Attachment-based Intervention Research Articles

Effective preventive interventions to support parents of young children: Illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD)

ABSTRACTSecure attachment relationships are essential for children’s current and later development. From attachment theory and research, it can be derived that sensitive parenting is the key to positive parent-child relationships. Is it possible to design effective interventions to enhance sensitive parenting? In this article, we review elements that are crucial for effective attachment-based interventions, and we proceed with illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We describe how this intervention program was developed, how it has been implemented in practice in different types of families and in daycare settings, and how effective the program is. We conclude that intervention programs like the VIPP-SD could play an important role in the community by serving families in need of parenting support.

Positive parenting as responsible care: Risks, protective factors, and intervention evaluation

ABSTRACTIn this themed issue of the Journal of Prevention & Intervention in the Community, the first four contributions provide knowledge on factors that can support or hinder positive parenting throughout children’s lives. In particular, the first article examined the spillover of work stressors on parenting behaviors and the role of spousal support as a moderator of stress spillover. The second contribution examines the association between parents’ promotion of volitional functioning and adopted children’s sense of strength of family bonds and belonging to the adoptive family. The third article analyzes the negative impact of intrusive parenting on young adult children’s romantic relationship quality and couple identity, and the fourth article examines parents’ autonomous and controlled motivations to transmit values to their adolescent children and their associations with parents’ socialization goals. Finally, the last two articles present the contents and evaluation of two parenting programs. The fifth article illustrates the development, content, and efficacy of an attachment-based intervention for parenting: the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD); the sixth article presents a qualitative evaluation of a group-based program focused on promoting parents’ identity together with parenting skills: The Groups for Family Enrichment_Parent version (GFE_P).

Parental and Adult Attachment and Eating Symptomology in Eating Disorder Patients and Sine Morbo Individuals

Attachment can contribute to eating disorder symptomology through various paths, including emotion regulation. However, the relationship between parental and adult attachment and emotional eating and other eating disorder symptoms have been barely investigated on comparative samples. This cross-sectional, questionnaire-based online survey aimed to assess the relationship between parental and adult attachment qualities with the eating behavior severity, emotional eating, and the level of depression in 67 female anorexia nervosa, bulimia nervosa, and binge eating disorder patients, compared to 67 female sine morbo individuals. Eating disorder patients less frequently had secure attachment, and were more often fearful or preoccupied than sine morbo individuals. In sine morbo individuals lower adult attachment security, but in patients, lower parental care was related to eating disorder symptoms. In sine morbo individuals, higher preoccupation, but in patients, higher fearfulness and lower care was related to emotional eating. Lower attachment security (OR = 0.54), younger age (OR = 0.93) and higher depression (OR = 1.04) explained 36.6% of the variance of diagnosed eating disorders. A complex interplay could be highlighted between dysfunctional attachment dimensions and eating symptomology in both groups—but with different patterns. Perceived parental care may be influential for eating disorder patients, whilst the degree of adult attachment security can be influential for sine morbo individuals. Lower attachment security was a predictor of eating disorders, which suggests the protective value of enhancing attachment security. However, further attachment-based interventions are required.

Parent–Adolescent Attachment and Academic Adjustment: The Mediating Role of Self-Worth

Within the theoretical framework of attachment theory, this study examined associations between adolescents’ attachment relationships with both mother and father and their academic adjustment, and explored the potential mediation role of self-worth in the associations. Participants were 384 Chinese adolescents (49.6% male, average age = 15.13 years) from public schools in Shanghai, China. They completed self-report measures of mother–adolescent attachment, father–adolescent attachment, general self-worth, academic engagement and school grades. The results indicated that adolescents’ attachments to both parents were associated with higher levels of academic engagement. There was partial support of the mediating role of self-worth, as adolescents who had high levels of parent–adolescent attachment were more likely to have high levels of self-worth, which in turn enhanced their academic engagement and then improved high school grades. The findings highlighted the importance of parental attachment-based intervention strategies to promote and maintain academic adjustment among adolescents.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

Testing the limits: Extending attachment-based intervention effects to infant cognitive outcome and parental stress.

Using a sample of 41 infants and toddlers (21 interventions, 20 controls) who were neglected or at serious risk for neglect, this randomized clinical trial examined the efficacy of a parent-child attachment-based video-feedback intervention on parental sensitivity, parental stress, and child mental/psychomotor development. Results showed that following the 8-week intervention, scores for maternal sensitivity and child mental and psychomotor development were higher in the intervention group than in the control group. The intervention appears to have no effect on self-reports of stress. All parents report lower levels of stress postintervention; however, when defensive responding is not considered (i.e., extremely low score of parental stress), parents in the control group report somewhat lower scores, raising questions as to the significance of this finding. Considering the small nature of our sample, replication of the present results is needed. Nevertheless, the present findings contribute to the burgeoning literature suggesting that the early attachment relationship provides an important context that influences developmental outcome in different spheres and raises questions as to how such intervention strategies may or may not affect the subjective experience of parenting.

Effectiveness of interventions in preventing disorganized attachment: A meta-analysis.

Disorganized attachment is associated with a host of negative developmental outcomes, leading to a growing interest in preventative interventions targeting the attachment relationship in infancy. The objective of this meta-analysis was to assess the effectiveness of interventions that aimed to prevent or reduce rates of disorganization among children at risk. We performed a literature search using PsycINFO, MEDLINE, and ProQuest databases for studies published between January 1989 and August 2016. All 16 studies (N = 1,360) included a control condition and reported postintervention rates of organized and disorganized attachments assessed by the Strange Situation Procedure. Results showed that, overall, interventions were effective in increasing rates of organized attachment compared to control conditions (d = 0.35, 95% CI [0.10-0.61]). Moderator analyses demonstrated that interventions were more effective (a) in more recently published studies than in older studies, (b) for maltreated samples than nonmaltreated samples, and (c) as children increased in age. These results have important implications for future development, tailoring, and implementation of attachment-based intervention programs.

“Hold Me Tight”: The Generalizability of an Attachment-Based Group Intervention to Chinese Canadian Couples

ABSTRACT“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this study was to test the effects of a Chinese-language version of the HMT relationship enrichment program in a sample of Chinese Canadians. Twenty-three men and 23 women (N = 46) in committed couple relationships completed an HMT relationship education program with their partners in Toronto, Ontario, Canada. Results indicated statistically significant improvements in participants' satisfaction with their attachment relationships, in their attachment security, and in their family functioning. The implications of these findings are discussed in light of relevant cross-cultural literature on attachment and couple relationships.

Placing Landy and Bowlby in dialogue: Role and distancing theories through the lens of attachment

This article highlights the clinical implications for integrating Robert Landy’s role and distancing theories with John Bowlby’s attachment theory. Theoretical underpinnings of these approaches are presented as authors explore parallels and divergences between them. The authors provide case material illustrating the implementation of Role Theory in attachment-based interventions and the use of distancing theory in attachment-informed psychotherapy. Benefits of using the theories in a mutually informed practice are discussed in an aim to encourage integrative treatment.

Quality of Caregiving in Mothers With Illicit Substance Use: A Systematic Review and Meta-analysis.

Background:The quality of caregiving in mothers with substance abuse problems appears to be compromised. However, divergent findings, methodological variability, and sample characteristics point to the need for research synthesis.Methods:A comprehensive systematic search was undertaken. Studies were eligible if they (1) compared substance-misusing mothers with non–substance-misusing mothers, (2) involved children from birth to 3 years, and (3) maternal sensitivity and child responsiveness were measured using observational methodology.Results:A global meta-analysis for maternal sensitivity (n = 24 studies) and child responsiveness (n = 16 studies) on 3433 mother-infant dyads yielded significant population effect sizes and significant heterogeneity. Subgroup analyses found reduced heterogeneity when the meta-analysis was conducted on studies where groups were matched on key demographic characteristics; although the effect size was small, it was still significant for maternal sensitivity but not child responsiveness.Conclusions:Compromised quality of caregiving is found in high-risk, substance-misusing mothers, emphasising the importance of early intervention that draws from attachment-based interventions.

39.4 EMOTION PROCESSING AND PSYCHOPATHOLOGICAL RISK IN THE PARENTAL BRAIN: PSYCHOSOCIAL INTERVENTION INCREASES ACTIVITY AND DECREASES STRESS

The mother-child relationship, central to social-emotional development, is impaired by trauma exposure and mental illness. Affected mothers are at risk for diminished parenting skills and sensitivity, placing children at risk for negative psychosocial outcomes. Certain neurological functioning, known to support parenting, is also defective with mental illness (including “perception and understanding of others/empathy” and “approach motivation”) and may be treatable. Mom Power is an attachment-based intervention that improves parental reflective functioning and emotion regulation toward reducing depression, posttraumatic stress, and caregiving helplessness. This study contributes to mechanistic understandings of parental brain function in mental health, illness, and intervention.

Perceptions and Experiences of an Attachment-Based Intervention for Parents Troubled by Intimate Partner Violence

It is known that intimate partner violence (IPV) negatively affects both parental capacity and children’s well-being, but few studies have focused on the experiences of those taking part in family interventions focused on IPV. In this study, 26 parents (16 mothers and 10 fathers) with a history of IPV participated in focus groups concerning their attachment-based group intervention experience in the program Parenting and Violence. The transcripts, subjected to thematic analysis, showed that participants experienced the intervention as supportive and confirming of their role as parents. Parents described feeling more in control, more self-confident, more skilled in communicating, and more able to provide security for their children. However, they also expressed a need for continuing support to maintain their improved parenting strategies.

Opioid Use Disorder, Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.

A controlled study of attachment representations and emotion regulation in female adolescents with anorexia nervosa

Background: Several recent studies highlighted that both attachment insecurity and emotion regulation difficulties form a key part of conceptual models of anorexia nervosa (AN), but they had never been analyzed in the same controlled study. Method: This study examined the attachment states of mind, assessed by the Adult Attachment Interview (AAI), and emotion regulation difficulties, measured by the Difficulties in Emotion Regulation Scale (DERS), among 25 girls with AN diagnosis aged 14-18 years (M age=16.52, SD= 1.23), and 25 general population controls, matched for gender, age, years of education and SES. Results. The AN group reported both significantly higher attachment insecurity (75% vs 46%, Fisher Exact Test, p =.04), dismissing (Ds) in particular (χ²=6.41, df=2, p =.03), and difficulties with emotion regulation than non-clinical controls. Two AAI’s scales connected to Ds classification – idealization of mother and lack of recall – were significantly correlated to lack of emotional awareness and clarity. Conclusions. Our results provide support for conceptualization of AN emphasizing the role of attachment insecurity and emotional dysregulation in the development and maintenance of this restrictive type of eating disorder. These findings may have implications for treatment programs which may prove more fruitful integrating attachment-based intervention with clinical work focused on development of emotion regulation abilities.

Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study.

This pilot study examined the effectiveness of an attachment-based intervention program, PRERAYMI, based on video technique, psychological counseling and developmental guidance in improving the style of interaction and emotion regulation of adolescent mothers and their infants after 3 and 6 months of intervention. Analyses revealed that adolescent mothers who participated in the intervention (vs. control group adolescent mothers) increased their Sensitivity and reduced their Controlling style after both 3 and 6 months of treatment. Infants who participated in the intervention (vs. control group infants) increased their Cooperative style and reduced their Passive style from 3 to 9 months. Moreover, the intervention group dyads (vs. control group dyads) increased the amount of time spent in affective positive coordination states (matches), decreased the amount of time spent in affective mismatches, and had a greater ability to repair mismatches from 3 to 9 months. Furthermore, the intervention group dyads (vs. control group dyads) increased the amount of time spent in reciprocal involvement in play with objects from 3 to 9 months. The quality of maternal attachment did not affect the intervention effect.

Couple emotional experience: effects of attachment anxiety in low and high structure couple interactions

This study used data from 63 heterosexual couples to investigate the effects of attachment anxiety and how they relate to emotional experience (i.e. psychophysiological distress and feelings towards a partner) in the context of two therapy-like conditions (low and high structure). We examined both the effect of an individual's anxiety on his/her own emotional experience (actor effects) and on the partner's experience (partner effects). During both interactional conditions, female partners of men higher in attachment anxiety experienced greater psychophysiological distress. In addition, men and women higher in attachment anxiety were not significantly different from others in terms of their feelings towards their partner during the low structure condition. However, their feelings were significantly more positive than others during the high structure condition, providing some evidence that attachment-based interventions can be especially useful for clients higher in attachment anxiety. Practitioner points Not only should therapists take into account couple distress and volatility when facilitating couple interaction, but they should also account for self-reported attachment Clients high in attachment anxiety may benefit from the emotional containment provided by having a therapist buffer the couple interaction Clients high in attachment anxiety may especially benefit from therapy process that is anchored in facilitating attachment-based expression

Practicing attachment in the real world: improving maternal insightfulness and dyadic emotional availability at an outpatient community mental health clinic

ABSTRACTThe purpose of the study was to examine the efficacy of an attachment-based intervention program practiced at an outpatient clinic. Changes in parental insightfulness and dyadic emotional availability were assessed in 32 mother–child dyads from pre- to post-intervention. At both data collection points, mothers were interviewed with the Insightfulness Assessment and the mother–child dyad was observed in play sessions coded with the Emotional Availability Scales. Findings revealed a strong association between maternal insightfulness and dyadic emotional availability, both before and after treatment. In terms of intervention efficacy, positive gains were observed in both insightfulness and dyadic emotional availability from pre- to post-intervention. Mothers who changed their classifications from non-insightful to insightful following the intervention showed the greatest gains in emotional availability. These findings have important implications for the type of interventions and service delivery model that could work in real world clinical settings.

The state of evidence-based parenting interventions for parents who are substance-involved.

Approximately 70 million children and adolescents live with at least one parent who abuses or is dependent on alcohol or an illicit substance. Given the negative parenting practices that substance-involved mothers and fathers tend to exhibit as well as the poor outcomes that their children, particularly their young children, experience, evidence-based parenting interventions are an important complement to substance abuse treatments. At this time, there are few studies that compare the efficacy of parenting interventions for these parents, however. Nonetheless, research has begun to examine skill-based and attachment-based parenting interventions for substance-involved families with young children. These parenting interventions should be considered within the context of the neurobiology of substance abuse, which emphasizes the role of dopamine in the reward systems that promote substance use. In the context of these neurobiological connections, parenting interventions that engender repeated intense emotional experiences may stimulate this same reward system and, therefore, may be more efficacious. Attachment-based interventions are particularly promising when such connections are considered. More attention needs to be paid to bringing impactful parenting interventions to substance-involved parents with young children.

The effectiveness of VIPP-V parenting training for parents of young children with a visual or visual-and-intellectual disability: study protocol of a multicenter randomized controlled trial.

BackgroundVisual or visual-and-intellectual disabilities of children make daily interactions more difficult for their parents and may impact the quality of the parent-child relationship. To support these parents, an existing intervention (Video-feedback Intervention to promote Positive Parenting; VIPP; Juffer F, Bakermans-Kranenburg MJ, van IJzendoorn MH, 2008. Promoting positive parenting; an attachment-based intervention. Mahwah, NJ: Lawrence Erlbaum Associates; 2008) was adapted for use with parents of children with a visual or visual-and-intellectual disability (VIPP-V). This attachment-based intervention was hypothesized to support parents’ interpretation and understanding of the behavior of their child with a visual or visual-and-intellectual disability and respond to their child’s signals in a sensitive way to improve parent-child interaction quality.Methods/DesignA randomized controlled trial (RCT) will be conducted to assess the effectiveness of the adapted intervention VIPP-V (Video-feedback Intervention to promote Positive Parenting in parents of children with Visual or visual-and-intellectual disabilities). Parent-child dyads will be randomized into two groups: 50 dyads will receive VIPP-V in combination with care-as-usual and 50 dyads will receive care-as-usual. Families with a child (1–5 years of age) with a visual or visual-and-intellectual disability will be recruited for participation in the study. Primary outcome measures are parental sensitivity and the quality of parent-child interaction. Secondary outcome measures are parental self-efficacy, and parenting stress. To assess feasibility of implementation of the intervention the experiences of early intervention workers with regard to using VIPP-V are assessed. Moderator variables are the child’s developmental age, working alliance between parent and VIPP-V intervention worker and empathy of the VIPP-V intervention worker. Data will be collected approximately one week before the intervention starts (T1), one week (T2) and three months (T3) after the intervention. Parent-child dyads in the care-as-usual-only condition will be assessed at the same time points. Both intention-to-treat and completer analyses will be performed.DiscussionDescriptive findings in pilot cases suggest benefits from VIPP-V, and compatibility with existing services for parents of children with a visual or visual-and-intellectual disability. The current study will provide insight into the effectiveness of this intervention for parents of children with a visual or visual-and-intellectual disability, and, if the intervention is effective, prepare the field for broad-scale implementation.Trial registrationNederlands Trial Register NTR4306 (registered 5 December 2013).

The Effectiveness of Video-Feedback Intervention on Promoting Positive Parenting and Child Development

For the last few decades, there has been an increase of interest in the development, implementation and evaluation of early intervention programs. In general, early interventions can contribute in a significant way to optimal child development. This paper reviews research on the effectiveness of an attachment-based early intervention program that promotes maternal sensitivity and child attachment security, and discusses the generalizability of this program to various samples in the context of limitations. It also addresses which child and family characteristics lead to more intervention effects with the purpose of identifying the mechanisms that are central to improvements in optimal child development. Thus, it contributes to researchers and practitioners who plan to develop, apply and evaluate early intervention programs that promote positive parenting and child development.