) asking participants to recall memories of being loved and supported by attachment figures, or asking people to imagine such scenarios. These priming procedures have been shown to influence such diverse variables as mood, attitudes toward novel stimuli, reactions to out-group members, death anxiety, aggression, and compassion and altruism. Moreover, security priming seems to reduce distortions in body image common among women with eating disorders and decrease symptoms of mild PTSD.  The idea behind both subliminal and supraliminal priming manipulations is that stimuli associated with a sense of security enter a semantic network and create a process of ‘spreading activation' that touches upon affective as well as semantic ‘nodes', thereby creating a sense of security similar to that which might be evoked by supportive attachment figures."

Omri et al also went on to discuss effects on "Long-term effects of security priming", commenting "In cognitive priming experiments, it has generally been found that the effects of priming one of two associated words and then measuring the speed of identifying the other word (‘semantic priming') last only a few seconds. However, exceptions to that conclusion have been noted.  Cave (1997) found that effects of semantic priming could be detected between 6 and 48 weeks after the priming procedure took place. Mitchell (2006) reported that people who saw pictures for only 1 to 3 seconds could identify fragments of them 17 years later. Similarly, when personality trait concepts instead of simple words were used as primes, the effects seemed to persist beyond the confines of the priming experiment. For example, Srull and Wyer (1980) found that priming participants with trait words such as ‘hostile' and ‘kind' affected evaluative judgments of a target person 24 h later. Dasgupta and Greenwald (2001) primed study participants with pictures of admired black or disliked white individuals and found that it weakened implicit pro-white attitudes measured 24 h after the priming session. Recently, Lowery, Eisenberger, Hardin, and Sinclair (2007) subliminally primed participants with intelligence-related words and found that it improved their test performance in an actual midterm examination one to four days after the priming session.  In addition to the nature of a prime, repeating its presentation seems to affect the duration of its effects. Brown, Jones, and Mitchell (1996), for example, found that as the number of exposures to the prime (repetitions) increased, the effects of the prime were stronger and longer lasting.  Similarly, Salasoo, Shiffrin, and Feustel (1985) found that accuracy of identification a year after priming was affected by number of repetitions of the prime stimuli.  In line with the abovementioned findings, we suggest that security primes are likely to result in long-term effects, especially when people are repeatedly exposed to such primes. Based on Bowlby's (1973) conceptualization that repeated interactions with an attachment figure not only alter attachment-system functioning in the short term but also affect consolidation of working models in the long term, we would expect repeated security priming to have long-lasting effects on people's attitudes and behaviors."

It's been said "Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support."   I think clinical application is growing and this is likely to be of real benefit. (For a further blog posting on attachment, see "A couple of fine, recent books on attachment").

Begley, S. (2009). "The plastic mind: new science reveals our extraordinary potential to transform ourselves."  London: Constable & Robinson, 2009.  [AbeBooks]  [Amazon UK]

Bakermans-Kranenburg, M. and M. van Ijzendoorn (2009). "The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups." Attachment & Human Development 11: 223-263.  [Abstract/Full Text] More than 200 adult attachment representation studies, presenting more than 10,500 Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) classifications, have been conducted in the past 25 years. In a series of analyses on the distributions of the AAI classifications in various cultural and age groups, fathers, and high-risk and clinical samples, we used the distribution of the combined samples of North American non-clinical mothers (23% dismissing, 58% secure, 19% preoccupied attachment representations, and 18% additionally coded for unresolved loss or other trauma) to examine deviations from this normative pattern, through multinomial tests and analyses of correspondence. The analyses were restricted to AAI classifications coded according to the Main, Goldwyn, and Hesse (2003) system. We did not find gender differences in the use of dismissing versus preoccupied attachment strategies, and the AAI distributions were largely independent of language and country of origin. Clinical subjects showed more insecure and unresolved attachment representations than the norm groups. Disorders with an internalizing dimension (e.g., borderline personality disorders) were associated with more preoccupied and unresolved attachments, whereas disorders with an externalizing dimension (e.g., antisocial personality disorders) displayed more dismissing as well as preoccupied attachments. Depressive symptomatology was associated with insecurity but not with unresolved loss or trauma, whereas adults with abuse experiences or PTSD were mostly unresolved. In order to find more reliable associations with clinical symptoms and disorders, future AAI studies may make more fruitful use of continuous AAI scales in addition to the conventionally used categorical classifications.

Omri, G., S. Emre, et al. (2008). "Moving Toward a Secure Attachment Style: Can Repeated Security Priming Help?" Social and Personality Psychology Compass 2(4): 1651-1666.  [Abstract/Full Text] 
Despite the abundant literature on attachment processes and the development of a secure or insecure attachment orientation during childhood, it is still unclear whether adult attachment style can be changed through systematic interventions, and if so how the change process works. One way to learn more about such change is to create it, on a small scale, in the laboratory. It is already known that a person's sense of security can be momentarily changed in the laboratory (Mikulincer & Shaver, 2007a). But there is clearly a difference between very short-term and longer-term change. According to Bowlby (1982), the development of an attachment orientation in childhood is based on many encounters and interactions with caregivers, which gradually create a mental network of relatively stable expectations and concerns. Thus, it may take many episodes of security priming in a laboratory to begin to affect a young adult's attachment style in a lasting way. Here, we explore this possibility, review existing evidence from our own and other researchers' laboratories, and discuss directions for future research.

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