A Neural Model of Empathic States in Attachment-Based Psychotherapy

A Pilot Study to Evaluate the Efficacy of Self-Attachment to Treat Chronic Anxiety and/or Depression in Iranian Women

The aim of this pilot study was to evaluate the efficacy of the new Self-Attachment Technique (SAT) in treating resistant anxiety and depression, lasting at least three years, among Iranian women from different social backgrounds. In this self-administrable and algorithmic intervention, the participant, using their childhood photos, imaginatively creates an affectional bond with their childhood self, vows to consistently support and lovingly re-raise this child to emotional well-being. We conducted a longitudinal study with repeated measurement to evaluate the efficacy of SAT using ANOVA. Thirty-eight women satisfying the inclusion and exclusion criteria were recruited from different parts of Tehran. To describe the SAT protocols, a total of eight one-to-one sessions were offered to the recruits, the first four were weekly while the last four were fortnightly. The participants were expected to practice the protocols for twenty minutes twice a day. Two questionnaires, GAD-7 and PHQ-9, were used to measure anxiety and depression levels before and after the intervention and in a three-month follow-up. Thirty women completed the course. The change in anxiety level between the pre-test and the post-test was significant at p < 0.001 with effect size 2.5. The change in anxiety between pre-test and follow-up test was also significant at p < 0.001 with effect size 3.5. The change in anxiety between the post-test and the follow-up was significant at p < 0.05 with effect size 0.6. For depression, the changes between pre-test and post-test as well as between pre-test and follow-up were significant at p < 0.001 with effect size 2.3 and 3.1 respectively.

Intrinsic and extrinsic motivators of attachment under active inference

This paper addresses the formation of infant attachment types within the context of active inference: a holistic account of action, perception and learning in the brain. We show how the organised forms of attachment (secure, avoidant and ambivalent) might arise in (Bayesian) infants. Specifically, we show that these distinct forms of attachment emerge from a minimisation of free energy-over interoceptive states relating to internal stress levels-when seeking proximity to caregivers who have a varying impact on these interoceptive states. In line with empirical findings in disrupted patterns of affective communication, we then demonstrate how exteroceptive cues (in the form of caregiver-mediated AMBIANCE affective communication errors, ACE) can result in disorganised forms of attachment in infants of caregivers who consistently increase stress when the infant seeks proximity, but can have an organising (towards ambivalence) effect in infants of inconsistent caregivers. In particular, we differentiate disorganised attachment from avoidance in terms of the high epistemic value of proximity seeking behaviours (resulting from the caregiver's misleading exteroceptive cues) that preclude the emergence of coherent and organised behavioural policies. Our work, the first to formulate infant attachment in terms of active inference, makes a new testable prediction with regards to the types of affective communication errors that engender ambivalent attachment.

A Neural Model of Empathic States in Attachment-Based Psychotherapy

We build on a neuroanatomical model of how empathic states can motivate caregiving behavior, via empathy circuit-driven activation of regions in the hypothalamus and amygdala, which in turn stimulate a mesolimbic-ventral pallidum pathway, by integrating findings related to the perception of pain in self and others. On this basis, we propose a network to capture states of personal distress and (weak and strong forms of) empathic concern, which are particularly relevant for psychotherapists conducting attachment-based interventions. This model is then extended for the case of self-attachment therapy, in which conceptualized components of the self serve as both the source of and target for empathic resonance. In particular, we consider how states of empathic concern involving an other that is perceived as being closely related to the self might enhance the motivation for self-directed bonding (which in turn is proposed to lead the individual toward more compassionate states) in terms of medial prefrontal cortex-mediated activation of these caregiving pathways. We simulate our model computationally and discuss the interplay between the bonding and empathy protocols of the therapy.