Continuing in our series on Neuropsychotherapy Basics, we look at the central, and critically important, need for attachment. I have touched briefly on attachment in the first blog “Basic Needs” and this time will expand on the concept of attachment as a basic psychological need.
It was Harry Stack Sullivan (1968) in the 1950s who first regarded interpersonal relations as a major cause of mental disorders. It was not until John Bowlby (1968) clearly demonstrated that the most substantiated basic need for an infant is the physical proximity of a primary attachment figure, that the importance of attachment became mainstream. We know now that this crucially important aspect of human wellbeing, substantiated by many studies now, has a neurobiological foundation that sets up a child for ways he or she will interact with the world as an adult.
Attachment Needs and Attachment Styles
Bowlby (1973) described the basis of this attachment theory into three central postulates that could be summarised like this:
1. If a child trusts that his or her primary caregiver (attachment figure) is available whenever needed, then there is less likelihood of intense or chronic anxiety in contrast to a child who doesn’t have this trust.
2. Trust, or the lack of trust, in the availability of the primary caregiver develops progressively from infancy to adolescence, and the expectancies that are developed over this childhood remain relatively unchanged for the rest of life.
3. What the child comes to expect from attachment figures (their availability or responsiveness) are relatively true reflections of the actual experiences the child had with attachment figures (especially so with the experience of the primary caregiver).
This whole theory of attachment by Bowlby was referred to as the inner working model, and this model is closely related to what we are talking about with the consistency model in our previous blog. Primarily, early dyadic relationships form implicit memories from which we form schemas, or ways of interacting with the world, to satisfy basic needs (in this case the need for attachment). In other words, the early experiences a child has with his or her primary caregiver, will shape the way a child develops to understand and interact with others to satisfy or protect certain needs.
Mary Ainsworth, a colleague of Bowlby, famously identified four attachment styles, of which I am sure you are familiar, based on Bowlby’s attachment theory. Ainsworth observed the behaviour patterns of young children when they were separated and then reunited with their mothers in a controlled environment. These identified attachment styles can be summarised like this:
1) Secure attachment relationship – The normal reaction of distress when separated from mother and immediately seeking proximity when mother returns. This attachment pattern is accompanied by solid basic trust and enables the development of conflict-free approach schemas to satisfy the attachment need.
2) Insecure-avoidant attachment relationship – The child avoids proximity when the mother returns without signs of distress. This correlates with poor positive satisfaction of the attachment need.
3) Insecure-ambivalent relationship – The child is anxious during separation and upon reunion oscillate between aggressive rejection and seeking. This results in conflicted motivational schemas – for example lack of closeness linked with fear of being alone.
4) Insecure-disorganized/disorientated – The child responds to reunion with mother with bizarre and stereotyped behaviour. This can have great negative consequences in developing future motivational schemas, typically associated with early childhood abuse and highly correlated with mental disorders as adults.
The children who were found to thrive in life are those children with secure attachment patterns rather than those with any of the insecure patterns. These patterns start to form in the first months of life—a time when brain development is extremely rapid—and lay a foundation for motivational schemas that ultimately drive behaviour.
Attachment Need Neurobiology
We know from animal studies that other mammals share this basic need for attachment, that unfavourable attachment experiences can have a devastating impact on the neurobiology, and ultimate mental health, of social mammals. Jaak Panksepp, a leading researcher in the neurobiology of affect, described a PANIC circuit that is activated when young animals are left alone in a strange environment (for a thorough discussion of the PANIC circuit see Panksepp & Biven, 2010, chapter 9. Panksepp has recently chosen to call this system the GRIEF system in his latest writings due to some confusion over the term PANIC). Distress signals can originate in what is called the ‘central gray matter’ and also from the areas of the thalamus, anterior cingulate cortex and amygdala (raw data from the thalamus is processed by the amygdala in close collaboration with the anterior cingulate cortex and orbitofrontal cortex). These circuits, that overlap considerably, are ultimately involved in the release of stress hormones (CRF) and endorphins as a response to an adverse situation (The excitability of this system decreases with age, more so in males, due to testosterone, than females.) The neurotransmitters that modulate this circuit are glutamate, to activate distress response, and oxytocin and prolactin that have a calming effect.
What happens on a neural level, with the satisfaction of an attachment need, is that the interaction (warm, loving, protecting, helpful interaction) of a primary attachment figure (usually the mother) facilitates a down-regulation of the fear response by initiating a neuropeptide (oxytocin and prolactin) release, and ensuing cascade of chemical events, that calm the child, inhibit the formation of negative memory, and reinforces neurophysiological circuits that will later influence emotional regulation. This healthy process develops neurological pathways, from the limbic areas via the anterior cingulate cortex through to the orbitofrontal cortex and prefontal cortex, with effective cortical blood flow and highly effective hippocampal functioning that enhances and reinforces healthy affect regulation. Such processes lead to approach motivational schemas from secure attachment experiences.
A child who is not down-regulated by the interaction of a sensitive and caring attachment figure will experience a prolonged stress response that will develop negative memories, emotions and alternative coping patterns, that can develop suboptimal avoidance motivational schemas and inability to regulate emotions. An inability for negative affect regulation is a clear marker of common mental disorders with a foundation traceable back to these early attachment insecurities. Damaging dysfunctional attachment relationships can result in ‘cortical loops’ that are typically overactive limbic functioning that increases the stress response, hippocampal atrophy, and looping activity in the prefrontal, orbitofrontal and anterior cortex and a decrease in pathways to the left prefontal cortex. When caught in such ‘loops’ the person may seem like they are ‘caught in a rut’ and are unable to effectively ‘think through’ or rationalise (when the prefontal cortex is able to effectively assess and modulate emotional responses from the limbic system) a situation, but ‘react’ in a typical, fearful way (often reinforcing an avoidance schema).
It is interesting to note that the neural foundation that places people at risk for the later emergence of mental disorders, like depression, is laid down before explicit memory is formed. In other words, we can not remember what happened to us that set the scene for a greater potential to develop depression. In a therapy situation it would be impossible for a client to recall what situation occurred to cause such implicit emotional memories and neural networks to develop in the first months of life, from which they base their motivational schemas. This does not, however, exclude the possibility that things can shift and new neural networks develop. But it does mean there is a deeply ingrained neural process that may take much patience and understanding to transform into a healthier way of responding to the world.
There is also a genetic risk involved here as well. Those with short alleles in the 5-HTT serotonin-transporter gene (less efficient in terms of gene expression) are likely to exhibit lower serotonin concentrations compared to long alleles. What was found (in animal studies) was the genotype did play a role in insecure attachment (short HTT-allele = lower serotonin concentrations), but did not materialize as serotonergic hypo-function in normal attachment relationships. The normal relationship mitigated the genetic risk—it was only under stress that the genetic expression was disadvantageous. This area of genetic expression is beyond this short blog, but we might have a closer look at such things further down the track.
Violations of the Attachment Need
What does it take to violate the basic need for attachment? To form an insecure attachment style the following patterns would typically result in the development of an insecure avoidant attachment style:
- If the primary caregiver, from the beginning of the relationship, responds to the child with a lack of empathy, and with an exaggerated delay or not at all.
- If there is a rejection of the child through a lack of hugging, cuddling, and a general physical and emotional withdrawal from the child.
- If the caregiver frequently interrupts the child in activities, ignoring them at other times, and is generally inconsistent with the child, and shows little response to child’s contact initiatives.
Overall, caregivers who are less well coordinated with their child, less engaged physically and emotionally, less responsive and inconsistently intrusive, were more likely to produce insecurely attached children. Obviously these patterns are by degrees and are on a persistent basis. We all have times, as parents, when we lack empathy, are emotionally detached, or are insensitive to our children’s needs at a particular time. It is not these inconsistencies of being human that result in insecure attachment styles, but the persistent non-responsiveness to a child’s attachment needs that will ultimately develop a poor attachment style in the child. There can also develop a negative feedback loop of interaction between a child who is becoming increasingly difficult to handle as they develop an insecure attachment style and the further withdrawal of a mother who is becoming increasingly “stressed out” over the situation. As you can imagine, this situation can spiral down and neither child or mother are experiencing a satisfying attachment relationship.
Stability of the Attachment Style
So how does attachment style influence the child as they grow? There seems to be marked advantages for the securely attached child as he or she enters the social world. For example securely attached children are rated by others (peers and teachers) as more socially orientated, relationship-competent, empathic, popular, better able to express themselves and have greater resilience to stress. These robust individuals are engaging with the world from primarily approach motivational schemas that have developed from a sense of security and control (we will talk about control in a later blog). However, insecurely attached children seemingly do not have these advantages, and social engagement often reinforces negative emotions, social incompetence and affect regulation. They seem to be less able to express their needs to significant others, and can behave with less empathy and inappropriately. Their schema for interacting with the world is more avoidance, in an attempt to protect their basic needs rather than competently go after their fulfilment. Insecurely attached children may also have a stronger cortisol response to stress, and as we will look at further on, a more easily triggered stress response. Securely attached children, on the other hand, enjoy a positive feedback loop of experiences that validates their positive control experiences, self-esteem enhancing experiences and positive emotions. These differences between secure and insecure attachment styles will typically remain stable through to adolescence.
There have been a number of longitudinal studies done to track the attachment styles of children into adulthood and there seems to be a high stability rate in attachment style over the lifetime. In one study (Waters, Merrick, Treboux, Croswell, and Albersheim, 2000) children were tracked for 20 years and found that their attachment style remained stable for 72% of the sample. In adulthood there has also been found a high correlation between attachment style and mental disorders. In a normal population securely attached people make up about 60% of the population, however, in a population of outpatients with mental disorders there are only about 10% securely attached people (for a comprehensive look at the studies that substantiate this claim, see Grawe, 2007, pp. 191-197)
What we experience as infants with our primary care givers, and with significant others as we grow, play a vital role in the development of our motivational schemas—the very ways we interpret and respond to the world. These early experiences with an attachment figure play a key role in the development of our attachment style, which Bowlby called the inner working model, which is synonymous to the motivational schemas we refer to in consistency theory. A persons attachment style, the deeply ingrained implicit memory that underpins the style, and reinforcement of that style through motivational schema presents a strong neural responsiveness to the environment—something that is unlikely to shift easily. If therapy is not targeting avoidance schemas (and conflicting schemas,) then it is not getting to the bedrock of mental problems.
“In order to do justice to the far-reaching consequences of a lifetime history of insecure attachment patterns, one would have to analyze in much more detail, in each individual case, which problematic constellations of approach and avoidance motivational schemas tends to be activated in the interpersonal relationships of the patient, and which additional sources of inconsistency have emerged as a consequence of the negative attachment experiences in the individual patient’s case. This would include a lowered stress tolerance, poor emotional regulation, unfavorable consistency-securing mechanisms, and poor self-esteem regulation. In order to answer the question about additional sources of inconsistency, however, basic needs other than the attachment need will also have to be considered” (Grawe, 2007, pp.210-211)
References & Further Reading:
This series on Neuropsychotherapy Basics is primarily sourced from Grawe, K. (2007). Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy. New York: Psychology Press. For a more detailed description of what has been discussed in this blog, and for associated references, I encourage you to read this book.
Bowlby, J. (1946). Maternal Care and Mental Health. Geneva: World Health Organization.
Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39, 1-23.
Bowlby, J. (1968). Attachment and Loss, Vol. 1: Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and Loss, Vol. 2: Separation, Anxiety, and Anger. London: Penguin Books.
Bowlby, J. (1980). Attachment and Loss, Vol. 3: Loss: Sadness and Depression. New York:Basic Books.
Panksepp, J., and Biven, L. (2010). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotion. New York: W. W. Norton & Company.
Sullivan, H. S. (1968). The Interpersonal Theory of Psychiatry. New York: W. W. Norton & Company.
Walters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Development, 71, 684-689.