Middle childhood attachment-based family therapy: Theory and model description

In middle childhood, the first manifestations of mental health problems can emerge and become a precursor of mental health issues in adolescence. Given that weak parent-child attachment can contribute to this distress, it is possible that strengthening the attachment bond could reduce risk trajectory. Unfortunately, evidence-based attachment-focused interventions are lacking at this age. Attachment-based family therapy (ABFT) is a well-studied intervention for troubled adolescents and has the potential to be extended downward to children. However, ABFT for adolescents focuses on mentalization and trauma conversation strategies that may be developmentally advanced for children's capacities. Therefore, we modified the intervention strategies to be more developmentally sensitive to childhood. Middle childhood ABFT (MCABFT) builds on the theory that insecure attachment develops through a learning process that can be interrupted and reorganized to promote secure attachment development. MCABFT uses less conversation and more play and puts parents more at the center of the therapy compared with ABFT for adolescents. In this article, we describe MCABFT's theoretical and clinical model.

Children's Attention to Mother and Adolescent Stress Moderate the Attachment-Depressive Symptoms Link

The breadth of children’s attentional field around their mother determines whether securely or insecurely attached children are at risk to develop depressive symptoms when confronted with distress in adolescence. To test this effect longitudinally, we measured children’s (M_age = 10.93; N = 109) baseline attentional breadth around their mother, attachment status (combining attachment coherence, secure base script knowledge, and self-reported trust), and self-reported depressive symptoms. One and two years later, we measured self-reported distress and depressive symptoms. We tested three-way interactions between attentional breadth × attachment × distress on changes in depressive symptoms. This three-way interaction was marginally significantly linked with changes in depressive symptoms from baseline to year 1, and significantly with changes in depressive symptoms from baseline to year 2. Results pointed to the protective role of a narrow attentional field around the mother in middle childhood for securely attached children who are confronted with distress later in life.

The effects of Cognitive Bias Modification training and oxytocin administration on trust in maternal support: study protocol for a randomized controlled trial

BACKGROUND

Lack of trust in parental support is a transdiagnostic risk factor for the development of psychological problems throughout the lifespan. Research suggests that children's cognitive attachment representations and related information processing biases could be an important target for interventions aiming to build trust in the parent-child relationship. A paradigm that can alter these biases and increase trust is that of Cognitive Bias Modification (CBM), during which a target processing bias is systematically trained. Trust-related CBM training effects could possibly be enhanced by oxytocin, a neuropeptide that has been proposed to play an important role in social information processing and social relationships. The present article describes the study protocol for a double-blind randomized controlled trial (RCT) aimed at testing the individual and combined effects of CBM training and oxytocin administration on trust in maternal support.

METHODS/DESIGN

One hundred children (aged 8-12 years) are randomly assigned to one of four intervention conditions. Participants inhale a nasal spray that either contains oxytocin (OT) or a placebo. Additionally, they receive either a CBM training aimed at positively modifying trust-related information processing bias or a neutral placebo training aimed to have no trust-related effects. Main and interaction effects of the interventions are assessed on three levels of trust-related outcome measures: trust-related interpretation bias; self-reported trust; and mother-child interactional behavior. Importantly, side-effects of a single administration of OT in middle childhood are monitored closely to provide further information on the safety of OT administration in this age group.

DISCUSSION

The present RCT is the first study to combine CBM training with oxytocin to test for individual and combined effects on trust in mother. If effective, CBM training and oxytocin could be easily applicable and nonintrusive additions to interventions that target trust in the context of the parent-child relationship.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02737254 . Registered on 23 March 2016.