Attachment Theory, Affect Regulation Theory and Working With Relational Trauma
A famous quote from Anaïs Nin asserts that “We don’t see things as they are, we see things as we are.” We are immersed within a paradigm from which we make sense of the world, and we cannot see the limitations of that paradigm precisely because we are immersed in it. The medical model is a paradigm that sees pathology, makes diagnoses, and seeks to cure with medication. But what if we put down our medical model glasses and review the landscape of mental and emotional distress from a modern evolutionary perspective?
An Evolutionary Perspective
You don’t have to be smart to suffer but you do have to be alive.
Anil Seth, 2017
Evolution is concerned with survival of the species. Its ruthless imperative is to drive us to reproduce before we die. We grow up in different environments; the relationships we have with our parents range from being safe and protective to the other extreme where we are in danger because of them, either by acts of commission—abuse, or omission—neglect. My unique relational environment is the specific environment I have to adapt to, to ensure the survival of my genetic line. Our early experiences of safety or danger are translated into our biology, and that same process sets us on a biological trajectory and chooses a strategy on our behalf that will increase our chances of reproducing before we die: this is life history theory (Chisholm & Sieff, 2015). Bowlby’s attachment theory and Allan Schore’s development of attachment theory into affect regulation theory (Schore, 2012) are consistent with this modern evolutionary perspective. Our experiences of being physiologically and emotionally regulated by our mothers, and the pattern of attachment we form with them (or whoever takes that role), provides information to our biological system about how safe we are, how responsive the environment is to our needs, and how much we can rely on it.
When I, as an infant, am moved out of a contented homeostatic state due to hunger, cold, fear, or shock, how far from homeostasis do I get? In other words, how hungry, how cold, how terrified do I get before someone notices and responds to me? How long am I suffering the biological discomfort that being away from a homeostatic state entails? How effective is my caregiver at returning me to homeostasis? Does she know that I am fearful not hungry, cold not wet? Can she identify what I need and respond to that specific need? Can she make me feel better? The hundreds of thousands of experiences we have with our caregivers where we move out of a homeostatically contented state, and they catch us or let us fall, tells our bodies how safe we are and how much we can rely on those close to us to respond to our needs.
If we can’t rely on our caregiver . . . if we spend too much time emotionally and physiologically dysregulated . . . or we get dangerously dysregulated . . . or worse still, if our caregiver abandons us when we are dysregulated or dysregulates us further, it compounds our experiences of danger, increasing the tally on the biological score card that is our brain and the systems that regulate our bodies. Both subjectively and biologically, our environment feels unsafe and we feel at risk. Through experience we come to anticipate that our needs will not be met, and perhaps that our caregiver makes us feel worse. If we experience a lack of safety in our earliest years, nature ruthlessly advances our schedule for reproduction. If we live in danger we might die. Or we might die before we reproduce, an evolutionary dead end. Better to get started on reproduction early, just in case. It may not even be enough to get started early on having children, so increasing the number of children we have is an evolutionarily sound decision. Having more babies in a risky environment means a better chance of our genes being passed on through at least one of them (Chisholm & Sieff, 2015).
If, on the other hand, we can rely on our caregiver . . . if when we are dysregulated our caregiver does a “good enough” job (Winnicott, 1964) of identifying what we need and responding to it, the biological scorecard—our brain and body regulatory system—becomes calibrated for a responsive environment and safety. From experience we come to biologically and subjectively anticipate safety and living a long life, because we are in a low-risk, benign, supportive environment. There is no rush to reproduce; we have time to acquire more resources, to be more selective about a mate; and when we do decide to have babies, maybe we’ll just have one or two offspring to invest in as their chances of survival in a safe environment are higher (Chisholm & Sieff, 2015).
The evolutionary imperative to reproduce before we die has no regard for our well-being. Evolution is single-minded and ruthless. Infants and children who grow up feeling more unsafe than safe are calibrated by and for stressful environments. We anticipate danger and are primed to respond defensively, aggressively (the fight or flight of the sympathetic nervous system), or to surrender, appease or dissociate (the freeze of the parasympathetic nervous system). Life does not feel comfortable. Compounding an already stressful and uncomfortable life in the service of evolution’s aim, our experiences have already selected a developmental biological trajectory that, below the level of our awareness, is enhancing our chances of reproduction. Evolution steering our choices adds to the burden of our stress by our “decision” to bear children when we have so few resources, so little sense of safety in the world, and such insecurity in our relationships. We had so few experiences of good care ourselves when we were infants and children, it is more than we are able to usually manage (impossible perhaps, without help) to provide better care to our own babies and children. The Adverse Child Experiences Study (Felitti et al., 1998) shows that when we experience adversity in childhood we suffer more illness and die younger. Adversity is so commonplace that had a biological strategy to ensure reproduction not evolved, the survival of the whole species could have been in jeopardy. Thus, adversity nudges us onto a trajectory of accelerated development. We may suffer more illness and die earlier but we have had our children. Evolution’s imperative to reproduce before we die has been lived out through us. We live fast, procreate early, and die young, but our lives are painful, stressful, and uncomfortable (Chisholm & Sieff, 2015). This cycle repeats down generations precisely because it is evolutionarily successful; but the suffering of so many lives lived in the shadow of fear, danger, and insecurity compels us to ask what can be done to stop it.
Prior to the conceptualisation of attachment theory, Harry Harlow worked with baby monkeys to understand the effects of separating them from their mothers. His work is documented on YouTube in a video that I find distressing to watch but which is highly informative. Harlow demonstrated that a baby monkey presented with a wire mother with eyes and a bottle of milk, or a soft mother with a face, would spend as much of the time that it could on the soft mother with a face, only running to the wire mother to feed before running back. He also demonstrated that, when frightened, the baby monkey would leap to the soft mother with a face. His work demonstrates that what we need from our mothers includes a face, comfort, and protection, and not just food.
John Bowlby observed the bond between an infant and a caregiver and understood it as a mutual bond that was affectionate, enduring, and survival positive (i.e., it enhanced the survival of the species). By seeking proximity to the mother, who is stronger and wiser and knows the environment better, the infant is afforded protection. Bowlby’s work with Mary Ainsworth using the Strange Situation protocol showed that there is a range of attachment patterns, one secure, and two patterns of insecure attachment—insecure avoidant and insecure ambivalent or anxious (Cassidy & Shaver, 2002). All else being equal, these patterns of relating persist throughout life and are the basis for the way we relate to our partners and our own children (Benoit & Parker, 1994; Hazan & Shaver, 1987).
A secure attachment comes from the many experiences the infant has of his mother being available to him and responding to him by doing things that make him feel better. He learns that he has the power to get her to come to him; if he needs her, he can call or alert her somehow—she will come. This builds a sense of worth in him (I matter; I am worth responding to) and of autonomy (I can get my Mum to respond to me). His certainty in the sensitivity, responsiveness and reliability of his mother, and her caring for him, means he is free to play and to explore the world. If he gets into difficulty, he knows that she will be there for him.
The insecure patterns of attachment were regarded as pathological at the time they were conceived but are now understood to be adaptive to the environment in which they emerge. Recall that it is by seeking proximity to the mother that the infant is afforded protection, thus any means of maintaining proximity that results in the infant being protected is survival positive.
An insecure avoidant attachment tends to come from experiences the infant has with a caregiver that may range from outright rejection to being accepted under certain conditions. A caregiver may reject her infant, perhaps favouring another child, or through disinterest or lack of feeling; or she may accept the infant only when she is displaying self-reliance and is emotionally contained, but reject her if she is too needy or demanding. In either circumstance, it is survival positive for the infant to adapt to the caregiver in such a way that she can maintain a sufficient degree of proximity to gain protection, but with a safe amount of distance so that they are not painfully rejected or in any way hurt by their caregiver. The infant has to do a lot of monitoring to work out and maintain an optimal distance that probably varies. All the while the infant is monitoring what the safe distance is, in this moment, this hour, with her caregiver in this or that mood, and she cannot freely play or explore the world because her capacities to do so are otherwise engaged.
An insecure anxious or ambivalent attachment may arise from experiences that an infant has with a caregiver who sometimes meets her needs but who then may be distracted by something (another child, a relationship, a compulsive habit) and falls out of a state of responsiveness to her infant. The infant has a sense that her caregiver can meet her needs but at the same time has an awareness that she may not. The infant has to be proactive to maintain her caregiver’s attention. It is survival positive for this infant to adapt to her caregiver’s inconsistent attention by being vigilant of her caregiver’s availability. An anxiously attached infant may try and maintain her caregiver’s attention for fear it drops away and cannot be regained when needed. The infant may be seen as clingy and demanding, not able to settle or be reassured, which is precisely the adaptation that the infant’s circumstance demands!
A fourth group was later classified by Mary Main. This group tends to be referred to as disorganised attachment, although this is misleading. These infants are faced with a paradox that manifests in both their biology (see below: Affect Regulation Theory) and their behaviour, as their caregiver (whose protection they are biologically motivated to seek) is also a source of threat to them. These infants then are in an unresolvable bind—the person who is supposed to offer them protection is the threat that they need protection from. This means that they cannot find a way to maintain sufficient proximity to their caregiver that affords them protection, because proximity to their caregiver is in itself a threat. There is no safe way to attach, so they become “disorganised with respect to attachment”; no pattern of safe attachment is possible. There is no safe way to relate. Infants who are mistreated by their caregivers frequently become disorganised with respect to attachment, but caregivers who have significant unresolved trauma of their own are so emotionally unavailable, and sometimes frightening to their infants, that their infants become disorganised with respect to attachment as a result. Being disorganised with respect to attachment is associated with subsequent diagnoses of mental illness. The paradox inherent in these infants’ circumstances, their ongoing experience of simultaneously seeking proximity and being fearful of proximity means that they are rarely in a state of contented homeostasis, and this experience manifests in the physiology of their feelings and behaviours as an adult too. As adults they may experience severe and prolonged emotional and physiological dysregulation requiring extreme coping strategies, such as addiction or self-harm, and/or they habitually dissociate. The paradox of wanting yet fearing proximity to another may also still be lived out by consumers who appear to desperately want to connect but flee or explode the moment their heightened vigilance warns them of impending danger. This can be emotionally exhausting for all parties as well as retraumatising for the consumer if it is not held and worked through.
Affect Regulation Theory
If the attachment relationship is indeed a major organiser of brain development . . . then the determinants of attachment relationship are important far beyond the provision of a fundamental sense of safety and security .
Schore, 2012, p. 33
Allan Schore has enriched attachment theory with contemporary neuroscience. The resulting affect regulation theory is an impressive and compelling body of work (Schore, 2012; Schore & Sieff, 2015). Our earliest relationships are not only the basis for our attachment pattern, they are the very experiences that trace out the first neural pathways in our brains and determine which pathways remain and which ones atrophy. Our early relationships form the structure and inform the function of our brains. Our brains are experience-dependent machines; experience calibrates our brains, which become the master controller of all our regulatory systems. Our early relationships set our brains up for life. The property of the brain that allows it to be shaped by experience is neuroplasticity. Our brains are naïve to direct lived experience when we are born and so are more receptive to experience then than at any other time.
The brain has two hemispheres, which Schore suggests can almost be thought of as two brains that process information in different ways. Our hemispheres are a team, but one may be dominant over the other. Whilst left-brain dominance is culturally sanctioned in Western society, it may not be desirable or helpful to us (a point which Iain McGilchrist makes in his TED talk; see also McGilchrist, 2009). Schore notes:
The left hemisphere of the vertebrate brain is specialised for the control of well-established patterns of behaviour under ordinary and familiar circumstances. In contrast, the right hemisphere is the primary seat of emotional arousal and the processing of novel information. Furthermore, there is now agreement that verbal, conscious, rational and serial information processing takes place in the left hemisphere, whereas nonverbal, unconscious, holistic, subjective emotional information processing takes place in the right. (Schore, 2012, p. 7.)
In addition, the right brain balances and recruits our hormonal responses, such as the hypothalamic pituitary adrenal (HPA) axis and the two branches of the autonomic nervous system (namely the sympathetic and parasympathetic nervous systems), as it determines they are needed. The HPA axis is also known as the stress axis and produces cortisol that helps us respond to threat and stress. The sympathetic nervous system is our adrenalin-fuelled fight-or-flight response that readies us for action, widening our eyes, tensing our muscles, and increasing our heart rate. Our parasympathetic nervous system is geared for rest-and-digest activities in the main, pushing the vagal brake that slows our heart rate and literally lets us relax, digest, and sleep. Furthermore, an extreme activation of the parasympathetic nervous system elicits a defence response too (Porges, 2011). When we are too young, too small, or too powerless or terrified to fight or flee, we freeze. The parasympathetic freeze response can override a pre-existing sympathetic activation when the right brain determines that fighting or fleeing are not viable life-preserving options. A freeze response is some kind of dissociation that may be complete, in terms of a discontinuity of consciousness, or may just feel like distancing from the body—a feeling of stepping away, or passivity. Freeze behaviour (also known as tonic immobility) is protective; it may mimic death—playing possum—and may also include surrendering to the circumstances, becoming compliant, or appeasing the perceived threat (also known as a fawn response).
The brain matures in the same order that it evolved, brain stem—limbic system—neocortex. The brain stem regulates functions that support life, heart rate and breathing, so it has to be functional at birth to be compatible with survival. Gradually the rest of the brain matures. However, the brain doesn’t just mature according to an intrinsic developmental timetable; its awesome neuroplastic capacity means that the brain matures in the context of the experiences it is having. Our development cannot be separated from our experiences in our environment and our adaptation to it. This is a crucial point—we can only develop capacities that we have had experiences of. We cannot learn to talk unless we are talked to; we cannot learn to play unless we are played with; we cannot empathise with another unless someone has empathised with us. This may appear over-simplified, but nonetheless, the neural pathways in our brains are built from the experiences we have. If we are not soothed and regulated, then pathways for soothing and regulation will not form by themselves. (Sad to say, if soothing, regulating, and rewarding interactions do not come from healthy relational experiences, substitutes that do lead to those states, such as dissociation or engaging in specific behaviours, will serendipitously be discovered, paving the way for habitual use of dissociation and compulsive behaviours to achieve soothing and regulation, or for reward.) Our development is contextual to our environment. The capacities we develop are a reflection of what we have experienced. This is obviously true when we consider language development, including the range of vocabulary and the accent that words are spoken with, but is also true for the attachment pattern we acquire and our emotional regulation. The capacity a caregiver has to regulate her infant trace out and gradually build the infant’s neural pathways for emotional regulation. This is the crux of Allan Schore’s affect regulation theory. The way that our affect is regulated by our caregiver is the way that our brain gets built to manage affect. Our right brain undergoes its most dramatic period of growth from the last trimester of pregnancy through to the second year and it is experiences with our caregivers that provide the context for, and content of, this growth.
In a mother–infant dyad where there is face-to-face play, shared attention, and emotional mirroring, and the mother is attuned to and regulates the arousal level of her infant, there will be synchrony between the right brain of the infant and the right brain of the mother.
As Allan Shore puts it: “On the same wavelength becomes more than a metaphor, as the subjective state of both mother and infant converge and his emotional reality is both validated and held safely through his mother’s ability to be with his feelings” (Schore & Sieff, 2015, p.117). These regulating experiences build the infant’s right brain and calibrate the HPA axis and other body regulatory systems for an environment that is responsive and safe. As the infant develops into a toddler and child, the regulation provided by the mother will change; she will be able to regulate with her voice, through the tone and content of her words, as well as with her whole presence. The child will internalise the experience of being regulated and will have a strong sense of being able to get regulation from his mother for what he cannot yet manage himself. His brain has developed, and is developing, within their safe relationship. His mother’s more advanced and mature brain scaffolds the development of his. From birth, when he experienced raw emotion in his amygdala and simply cried to have his needs met, his anterior cingulate cortex will develop his attachment style, which in this safe and responsive relational context is likely to be secure. As he learns to speak, his mother will help him name his emotions and also help him to tell the story of what happened that he feels like this, and help him too to articulate what he feels he needs—a cuddle before he tries again, or that Mummy needs to watch; and when he gets what he needs, homeostasis will be restored.
These stories, the expression and naming of emotions, their sense and meaning and place in a story, the capacity to identify and ask for what is needed, to get what you need and having agency in that process, all build connections that facilitate emotional regulation from the limbic system to the frontal cortex, and by repetition these pathways are strengthened. Without someone to scaffold these crucial abilities, to be the safe other who provides us with these experiences, we cannot build connections between our limbic system and our orbitofrontal cortex. Experiences build connections. Robust connection between our limbic system and our orbitofrontal cortex is what help us to emotionally regulate from the top down. Our orbitofrontal cortex can regulate our amygdala and also (by acting via the vagus nerve) regulate our heart rate. Top-down regulation can only work when there is a robust connection between our limbic system and our orbitofrontal cortex, and for that to exist we need to have had the experiences that scaffold that connection.
Infants and children whose brains develop in different contexts may not be so lucky. Emotional neglect, emotional abuse, and other types of maltreatment that occur within a caregiving relationship contextually impact the infant’s developing brain. The brain will be shaped by whatever experiences it has, becoming a reflection of that environment as well as adapted to survive as best it can within that environment. Opportunities to be helped by a caregiver to tell the story of your experience, what happened, what led to you feeling the way you do, and what would help, may be few and far between, establishing only a tenuous connection between your limbic system and orbitofrontal cortex. In the context of neglect or abuse or experiences that lead to a child becoming disorganised with respect to attachment, an infant’s repeated unchecked or exacerbated dysregulation will build and strengthen neural pathways that promote vigilance and activate sympathetic fight-or-flight responses and/or parasympathetic freeze, surrender, dissociative responses. Experiences build connections: whatever the infant experiences most frequently will become a popular neural pathway (Perry, Pollard, Blakley, & Baker, 1995)...
This has been an excerpt from Evolutionary Perspectives: Attachment Theory, Affect Regulation Theory and Working With Relational Trauma by Haley Peckham. For more excellent material for the psychotherapist, please subscribe to our monthly magazine.