Enhancing Attachment Security 2016: Clinical & Neurobiological Perspectives

Daniel J Sonkin, Ph.D., LMFT1505 Bridgeway, Suite 105Sausalito, CA 94965(415) 332-6703www.danielsonkin.comcontact@danielsonkin.com

Overview❖ Attachment theory in a nutshell

❖ Attachment theory: Affect and cognition

❖ Secure attachment and the brain

❖ Priming and memory

❖ Psychotherapy and priming

❖ Secure base priming: What it does and how it works

❖ Secure base priming research studies

Attachment Theory in a Nutshell❖ Attachment theory is an attempt to explain how secure

attachment develops and how it helps people survive temporary bouts of pain, discomfort, doubts and distress and help individuals reestablish hope, optimism and emotional equanimity

❖ It also explains how various forms of attachment insecurity develops and interferes with emotion regulation, social adjustment and mental health

❖ According to Bowlby (1982), the development of an attachment orientation in childhood is based on many encounters and interactions with caregivers, which gradually creates mental networks (neural activity patterns) of relatively stable expectations and concerns

❖ These activation patterns may be thought of memory processes that the brain activates during problem-solving

Adult Attachment❖ Adult attachment theory has become one of the dominant theoretical

frameworks for understanding interpersonal dynamics in close relationships.

❖ Based on Bowlby's theory of child development, adult attachment theory emphasizes the role of positive internal working models of attachment (self and other) in shaping the quality of adult romantic relationships.

❖ Twenty-five-plus years of evidence based on varying samples (across ages, cultures/ethnicity, marital status) has clearly documented the links between attachment style and romantic relationship satisfaction and stability.

❖ Secure adult attachment has also been positively correlated to general mental health characteristics that promote states of well-being (altruism, gratitude, compassion, resilience and optimism).

❖ There is also growing evidence that secure attachment promotes physical health as well.

What's So Great About Attachment Security?❖ Children: Engage in more elaborate make-believe play, display

greater enthusiasm for tasks, are flexible and persistence in problem solving, have higher self-esteem, are socially competent, are cooperative with peers, are liked by peers, are empathic, have closer friendships and have better social skills.

❖ Adults: Are happy, adaptively regulate their emotions, have stable close relationships, are flexible, are attuned to others, are compassionate, altruistic, and empathic, and more accepting of differences.

❖ What’s not to like?❖ Secure attachment presents a more fully activated, integrated

and smoothly functioning brain. And this can lead to improved physical health.

Attachment Theory and Affect❖ Attachment theory can be thought of as a theory of affect

regulation❖ If we think of regulating affect on a continuum from down-

regulating to up-regulating, securely attached people are flexible and adaptable to the needs of the situation

❖ Insecurely attached people tend to either habitually down-regulate or up-regulate

❖ Securely attached people tend to be more conscious of the ebb and flow of their emotions and can tell you how they feel (eg, I notice that when I need support I have an urge to pull away from you as I approach you).

❖ Insecurely attached are less aware and therefore show you how they feel, but often do not represent emotion through language (approach/avoidance behavior)

Attachment and Cognition❖ There is also a cognitive aspect to attachment (working models)

that refers to our beliefs about our own worthiness and the safety of others (world is generally a benign place)❖ “Am I the kind of person who is worthy of receiving care?”❖ “Can I trust that my attachment figure will provide care when

needed?”❖ These working models can be thought of implicit memories

created through interactions with attachment figures in childhood❖ Those memories may also be explicit - “My mother or father used

to say….”❖ However the most powerful attachment memories are implicit -

learning through experience - because they are automatic❖ Priming is one way affect regulation and working models of self

and others are learned.

Schemas and Behavior❖ Attachment working models can also be thought of a cognitive schemas that

are activated by social cues or triggers❖ The activation of a particular schema will depend on whether or not it is

present in the fund of cognitive attachment representations, and how accessible - the ease in which that neural pattern is activated

❖ The more often an available schema is activated, the more accessible it becomes in response to relevant environmental cues

❖ Attachment style may be thought of an individual’s most well-rehearsed and therefore most naturally accessed attachment schema 

❖ Because behavior most often precedes conscious cognitive processes, and our tendency to interpret events in the hear and now, behavioral solutions to problems or opportunities will be based on these schema and executed without thought

❖ Typically, the conscious, after-the-fact explanation for behavior will be biased toward present-day triggers (he/she did this or that) rather than the attachment schema that are activated at a given point in time

Attachment and the Brain❖ Bowlby believed that there was an "attachment-part" of the brain. Rather than a

particular brain structure there are brain areas are functionally related to attachment emotions, cognitions and behaviors.

❖ Affective: cerebellum (positive affect) and post-central gyrus; middle temporal, inferior parietal areas (social emotion processing and emotional experience)

❖ Cognitive: Medial and prefrontal cortex (higher order cognitive processes including attentional control, emotion regulation, and appraisal) and hippocampus (memory) and parietal lobe (social and sensory attention and processing)

❖ Behavior: Supplementary motor area and supra-marginal gyrus (areas linking reward and motivation).

❖ Amygdala: SB priming reduces activation in response to stimuli (Norman, et al, 2015)

❖ Gillath (2012) found SB priming activates areas of the brain involved in the release of dopamine, vasopressin and oxytocin.

Attachment Patterns as Habits❖ Habits are actions that have come to be automatically triggered by situational

cues (e.g. Maddux, 1997; Verplanken & Aarts, 1999)❖ Habits are learned through context-dependent repetition (Lally et al, 2010)❖ Habits are cue-dependent (stimulus-response)❖ Habits are automatic:

❖ Do not require intention❖ May be initiated without awareness❖ Are initiated outside of volitional control❖ Requires little/no effort (Bargh, 1996)

❖ Basal Ganglia: Located in the brain stem the BG has been associated with habit making and breaking - stop and go circuits. The relative strength and speed of the activation of these circuits will result in observed behavior (O'Hare, Ade, Sukharnikova, Van Hooser, Palmeri, Yin and Calakos, 2016)

❖ Habit change/development requires attention, intention and active participation to change

Reflective & Impulsive Habit Acquisition

❖ Reflective Process

❖ Reflective process involves perception of a cue or stimuli

❖ That information is related to current fund of knowledge

❖ You utilize reasoning to think about it in a logical and sensible way in order to form a conclusion or judgement

❖ Then you formulate an intention to behave one way or another

❖ That manifests in final behavior

❖ The learned behavior is stored at declarative memory - also known as explicit memory. The process is very conscious and deliberate.

Two Routes to Learning Behavior❖ Impulsive Process (Reactive)

❖ Perception of a cue

❖ Associative learning: the process by which an association between two stimuli or a behavior and a stimulus is learned

❖ Two types of learning: classical and operant

❖ Classical conditioning is the pairing of two stimuli in order to get a response (Pavlov’s Dogs)

❖ Operant conditioning (behavior therapy) is the use of consequences to modify the occurrence and form of behavior (rewards/punishments)

Learning New Behaviors❖ Just as learning a habit can be implicit or explicit, learning new attachment

behaviors may occur through either process

❖ Psychotherapy is an attachment relationship - a laboratory for learning new behaviors in the context of an interpersonal relationship

❖ This will happen through cognitive processes - talking, thinking, reflecting, etc.. But it may also occur through the context of the interpersonal relationship between therapist and patient - experiential learning

❖ Working with the therapist/patient relationship in psychotherapy is key for experiential learning because it's not theoretical, but here and now.

❖ This requires the therapist to be fully present, a good observer of human behavior, flexible in their interpretation, genuine and able to reflect on their own interpersonal process and experience.

Priming and Memory❖ Attachment patterns may be understood as memory:

emotional, cognitive and behavioral

❖ Memory is either explicit and implicit

❖ Explicit: conscious, intentional recollection of previous experiences and information

❖ Implicit: previous experiences aid the performance of a task without conscious awareness of these previous experiences

❖ Priming is a form of implicit memory where the exposure to one stimulus influences one’s response to another stimulus. For example: When primed with the word “NURSE” a person will more quickly unscramble the word: RTODCO

Priming and Memory❖ Priming generally occurs without focused attention to learning,

though it can occur through conscious processes

❖ As a form of implicit memory, there no sense of remembering, just thinking, feeling and doing

❖ Psychotherapy helps link the thought, feeling or behavior to the memory(s).

❖ Two classic priming experiments:

❖ Mommy and I are One (Subliminal Psychodynamic Activation) (Silberman, 1985): Ameliorated symptoms, increased adaptation

❖ Patience (Priming) (Bargh, 1996): Reduced interrupting & rudeness between professor and student

Psychotherapy and Priming❖ Unlike parenting, where models are being established (newborns),

psychotherapy involves an encounter with an individual who already has established and reinforced expectations about self and others

❖ The therapist interactions with the client will either confirm or not confirm expectations, and even when not confirmed behaviorally, may be perceived otherwise.

❖ Additionally, often the therapist may get challenged to act-out the client's models

❖ Repeated positive interactions can result in restructuring of self-other models and facilitating healthy relational-affect regulation strategies (earned security)

Psychotherapy and Priming❖ Attuning to the clients signals and responding appropriately is critical to

the client experiencing:

❖ The alleviation of distress resulting from the healthy seeking of proximity to an attachment figure (showing up in therapy),

❖ Learning to associate emotional equanimity with language (talking in therapy), and

❖ Learning how distress relief allows for easier exploration (feeling better/lighter when they return to their life).

❖ Repetition of this process theoretically strengthens the secure attachment neural circuit activations in the brain

❖ When a client tells you that he/she thought what you would say during a particularly difficult event, they’re using explicit memory to support the change process of psychotherapy

Secure Base Priming

❖ Can people with insecure attachment, temporarily behave more like people with secure attachment when primed with secure base stimuli?

❖ Shaver and Mikulincer (2001): Attachment theory and Intergroup Bias: Evidence that Priming the Secure Base Schema Attenuates Negative Reactions to Out-Groups

❖ Found that activating secure base schemas allows subjects to appraise threatening situations into more manageable events without activating insecure attachment type behaviors such as avoidance, fear, or anxiety

❖ Mikulincer, M., & Shaver, P. R. (2015). The psychological effects of the contextual activation of security-enhancing mental representations in adulthood. Current Opinion in Psychology, 1, 18-21.

Priming Attachment Security❖ The sense of attachment security may be primed using implicit (not-

conscious) or explicit (conscious) methods.

❖ Successful methods include 1) Name of an attachment figure, 2) Words associated with the sense of security (e.g., love, hug, affection), 3. Images representing secure attachment, and 4) Guided imagery concerning the availability and supportiveness of attachment figures.

❖ These techniques temporarily activated secure attachment mental representations (and the support and comfort associated with them) and therefore changed perceptions and behaviors.

❖ Security priming has been shown to leads to temporary changes in: 1) positive perceptions of self and others, 2) pro-sociality, 3) compassion, 4) intergroup openness, and 5) improved mental health (reduced anxiety, PTSD symptoms, etc).

Rationale for the Study

❖ What does it take to change or establish a habit? Approximately 66 daily repetitions (18-254) (Lally, et. al, 2010)

❖ Effects of repeated priming on depressed and anxious mood (text delivery) (Carnelley, Otway & Rowe; under review)

❖ Brain asymmetry studies indicate that 60 days of meditation changes the relative activation of the PFC from right-dominant to left-dominant (Davidson, 2004)

❖ Braining training programs: CogMed Working Memory Training (5 days/week, 35-50 minutes/day, for 5 weeks)

Secure Base Priming Study #1 Daniel Sonkin, Ph.D. & Mayté Frias, Ph.D.

Study Questions & Methodology❖ What effect does secure base priming have on mood and attachment style

- immediately and repeated over time?

❖ Complete a brief demographic questionnaire and informed consent

❖ Pre-tests: ECR-Short (12 items) and WHOTO. Prior to each priming session participants complete a two-question mood scale (primary: happy/sad; and background: good/bad)

❖ Post-tests: After each session participants complete a post-mood scale. After ten sessions participants complete the ECR-Short

❖ Two Data Sets:

• 1) Subjects who were primed with 3 primes/day (words, images and guided imagery)

• 2) Subjects who were primed with 1 prime/day on a rotating basis.

Study #1 Data Analysis

ECR-12 Change Over 10 Days of Priming

0.#

0.5#

1.#

1.5#

2.#

2.5#

3.#

3.5#

4.#

4.5#

5.#

Avoidance# Anxiety#

Mean#ECR#Scores#Day#0#

Mean#ECR#Scores#Day#10#

Mean Mood in Response to Word Primes (Participants who received 1 prime/day)

3.6$

3.8$

4.$

4.2$

4.4$

4.6$

4.8$

5.$

Day$1$(Pre)$ Day$1$(Post)$ Day$4$(Post)$ Day$7$(Post)$

Mean%Mood%(Word%Primes)%

Mean$Mood$(Word$Primes)$

Mean Mood in Response to Image Primes (Participants who received 1 prime/day)

3.9$

4.$

4.1$

4.2$

4.3$

4.4$

4.5$

4.6$

4.7$

4.8$

4.9$

Day$2$Pre$ Day$2$Post$ Day$5$Post$ Day$8$(Post)$

Mean%Mood%(Image%Primes)%

Mean$Mood$(Image$Primes)$

Mood Increase Pre/Post-Guided-Imagery-Prime (Participants who received 1 prime/day)

0.#

1.#

2.#

3.#

4.#

5.#

6.#

G1#Pre# G1#Post# G2#Pre# G2#Post# G3#Pre# G3#Post# G4#Pre# G4#Post# G5#Pre# G5#Post# G6#Pre# G6#Post#

PRE# POST# PRE# POST# PRE# POST# PRE# POST# PRE# POST# PRE# POST#

Mean%Mood%

Mean#Mood#

Guided Imagery Data❖ G1 (.00007) - Distress Guided Imagery (Real person)

❖ G2 (NS) - Distress Affirmation (Not a real person)

❖ G3 (approaching) - Secure Base Guided Imagery Based on Original ECR (Real person either presently or in past)

❖ G4 (NS) - Distress Guided Imagery (Not a real person)

❖ G5 (.02) - Secure Base Attachment Figure (Real person)

❖ G6 (.004) - Secure Base Guided Imagery based on Original ECR (Real person in past)

Mean Mood Days Post Priming (Participants who received 3 primes/day)

3.4$

3.6$

3.8$

4.$

4.2$

4.4$

4.6$

$Day$0$Pre$ Day$0/1$ Days$2/3$ Days$4/5$Post$ Days$6/7$Post$ Days$8/9$Post$

Mean%Mood%(3%Primes/Day)%

Mean$Mood$(3$Primes/Day)$

Secure Base Primes

Comfort

Embrace

Love

Support

Secure Base Guided Imagery❖ Secure Base Distress Script

• Think of the people to whom you've turned when you felt distressed or worried. Think about these people's central qualities that makes it easy to turn to them for support.  Now visualize a specific situation in which one of these people actually provided comfort and help when you were feeling distressed or worried.  Think about the recalled situation and the way you felt during it.

❖ Prototypical Secure Base Script• Please think about a relationship you have had in which you found

that it was relatively easy to get close to the other person and you felt comfortable depending on the other person. In this relationship you didn't often worry about being abandoned by the other person and you didn't worry about the other person getting too close to you.

Secure Base Priming Study #2 Daniel Sonkin, Ph.D. & Mayté Frias, Ph.D.

Study Questions & Methodology❖ What effect does repeated (9 sessions) secure base priming have on

positive/negative mood, felt security and attachment style? Do these effects decay after one week of no priming?

❖ Complete brief demographic questionnaire and informed consent

❖ Agree to priming for 9 days (every other day) and complete post assessment at the end of 9 days and again one week later.

❖ Pre-tests: ECR-Short (12 items), PANAS, Felt Security Scale and WHOTO

❖ Post-tests: ECR-Short (12 items), PANAS, and Felt Security Scale

❖ Three groups: Words, SB Guided Imagery (G1), Neutral Guided Imagery

Secure Base Priming Study

www.securebasepriming.com

info@securebasepriming.org