Secure Base Provision: A New Approach to Examining Links Between Maternal Caregiving and Infant Attachment.

This observational study addressed a critical gap in the understanding of the precursors of infant attachment by examining whether a new conceptualization of maternal caregiving behavior, secure base provision (SBP), explained variance in attachment above and beyond variance explained by sensitivity. Participants included 83 low-socioeconomic status (SES), 4.5-month-old infants (56% male) and their mothers. Infant-mother dyads completed laboratory tasks at 4.5 months and three 30-min home visits between 7 and 9 months, then returned to the laboratory at 12 months for an attachment assessment. Maternal sensitivity did not significantly predict infant attachment security. SBP significantly predicted infant attachment, over and above sensitivity, with an effect size eight times larger than that of sensitivity in meta-analytic findings for low-SES families.

Attachment Security Priming Decreases Children's Physiological Response to Threat.

Ninety 6- and 7-year-olds (49.3% White, mostly middle class) from greater Washington, DC were randomly assigned to a subliminal priming condition (secure, happy, or neutral) to determine if attachment security priming decreases physiological, expressive, and self-reported fear reactions to threatening stimuli. Dispositional attachment security was also assessed. Secure priming and attachment security each decreased electrodermal reactivity, increased vagal augmentation, and decreased fearful facial expressions compared to control conditions. Examination of a statistical interaction between security priming and child attachment indicated that, although secure children had increased vagal augmentation and fewer fearful expressions than insecure children, the effects of priming were constant across secure and insecure children. There were no priming or attachment effects associated with children's self-reported fear.

Learning to provide children with a secure base and a safe haven: The Circle of Security-Parenting (COS-P) group intervention.

Insecure attachment is linked to a host of negative child outcomes, including internalizing and externalizing behavior problems. Circle of Security-Parenting (COS-P) is a manualized, video-based, eight unit, group parenting intervention to promote children's attachment security. COS-P was designed to be easily implemented, so as to make attachment interventions more widely available to families. We present the theoretical background of COS-P, research evidence supporting the COS approach, as well as a description of the COS-P intervention protocol. The case example of "Alexa," mother of three children (aged 7, 6, and 4 years), illustrates how parents can make use of the COS-P intervention to better understand children's needs, build skills in observing and interpreting children's signals, learn to recognize and regulate their own responses to their children, and learn new ways of responding to children's needs.

Attachment-based interventions for families with young children.

Given a large body of research indicating links between child attachment and later mental health outcomes, interventions that promote children's secure attachment to their caregivers have the potential to contribute to prevention of psychopathology and promotion of well-being. A number of attachment-based interventions have been developed to support parents, enhance caregiving quality, and promote children's attachment security with the aim of improving children's mental health. There is now a growing evidence base to support the efficacy of a number of these interventions. The present literature review and introduction to the special issue on attachment-based interventions for families with young children describes key aspects of attachment theory and research that form the theoretical and empirical background for attachment-based interventions, and introduces seven case studies illustrating five different attachment-based interventions. The case studies represent a variety of attachment-based models, including both group and individual treatments, and show applications across a range of caregiver contexts.

Circle of Security-Parenting: A randomized controlled trial in Head Start.

Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security-Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of "what works for whom" in attachment intervention.

Attachment status and mother-preschooler parasympathetic response to the strange situation procedure.

BACKGROUND: Early attachment relationships are important for children's development of behavioral and physiological regulation strategies. Parasympathetic nervous system activity, indexed by respiratory sinus arrhythmia (RSA), is a key indicator of self-regulation, with links to numerous developmental outcomes. Attachment-related changes in and associations between mother and child RSA during the Strange Situation procedure (SSP) can elucidate individual differences in physiological response to stress that are important for understanding the development of and intervention for psychopathology. METHODS: A sample of 142 at-risk mothers and preschool-age children participated in the SSP and provided time-synchronized RSA data during the 7 episodes, which included 2 separations and 2 reunions. Attachment classifications were obtained using the Cassidy et al. (1992) coding system. Linear mixed-effects models were constructed to examine attachment-related change in RSA during the SSP and the concordance between mother and child RSA over time. RESULTS: Findings demonstrated attachment-related differences in children's RSA. Secure children's RSA was relatively stable over time, whereas insecure-avoidant children showed RSA increases during the first separation and insecure-resistant children's RSA declined across the SSP. Mothers showed RSA withdrawal during separation regardless of child's attachment classification. Mother-child RSA showed a positive concordance that was strongest in the insecure-resistant group, compared with the other groups. CONCLUSIONS: Results support attachment theories concerning parasympathetic response to stress and the role of the mother-child relationship in physiological regulation. Our findings advance previous research by focusing on at-risk mother-preschooler dyads within diverse attachment classifications.

Psychotherapy process and relationship in the context of a brief attachment-based mother-infant intervention.

The present study investigated links between the observer-rated process of psychotherapy and 2 key psychotherapy relationship constructs (i.e., working alliance and attachment to the therapist) in the context of a brief, attachment-based, home-visiting, mother-infant intervention that aimed to promote later secure infant attachment. Additionally, links between observer ratings of intervener and mother contributions to process were examined. Participants included 85 economically stressed mothers of first-born, 5.5-month-old, temperamentally irritable infants. Therapists included 2 doctoral-level and 4 master's-level home visitors. Observer-rated therapist psychotherapy process variables (i.e., warmth, exploration, and negative attitude) were not linked to maternal ratings of working alliance. Therapist warmth, however, was positively associated with maternal ratings of security of attachment to the therapist, and therapist negative attitude was positively related to maternal ratings of preoccupied-merger attachment to the therapist. As expected, both therapist warmth and exploration were positively associated with both maternal participation and exploration. Therapist negative attitude was inversely related to maternal exploration, but not to maternal participation. Results support the idea that attention to the psychotherapy process and relationship may be important in the context of a brief home-visiting parenting intervention with a nonclinical sample.

Attachment-related biases in adolescents' memory.

Attachment theorists propose that individuals' internal working models influence their social information processing. This study explored links between attachment representations and social information processing by examining adolescents' (n = 189; Mage  = 16.5 years) attachment-related memory biases. Participants completed laboratory tasks assessing memory for (a) emotionally salient childhood events, (b) adjectives describing their parents, and (c) generalized parent-related characteristics not specific to their own parents. As expected, dismissing attachment (assessed using the Adult Attachment Interview) was linked across tasks to a deactivating strategy in which memory for emotional childhood events and attachment-relevant stimuli was reduced. In contrast, evidence that preoccupied attachment was linked to a hyperactivating strategy in which memory was heightened emerged only in relation to emotional childhood events.

Attachment-related differences in perceptions of an initial peer interaction emerge over time: evidence of reconstructive memory processes in adolescents.

This study examined whether attachment, assessed using the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996) was linked to how adolescents reconstructed their memory for an initial interaction with an unfamiliar peer. Adolescents (N = 189, 62% female) completed a 10-min laboratory task with a student whom they did not know. Immediately following this task, adolescents rated their perceptions of the interaction. Adolescents completed the same perception measure 2 weeks later. Although adolescents classified as secure and insecure on the AAI did not differ in how they perceived unfamiliar peers initially, attachment-related differences emerged over time. Insecure adolescents remembered the interactions as less positive and more negative and also reported being treated with greater hostility than they had initially reported 2 weeks earlier. In contrast, secure adolescents' memories for the negative aspects of the interaction and for hostile treatment remained stable, although, like insecure adolescents, they remembered the conflicts as being less positive than initially reported.

Clinical writing: additional ethical and practical issues.

The recommendations by Sieck (2011, Obtaining clinical writing informed consent versus using client disguise and recommendations for practice, Psychotherapy, 49, pp. 3-11.) are a helpful starting point for considering the ethical issues involved in the decision to seek or not to seek informed consent from clients before writing about them. Sieck makes a compelling case for the idea that there are circumstances in which the most ethical choice would be to engage in clinical writing about a client without seeking informed consent, but instead disguising the client's identity. The present response raises a number of questions not considered in the article by Sieck. First, how should one disguise a case? Moreover, how should one assess whether the disguise is sufficient to preserve confidentiality while not distorting the clinical material to the point that the material is no longer useful to the field? Second, how can we estimate the likelihood of clients reading clinical writing, particularly in the age of the Internet? Given that psychologist-authored blogs that include reference to clinical material are beginning to emerge, it is crucial that we engage in a much deeper dialogue about the ethics of clinical writing. Third, how does the presentation of clinical material influence public perceptions of psychotherapy and confidentiality? If these public perceptions, in turn, could influence the likelihood of seeking psychotherapy, might these attitudes be important to consider in ethical thinking about clinical writing? Finally, where do we draw the line between clinical writing and single case study research (which requires informed consent)?

Enhancing infant attachment security: an examination of treatment efficacy and differential susceptibility.

This randomized controlled trial examined (a) the efficacy of a brief intervention designed to increase the rate of secure infant attachment, (b) the differential susceptibility hypothesis, and (c) whether maternal attachment styles moderated the expected Treatment x Irritability interaction in predicting infant attachment outcomes. Although there was no main effect of treatment, a significant Treatment x Irritability interaction revealed intervention effects for the highly irritable infants only, thus supporting one of two predictions of the differential susceptibility hypothesis: highly irritable infants would have disproportionately better outcomes than moderately irritable infants in better conditions (i.e., with intervention). When separate analyses were conducted with maternal attachment styles, we found significant three-way interactions among treatment, irritability, and each of the examined maternal attachment style dimensions (i.e., secure-fearful and dismissing-preoccupied). Specifically, with more secure mothers, beneficial effects of intervention emerged for highly irritable infants. For more dismissing mothers, the results revealed support for both predictions of the differential susceptibility hypothesis: highly irritable infants, compared to moderately irritable infants, were both more likely to be secure with intervention and less likely to be secure when in the control group. It is interesting that, for more preoccupied mothers, a treatment effect emerged only for moderately irritable infants. We discuss the implications of these findings for the differential susceptibility hypothesis as well as for early intervention.

Do adolescents and parents reconstruct memories about their conflict as a function of adolescent attachment?

This study examined whether 17-year-old adolescents (n=189) and their parents reconstructed their memory for an adolescent-parent laboratory conflict over a 6-week period as a function of adolescent attachment organization. It also compared participants' perceptions of conflict over time to observational ratings of the conflict to further characterize the nature of the attachment-related memory biases that emerged. Secure adolescents reconstructed interactions with each parent more favorably over time, whereas insecure adolescents showed less favorable reconstructive memory. Likewise, mothers of secure girls reconstructed conflicts more favorably over time, whereas mothers of insecure boys showed less favorable reconstructive memory. Participant ratings were associated with observational ratings in theoretically consistent ways. Contrary to expectations, fathers showed no attachment-related memory biases.

Dyadic interactions as precursors to attachment security: implications for intervention and research.

This commentary focuses on the important contributions of the Beebe et al. (present issue) study to understanding precursors to attachment, including the addition of a particular focus on infant contributions to the dyadic interactions related to attachment outcomes, as well as a better understanding of the precursors specific to insecure-ambivalent attachment and attachment disorganization. In addition, limitations of the time series methodology for interpreting the meaning of maternal interactive contingency findings from an attachment perspective are discussed. Finally, implications of the present study for both clinical work and research are highlighted throughout.

The role of adolescent attachment in moderating and mediating the links between parent and adolescent psychological symptoms.

The present study examined whether adolescent attachment security and attachment-related representations moderate and mediate, respectively, the link between parent symptoms (depressive and anxiety) and adolescent depressive symptoms. Participants were 189 (118 girls) eleventh graders and their parents in a community sample. Results showed that adolescent attachment moderated the connection between parent and adolescent symptoms; in most cases attachment security was more protective if both parents were high on anxiety symptoms or if one parent was high on anxiety but the other parent was low on depressive symptoms. Mediational analyses indicated that representations of their mothers as a secure base mediated the link between maternal and adolescent depressive symptoms. Perceptions of fathers as a secure base did not play a mediating role, although paternal depressive symptoms were associated with lower perceptions of the father as a secure base. Neither parent's anxiety symptoms were related to perceptions of the parent as a secure base or to adolescent depressive symptoms.

Perceptions of secure base provision within the family.

The present study examined three sets of questions about secure base provision in the context of the family, including (1) relations between inter-parental perceptions of secure base provision and parents' adult romantic attachment and marital satisfaction, (2) interrelations among family members' perception of secure base provision, and (3) links between both adolescents' and parents' perceptions of secure base provision and adolescent symptoms. Participants were 189 adolescents from two-parent families (mean age = 17 years; 118 girls) and their parents. We found partial support for theorized links between perceptions of spousal secure base provision and spousal romantic attachment, as well as full support for expected associations between secure base provision and marital satisfaction. Family members' perceptions of secure base provision were linked in theoretically expected ways: mothers' perceptions of her spouse as a secure base were positively related to their adolescents' perceptions of the mother as a secure base and the father as a secure base. Further, adolescents tended to agree with mothers about perceptions of the husband/father and with fathers about the wife/mother as a secure base. Finally, adolescents' perceptions of parents as a secure base were associated with lower adolescent internalizing and externalizing symptoms. Inter-parental perceptions of secure base provision were not linked to adolescent symptoms.

Narrative assessment of attachment representations: links between secure base scripts and adolescent attachment.

We explored the notion that adolescents possess mental secure base scripts of attachment-related events and examined, for the first time, whether these scripts were linked to adolescent attachment security. Results indicated that adolescents possessed a general script for mother and for father, and that they drew upon these scripts across different contexts. Adolescents' scripts for mother and for father were related, but only the scripts for mother predicted unique variance in adolescents' scripts for nonspecific others. Moreover, greater attachment security (as measured by the Adult Attachment Interview; AAI) was linked to greater access to and knowledge of secure base scripts for mothers, fathers, and nonspecific others. Only mother scripts, however, predicted unique variance in adolescents' AAI coherence of mind scores. Adolescents' romantic-attachment avoidance and anxiety scores (as assessed using the Experiences in Close Relationship Inventory) were linked negatively to scripts for mothers and nonspecific others, respectively.