A systematic review of attachment interventions for people with intellectual disability and their caregivers.

OBJECTIVE: The current mixed-methods systematic review evaluated available literature to find out which attachment-based interventions have been implemented for people with intellectual disability and whether they are efficacious and acceptable. METHODS: Five databases were searched (in July 2023 and April 2024), using terms related to intellectual disability and attachment-based interventions. The search yielded 793 papers; 15 papers (13 studies) met inclusion criteria. Relevant data was extracted from each study. Paper quality was appraised using the Mixed Methods Appraisal Tool. Findings were synthesised in an integrative review. RESULTS: Of the included studies, 7 had people with intellectual disability as participants and 6 had their caregivers. Interventions included education, psychotherapy, technology assisted therapy, video interaction guidance/feedback and circle of security. Research methods varied. CONCLUSIONS: Evidence for efficacy and acceptability of interventions was mixed but promising. Most studies had limited generalisability. Therefore, further research is required. Pre-registration with PROSPERO [351287].

A Comprehensive Scoping Review of Empirical Studies on Earned Secure Attachment.

Earned-Secure Attachment (ESA) can be defined as the process by which individuals with insecure childhood attachment rise above malevolent childhood experiences to develop secure relationships pattern in adulthood. To our knowledge, no previous review has summarized findings from empirical literature about this topic. To fill this gap, we conduct a preregistered scoping review (research published until 2023) following the PRISMA Extension for Scoping Reviews, to find how ESA has been defined, assessed, and studied in the empirical literature. Four databases were searched (Scopus, PsycInfo, PubMed and Web of Science), 24 studies were included in the review and were assessed using the Mixed Methods Appraisal Tool. Findings from our review reveal a more formal than substantial agreement on the conceptualization of ESA and the conclusions that can be made, considering the heterogeneity of our results, are only preliminary. Developmental factors, the association between ESA and depressive symptoms and the role of fathers remain poorly defined, although the importance of secondary attachment figures and reflective functioning as factors that may contribute to earned-security in attachment is clear. Recommendations and future steps for researchers and practitioners are highlighted.

Congenital absence of touch does not preclude normal cognitive and socioemotional development.

Attachment theory holds that development of normal affective and social behavior requires physical contact between infant and caregiver. The elevation of touch to paramount importance has gone unchallenged because, prior to the present study, no individual with a congenital lack of somatosensation has been reported, much less studied for psychosocial development. Here we describe Kim, who since birth, has been unable to perceive touch, temperature changes, or pain on the body surface. Despite her inability to sense physical contact, Kim has above-average intelligence. She functions normally in social situations with a variety of people, recognizing emotions in herself and others and demonstrating appropriate affect. Kim experiences anxiety that appears grounded in realistic fears and uncertainties particular to her somatic insensitivity, thus serving as adaptive vigilance in reaction to an abnormal sensorium. Her normal socioemotional development, evident from an early age, likely resulted from Kim being able to appreciate her parents' loving care through gaze, movement, and hearing. In sum, Kim upends the idea of touch as critical to developing a sense of self, secure attachment, and family bonds.

Mary Main's written legacy: a bibliometric analysis.

Mary Main's written work profoundly changed the direction of attachment research through her publications and through her teachings. The current study describes the scientific impact of her her published and unpublished work. We identified 85 such works. Web of Sciences contained k = 7,571 citations to these works from by 13,398 unique authors. The topics of citing work clustered around clinical psychological research, early dyadic relationships, romantic attachment, traumatic experiences, and the adult attachment interview itself. Based on co-citation patterns, Main shared an intellectual space with authors known for developmental psychopathology and child development, parent-child relationships, adult attachment, psychodynamic theorizing, and reciprocity in interaction and infant mental health. We discuss the impact of the "move to the level of representation" and how new ties with researchers unfamiliar with these ideas will be important to realize unused potential in the ideas and methods given to the field by Mary Main.

Gender, attachment, and demand/withdraw patterns in the context of moderate couple conflict in cisgender, heterosexual relationships.

A common pattern in couple relationships is demand/withdraw. Within this pattern, one partner seeks connection, change, and resolution of the issue, whereas the other seeks to end the discussion and limit closeness. We sought to further understand and update the literature by examining the relationship of gender and attachment (both self-report and narrative discourse) with demand/withdraw behaviors during moderate couple conflict. Using data from 63 cisgender, heterosexual couples, we used the actor-partner interdependence model within multilevel modeling, to explore the research questions. Findings revealed that during the woman's issue, men were more likely to withdraw. During the man's issue, preoccupied attachment in either partner was associated with more demand and women higher in attachment anxiety were more likely to demand. Demand behaviors in one partner were also associated with withdraw behaviors in the other (and vice versa). In this article, we discuss the research and clinical implications of these findings.

Understanding the Relationship Between Attachment Orientation and Physical Activity Participation: An Exploratory Study.

BACKGROUND: Physical inactivity is recognized as a global health challenge. Attachment theory may provide insight into individual physical activity (PA) patterns, informing the development of PA interventions to promote the maintenance of behavior change. This study investigated the associations between attachment orientation and why and how individuals engage in PA. Given the association between attachment and sensory processing, this study also investigated the link between sensory processing and PA participation. METHODS: Participants (N = 141) completed an online questionnaire that included the Modified Experiences of Close Relationships Scale and the Highly Sensitive Person Scale. The relationship between attachment orientation and sensory processing patterns, and preference for PA participation were analyzed using 2-sided independent t tests. RESULTS: Attachment avoidance, attachment anxiety, and sensory sensitivity were significantly related to participants' preference for PA participation in theoretically consistent ways. Avoidantly attached individuals were less likely to participate in PA as a form of social interaction (mean = 8.57, SD = 2.87, P = .005, d = 0.48). Anxiously attached individuals were more likely to participate in PA to support weight management (mean = 37.02, SD = 11.54, P = .01, d = -0.46) or if recommended by a health professional (mean = 43.55, SD = 12.45, P = .039, d = -0.88). Sensory sensitive individuals were more likely to participate in PA alone (mean = 124.11, SD = 19.23, P = .005, d = -0.510), and more likely to prefer light-intensity forms of PA (mean = 133.29, SD = 12.67, F3,123 = 5.49, P = .001). CONCLUSIONS: Findings highlight the potential value of considering an individual's attachment orientation and sensory processing patterns in the development of PA interventions. This may help to address the challenges of PA participation, by individually tailoring interventions to participants.

Associations Between Breastfeeding, Maternal Emotional Availability, and Infant-Mother Attachment: The Role of Coparenting.

BACKGROUND: Breastfeeding is a parenting practice that combines close intimate contact with the opportunity to be sensitive and responsive to the infant, and may have direct and indirect relations with infant attachment. However, researchers have produced inconsistent findings, suggesting there may be other mechanisms involved. Coparenting may play a significant role, as it has been consistently associated with mother-infant relationships. RESEARCH AIMS: The aims of this study were to examine: (1) whether breastfeeding would be directly associated with infant-mother attachment; (2) whether this association was also indirect, through mothers' quality of caregiving; and (3) whether partners' coparenting support moderates breastfeeding's indirect association with attachment. METHODS: This was a prospective, longitudinal study that drew data from a larger NIH-funded study on sleep and family relationships (R01HD052809). Mothers reported on their feeding practices and coparenting relationships. Independent observations were used to assess mothers' emotional availability toward infants. A separate team of observers assessed infant-mother attachment. RESULTS: Exclusive breastfeeding during the first 6 months, and longer duration of any breastfeeding across the 1st year, were directly associated with more secure infant-mother attachment. These associations were also indirect, through maternal emotional availability. Coparenting was a significant moderator, such that the influence of longer breastfeeding duration on improved emotional availability, and, in turn, on more secure attachment, was significant only for mothers who perceived coparenting quality to be low. CONCLUSION: Findings highlighted the importance of breastfeeding on both the quality of mothering and infant attachment, but also emphasized that coparenting support may be particularly important for mothers who are unable to breastfeed.

Understanding parental secure base support across youth sport contexts in Sweden.

The notion of secure base explains how a child can grow and become independent through access to a significant other (i.e., parent) who is available, encouraging, and noninterfering. The purpose of the current study was to develop an understanding of parental secure base support within the context of youth sport in Sweden, with a specific focus on: (a) what parental behaviors constitute a secure base, and (b) how these behaviors differ across contexts (at home before and after sport, at practice and during competitions). An interpretive descriptive methodology (Thorne, 2016) was used. Interviews were conducted with 13 family triads (children aged 12-15 years) and 1 dyad living in Sweden. Analysis was conducted to illuminate associations, patterns, and relationships within the sample. Analysis led to the development of nine categories of parental behaviors that were perceived to underpin a secure base. Availability was seen to comprise physical presence and support provision, being responsive, and developing positive mental representations. Encouragement encompassed demonstrating that sport participation is valued, motivating to explore sporting endeavors, and reinforcing and rewarding persistence in sports. Interference was described as unrequested interference, requested interference, and intentionally constrained involvement. Additionally, influencing factors such as communication, family structure and culture, were identified. The findings provide an empirical illustration for several behaviors that have been perceived as positive in previous literature, as well as highlighting numerous further complexities, particularly as it relates to interference.

Leadership Blossoms in Parental Warmth: Positive Parenting Practices Shape Adolescent Leader Emergence via Intrapersonal and Interpersonal Mechanisms.

Developing leadership skills during adolescence is crucial for future career success. Previous studies have primarily focused on the impact of school settings, academic courses, and simulated team tasks on leader emergence, neglecting the significant role of parental influence in this process. Employing a mixed-methods approach, this research investigated the positive relationship between parental warmth and adolescent leader emergence and the underlying mechanisms of this relationship. The quantitative study (Study 1) collected multi-source data from 1255 adolescents (Mage = 14.2, SDage = 0.56, 48.2% male) and their parents, teachers and peers. Findings from Study 1 revealed a positive correlation between parental warmth and adolescent leader emergence. Structural equation modeling showed two mediating pathways: an intrapersonal pathway involving self-esteem and leader self-efficacy, and an interpersonal pathway involving empathy and prosocial behavior. Encouragement of independence, as an additional adolescents-focused parenting practice, strengthened the observed positive relationship. The qualitative study (Study 2) conducted in-depth interviews with adolescents to identify the parental practices that facilitate or hinder adolescent leader emergence for the triangulation of the central research question. Study 2 collected data from 32 adolescents (Mage = 15.16, SDage = 1.37, 50% male). Findings from Study 2 corroborated the significance of parental warmth and the encouragement of independence for adolescent leader emergence, elucidating specific parenting behaviors conducive to these positive parenting practices, such as providing companionship and communication, as well as encouraging adolescents to participate in household tasks. This mix-methods research prepositioned the stages of leadership development, advocating for the importance of the warmth and autonomy from parents as formative factors for cultivating the next generation of leaders.

A family reunion of "clinical cousins": Attachment and emotion in four family-oriented therapy models.

Attachment theory and the science of emotion provide a strong foundation for intervention at the family system level. Four therapeutic models in particular, Attachment-Based Family Therapy, Emotion-Focused Family Therapy, Dyadic Developmental Psychotherapy, and Emotionally Focused Family Therapy, demonstrate how a broad and accurate view of attachment relationships and emotion can be utilized to effectively intervene for a variety of presenting problems in a relational and empathic way for all involved. This paper continues a conversation that began at the Summit for Attachment and Emotion in Family Therapy in 2021 and aims to foster openness, collaboration, and affirmation between four different models of family therapy with shared theoretical roots. The presenters at the Summit and the authors of this paper view similarities across these models as validating and differences as opportunities to serve more families in unique ways, learning from one another's creativity to promote healing within families in the most effective and efficient ways possible. The paper frames the value of attachment theory and emotion science for family therapy, discusses the importance of learning from a variety of models with shared theoretical roots, presents brief summaries of the four models presented at the Summit, compares the models for similarities and complementarities, and shares highlights from each of the presenters from the Summit.

The American contribution to attachment theory: John Bowlby's WHO trip to the USA in 1950 and the development of his ideas on separation and attachment.

This paper explores John Bowlby's foundational contributions to attachment theory, particularly his fascination with 'separation' and its impact on child development. Tracing the origins of Bowlby's interest to his personal experiences and his exposure to ideas of mental hygiene and child guidance in the 1930s, it underscores the alignment of his ideas with key figures in the English school of psychoanalysis. The central narrative of this paper unfolds during Bowlby's 1950 WHO research trip, investigating orphaned and separated children in Europe and the USA. Utilizing archival materials from the Wellcome Library in London, the authors offer unique insights into Bowlby's journey, highlighting his evolving views on mother-child separation through interactions with his American colleagues. This comprehensive exploration sheds light on Bowlby's pioneering work, emphasizing the American influence on his ideas, and the evolving theoretical framework that continues to shape our understanding of child development and attachment today.

Diversity in singlehood experiences: Testing an attachment theory model of sub-groups of singles.

OBJECTIVE: Relationship science has developed several theories to explain how and why people enter and maintain satisfying relationships. Less is known about why some people remain single, despite increasing rates of singlehood throughout the world. Using one of the most widely studied and robust theories-attachment theory-we aim to identify distinct sub-groups of singles and examine whether these sub-groups differ in their experience of singlehood and psychosocial outcomes. METHOD: Across two studies of single adults (Ns = 482 and 400), we used latent profile analysis (LPA) to identify distinct sub-groups of singles. RESULTS: Both studies revealed four distinct profiles consistent with attachment theory: (1) secure; (2) anxious; (3) avoidant; and (4) fearful-avoidant. Furthermore, the four sub-groups of singles differed in theoretically distinct ways in their experience of singlehood and on indicators of psychosocial well-being. CONCLUSIONS: These findings suggest that singles are a heterogeneous group of individuals that can be meaningfully differentiated based on individual differences in attachment security.

Attachment Theory and Sexual Offending: Making the Connection.

PURPOSE OF REVIEW: The purpose of this review is to discuss how attachment theory can be applied to explain sexual violence. Specifically, it discusses how the development of certain risk factors contributes to these behaviors and how attachment-based models can be used to address this issue through prevention and therapeutic interventions. RECENT FINDINGS: Recent research demonstrates that individuals who commit sexual offenses have higher rates of insecure attachment styles and that these styles are associated with a number of criminogenic risk factors associated with sexual offending. Such risk factors include cognitive processing difficulties, affect dysregulation, and challenges in interpersonal relationships, among others. Fortunately, treatment interventions have been shown to foster more secure attachment styles and reduce these risk factors. Attachment theory is a viable theory to both understand and intervene with those who have committed sexual violence to reduce the risk factors associated with sexual violence.

Identity fusion is associated with outgroup trust and social exploration: Evidence for the fusion-secure base hypothesis.

Identity fusion - a powerful form of group alignment - is a strong predictor of using violence to defend the ingroup. However, recent theorizing suggests, in the absence of outgroup threat, fusion may instead promote intergroup trust and cooperation. Across five studies we find evidence that fusion to a range of groups (e.g., country, football team) was consistently positively associated with a willingness to trust others generally, trust outgroup members, and social exploration. An internal meta-analysis indicated that fusion was more strongly associated with trust and social exploration, compared to several measures of group identification. These findings provide support for the fusion-secure base hypothesis (Personality and Social Psychology Review. 2023, 27(2), 107-127) and suggest that fusion has the potential to increase a willingness to interact with, and trust, outgroup members.

Married women's response to spousal pornography use: A grounded theory.

Empirical research suggests that married women may more commonly experience spousal pornography use as a relational attachment threat and are more likely to experience negative relational outcomes such as distress and loss of trust. The purpose of this study was to develop a grounded theory of married women's response to the discovery or disclosure of spousal pornography use. This study included the experiences of 30 married women who reported spousal pornography use as a threat to relational attachment, who chose to remain with their spouse, and who reported evidence of individual and relational healing thereafter. The research question, "How do married women describe the experience of learning of their spouse's pornography use and the individual and relationship sequelae that follow?" was explored using grounded theory methods to analyze deidentified blogpost accounts emphasizing response to a spouse's pornography use. The results describe a process model highlighting three interrelated informant categories-emotional response, mental response, and physical response-and one resultant category-behavioral response. Implications include (a) the importance of open communication regarding pornography use within relationships, (b) the necessity for individual and relational healing following betrayal trauma, and (c) the role of therapeutic intervention in shaping adaptive healing processes.

Pathways from childhood trauma to aberrant salience: A structural equation approach to mentalization model.

OBJECTIVE: The aim of this study was to explore the relationship between affective disturbances and aberrant salience in the context of childhood trauma, attachment, and mentalization in an analogue study. METHODS: Using a cross-sectional design, an online community sample completed self-report measures of key variables. Structural equation modelling was used to test childhood trauma's influence on aberrant salience via a set of intermediate risk factors (depression, negative schizotypy, and insecure attachment). These intermediate risk factors were assumed to lead to the proximal risk factors of aberrant salience (i.e., disorganized schizotypy and disorganized attachment) depending on the vulnerability of mentalizing capacity to elevated stress. RESULTS: The sample (N = 1263) was 78% female and aged between 18 and 35 years. The tested models closely fitted the observed data, revealing significant pathways from childhood trauma to aberrant salience via the hypothesized pathways. The direct effect of childhood trauma on aberrant salience was significant. CONCLUSION: Findings suggest that the pathway to aberrant salience may be characterized by disorganization of self-state and intersubjectivity as a function of diminishment in mentalizing ability. This may relate to changes in attachment organization and socio-cognitive capacity, which could constitute possible risk factors signalling development of aberrant salience.

Enduring Bonds: Duration and Contact in Close Relationships in Late Life.

BACKGROUND AND OBJECTIVES: Older adults maintain ties to long-duration social partners, some with whom have regular contact and some with whom have little contact. We asked whether these ties with little contact still offer a sense of connection and security, and buffer the effects of interpersonal stress in daily life. Helping older adults foster these ties may improve their mental health. RESEARCH DESIGN AND METHODS: Participants (n = 313) aged 65+ completed a baseline interview reporting duration and contact frequency of their closest ties. Then, participants completed ecological momentary assessments every 3 hr for 5-6 days, reporting their social encounters and mood. RESULTS: We classified ties according to duration (10+ years = long vs shorter duration) and frequency of contact (at least once a month = active vs dormant). Throughout the day, participants were more likely to have stressful encounters with long-duration active ties. Encounters with active ties were associated with more positive mood (regardless of duration) and encounters with long-duration dormant ties with more negative mood. Having more active ties buffered effects of interpersonal stress on mood, but more long-duration dormant ties exacerbated these effects. DISCUSSION AND IMPLICATIONS: Supporting social integration theory, ties with frequent contact were associated with positive mood. Surprisingly, long-duration ties with infrequent contact exacerbated effects of interpersonal stress on mood. Older adults who lack contact with long-duration social partners may be more sensitive to interpersonal stress. Future interventions might focus on phone or electronic media to increase contact with long-duration social partners.

The Role of Attachment, Insecurity, and Stress in Partner Maltreatment: A Meta-Analysis.

Negative, destructive, and abusive behaviors in romantic relationships can vary from explicit kinds of abuse and aggression to more subtle and seemingly innocuous slights against or ways of treating a partner. However, regardless of the severity or explicit nature, these behaviors all, to one extent or another, reflect acts of invalidation, disrespect, aggression, or neglect toward a partner, and could be considered maltreatment of a partner. The current paper proposes the term partner maltreatment as a broad overarching concept, which was used to facilitate a meta-analytic synthesis of the literature to examine the associations between attachment insecurity (i.e., attachment anxiety, attachment avoidance) and perpetration of partner maltreatment. Additionally, this paper situated partner maltreatment within an attachment-based diathesis-stress perspective to explore the moderating role of stress. Five databases were systematically searched for published and unpublished studies that examined the direct association between perpetrator's adult attachment orientation and perpetration of partner maltreatment behaviors. We synthesized effect sizes from 139 studies (N = 38,472) and found the effect between attachment insecurity and acts of partner maltreatment varied between r = .11 to .21. Our findings provide meta-analytic evidence to suggest that attachment insecurity is a significant individual vulnerability factor (diathesis) associated with partner maltreatment; and that when individuals with an insecure attachment orientation experience stress, the tendency to perpetrate partner maltreatment is typically heightened. The findings of this meta-analysis provide empirical evidence for the importance of considering and addressing contextual factors, especially stress, for those individuals and couples seeking therapy for partner maltreatment.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships.

BACKGROUND: Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives. METHODS: Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis. RESULTS: Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation. CONCLUSIONS: We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

CoViD-19 effects on social-emotional development: Putative underlying mechanisms.

Early childhood is the timely and critical period in the growth of the human being when the trajectory of children's holistic development is traced, and the foundation for their future as well-established and productive adults is set. The CoViD-19 pandemic produced profound changes in everyday life almost everywhere in the world. The personal, social and societal restrictions imposed during the CoViD-19 pandemic unquestionably blunted early childhood development by depriving young children from normal and healthy attachments through secure relationships with parents, teachers and peers. Furthermore, the public health measures enacted to counter the spread of the pandemic (e.g., mandatory masking, lockdown) contributed to a lack of social interactions essential for childhood development, and provoked perceptions of psycho-emotional stress (e.g., objective fear of the masked interlocutor, perceived fear of abandonment) in the children, which may have hampered critical periods of development. Based on theoretical foundation and our observations in the field, we propose that early intervention support may have a significant impact on the development of children victims of the effect of the CoViD-19 pandemic.