Convergent validity and stability of secure base script knowledge from young adulthood to midlife

The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial

BACKGROUND

Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with devastating consequences for individuals and their families, and substantial economic costs. However, psychological and pharmacological treatments currently recommended in guidelines for treatment of high-risk youth for fatal suicide have limited effect. In line with the World Health Organization's (WHO) recommendation to involve the family in treatment of these youth, attachment-based family therapy (ABFT) was developed, a 16-week attachment and emotion-focused treatment, implemented in mental health care settings across various European countries in the past years, and becoming increasingly popular among therapists. However, the (cost-)effectiveness of ABFT has not been studied in emerging adults. In the proposed pragmatic randomized controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of ABFT compared to treatment as usual (TAU) on suicidality, as delivered in daily practice.

METHODS

This pragmatic multicenter study in the Netherlands and Belgium includes 13 participating sites. Participants are suicidal young adults (≥ 31 SIQ-JR score) between 16 and 30 years old who seek mental health treatment (n = 142) and their caregivers. The primary outcome is suicidality (SIQ-JR), with assessments at baseline, post-intervention (5 months after baseline), 3, 6, and 12 months after intervention. We predict that, compared to TAU, ABFT will lead to a stronger reduction in suicidality and will be more cost-effective, over the course of all time points. We also expect stronger decreases in depressive symptoms, given that suicidality is very common in individuals with depressive disorder, as well as more improvement in family functioning, autonomy, entrapment, and young adult attachment, in the ABFT condition.

DISCUSSION

This study can contribute to improving the care for suicidal youngsters with high mortality risk. Treatment of suicidal emerging adults is understudied. The results will inform clinical guidelines and policy makers and improve treatment of suicidal emerging adults.

TRIAL REGISTRATION

This trial is registered on ClinicalTrials.gov (NCT05965622, first posted on July 28, 2023).

Attachment and propensity for reporting compassionate opportunities and behavior in everyday life

Introduction

Researchers have identified links between anxious and avoidant attachments and difficulties with self-compassion, giving others compassion, and receiving compassion. However, while compassion requires both awareness of opportunities for compassion and compassionate action, little is known about attachment-related differences in reporting compassionate opportunities. Further, most research relies on retrospective-reports that may not accurately assess compassionate behaviors in everyday life.

Method

Consequently, we collected 2,757 experience sampling survey responses from 125 participants (95 women, 27 men, 3 non-binary, M age = 18.74, SD age = 1.66) to investigate whether attachment anxiety, avoidance, or their interaction were associated with differences in propensity for reporting compassionate opportunities, actions, and emotional responses to opportunities in everyday life across self-compassion, giving compassion, and receiving compassion.

Results

Anxiety was associated with greater likelihood of reporting all types of compassionate opportunities and less positive responses to opportunities to receive compassion. Avoidance was associated with less likelihood of reporting opportunities to give and receive compassion and less positive responses to opportunities to give compassion. Those high in anxiety but simultaneously low in avoidance reported fewer self-compassionate actions, but we identified no further differences in compassionate action.

Discussion

This study highlights the potential role of awareness of compassionate opportunities in attachment-related differences in compassion.

Deactivation, hyperactivation, and anomalous content in the attachment script assessment: stability over time and significance for parenting behavior and physiology

This study examined the stability of Attachment Script Assessment (ASA) deactivation, hyperactivation, and anomalous content and their significance for parenting outcomes in mothers (Mage = 31 years; 78% White/European American) and 6-month-old infants. Comparable to ASA secure base script knowledge (SBSK), mothers' ASA deactivation, hyperactivation, and anomalous content were significantly, moderately stable over two years (r's = .40 - .43). Mothers' ASA hyperactivation and anomalous content were associated with greater maternal intrusiveness, whereas ASA deactivation was associated with greater detachment and less intrusiveness. Only ASA anomalous content was associated with lower maternal sensitivity. Mothers' ASA deactivation was associated with less dynamic change in respiratory sinus arrhythmia during the Still-Face Procedure-reflective of limited mobilization of physiological resources to support responding to infants. Findings support the validity of ASA deactivation, hyperactivation, and anomalous content scripts, and demonstrate their utility in examining adult attachment stability and predictive significance for parent-child outcomes.

Assessing the Impact of Relationship Profile Test Scores, Self-Identified Ethnic Group, and Gender on Adult Attachment Style

Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap in the literature in terms of using the RPT to predict attachment styles and to assess gender and ethnic group differences in RPT scores. Four samples from various treatment settings were combined to yield a heterogeneous group of ethnically diverse men and women (N = 470) with a mean age of 31.96. No gender differences were observed; however, ethnic differences were noted, with the RPT scales predicting unique variance in secure and insecure attachment styles. This study evidences the incremental validity of the RPT scales when predicting adult attachment style with consideration of ethnic group differences, which can help inform the treatment and assessment process.

The predictive significance of fluctuations in early maternal sensitivity for secure base script knowledge and relationship effectiveness in adulthood

Attachment theory suggests that both the quality and consistency of early sensitive care should shape an individual's attachment working models and relationship outcomes across the lifespan. To date, most research has focused on the quality of early sensitive caregiving, finding that receiving higher quality care predicts more secure working models and better long-term relationship outcomes than receiving lower quality care. However, it remains unclear whether or how the consistency of early sensitive care impacts attachment working models and adult relationship functioning. In this research, we utilized data from the Minnesota Longitudinal Study of Risk and Adaptation to examine to what extent the quality (i.e., mean levels) and consistency (i.e., within-person fluctuations) in behaviorally coded maternal sensitive care assessed 7 times from 3 months to 13 years prospectively predicts secure base script knowledge and relationship effectiveness (i.e., interpersonal competence in close relationships) in adulthood. We found that larger fluctuations and lower mean levels of early maternal sensitivity jointly predict lower relationship effectiveness in adulthood via lower secure base script knowledge. These findings reveal that nonlinear models of early caregiving experiences more completely account for relationship outcomes across the lifespan, beyond what traditional linear models have documented. Implications for attachment theory and longitudinal methods are discussed.

A Learning Theory Approach to Attachment Theory: Exploring Clinical Applications

Although clinicians typically acknowledge the importance of insecure attachment as one factor that can contribute to children's psychopathology, translating attachment theory into clinical practice has proved a challenge. By specifying some of the mechanisms through which the child's attachment develops and changes, learning theory can enhance attachment based approaches to therapy. Specifically, interventions building on operant (parent management training) and classical (exposure therapy) learning can be used to stimulate new learning that increases the child's security and confidence in the parent's availability and responsiveness. To explore the clinical application and utility of a Learning Theory of Attachment (LTA), we focus on two attachment-focused interventions: Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and Middle Childhood Attachment-based Family Therapy (MCAT). VIPP-SD is an evidence-based parent management training designed to promote sensitive parenting and secure attachment in early childhood. MCAT is a recently developed intervention that uses exposure to stimulate secure attachment in middle childhood. LTA sheds light on the mechanisms set in train by VIPP-SD and MCAT facilitating the induction of professionals in clinical applications.

Does secure base script knowledge mediate associations between observed parental caregiving during childhood and adult romantic relationship quality and health?

Increasingly, attachment representations are being assessed via secure base script knowledge - the degree to which individuals show awareness of the temporal-causal schema that summarizes the basic features of seeking and receiving effective support from caregivers during times of need. Limited research has assessed the links between secure base script knowledge and aspects of adult functioning and the role that secure base script knowledge may play in accounting for associations between early caregiving quality and adulthood functioning. We used follow-up assessments of the NICHD Study of Early Child Care and Youth Development cohort (N = 585) to examine whether secure base script knowledge at age 18 years: (a) is associated with later romantic relationship quality, depressive symptoms, and body mass index (BMI) at age 26 years, and (b) mediates expected associations between the quality of maternal and paternal sensitivity across the first 15 years of life and age-26 outcomes. More access to, and elaborated knowledge of the secure base script predicted less extreme hostility with romantic partners, and better emotional and physical health. Moreover, secure base script knowledge mediated the links between early maternal and paternal sensitivity and both later romantic partner hostility and depressive symptoms, but not BMI.

Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up

This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.