Disorganized Attachment Patterns Research Articles

The Impact of Attachment Styles on the Depth of Self-Disclosure and Topic Selection in Initial Psychotherapy Sessions

This paper explores the significant influence of attachment styles on self-disclosure and topic selection in initial psychotherapy sessions, examining how secure, anxious, avoidant, and disorganized attachment patterns impact the therapeutic process and outcomes. Attachment theory, as developed by John Bowlby and Mary Ainsworth, provides a framework for understanding the internal working models that individuals carry into therapy, affecting their openness and engagement. Securely attached clients tend to disclose more freely, facilitating stronger therapeutic alliances, while those with anxious attachment may require reassurance to mitigate fears of rejection. Avoidant clients often struggle with emotional intimacy, necessitating gradual trust-building strategies, and disorganized clients benefit from structured, trauma-informed approaches. Through case studies and research findings, the paper underscores the importance of tailoring therapeutic strategies to accommodate attachment-related dynamics, enhancing client engagement and therapeutic success. The implications for practice include the need for therapist training focused on recognizing and adapting to diverse attachment styles, fostering personalized and effective therapeutic interventions. Future research directions are suggested to further explore the intersection of attachment styles with cultural and socio-economic factors, and to develop specialized techniques for optimizing therapy based on attachment patterns.

Perinatal Predictors and Mediators of Attachment Patterns in Preschool Children: Exploration of Children's Contributions in Interactions with Mothers.

Insecure and disorganized attachment patterns in children are linked to poor health outcomes over the lifespan. Attachment patterns may be predicted by variables that influence the quality of children's interactions with their primary caregivers/parents (usually mothers) such as prenatal and postnatal exposures and the children's own behaviours in interactions. The purposes of this exploratory study were to examine: (1) prenatal predictors of children's attachment patterns, and (2) postnatal mediators and moderators of associations between prenatal predictors and children's attachment patterns, with adjustment for relevant covariates. Mother-child dyads (n = 214) from the longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were studied using valid and reliable measures. Hayes' mediation analysis was employed to determine direct and indirect effects. Mothers' prenatal cortisol levels directly predicted disorganized (versus organized) child attachment in unadjusted models. Children's passivity (in adjusted models) and compulsivity (in unadjusted and adjusted models) in parent-child interactions mediated the pathway between mothers' prenatal cortisol levels and children's disorganized attachment patterns. Serial mediation analyses revealed that mothers' cortisol levels predicted their children's cortisol levels, which predicted children's compulsivity, and, ultimately, disorganized attachment in both unadjusted and adjusted models. No predictors were correlated with children's insecure (versus secure) attachment. This exploratory research suggests that prenatal exposure to mothers' cortisol levels and children's behavioural contributions to parent-child interaction quality should be considered in the genesis of children's attachment patterns, especially disorganization. Interventions focused on parent-child interactions could also focus on addressing children's behavioral contributions.

The revised Psychosis Attachment Measure: further psychometric evidence

PurposeDisorganised attachment is a key concept in understanding the development of psychosis. However, existing questionnaires of adult attachment do not adequately measure this construct hindering future research into the psychosocial causes of psychosis. The most widely measure of adult attachment in people experiencing psychosis is the Psychosis Attachment Measure (PAM). The measure has recently been revised to include disorganised attachment items. This study develops previous research by providing a rigorous examination the psychometric properties of the revised questionnaire (PAM-R).MethodsA total of 407 participants with self-reported experiences of psychosis completed a battery of questionnaires which included the PAM-R and other measures which were conceptually related to the concept of disorganised attachment.ResultsConfirmatory factor analysis (CFA) indicated a three-factor solution with factors corresponding to anxious, avoidant, and disorganised attachment. The majority of the fit statistics were acceptable with the exception of the RMSEA statistic. Internal consistency and test–retest reliability were good for all subscales. The disorganised subscale correlated in expected directions with other measures of attachment, dissociation, trauma, and psychotic experiences.ConclusionThe PAM-R is a valid and reliable measure of adult attachment. It is a practical assessment tool for clinicians and researchers to measure insecure and disorganised attachment patterns that is acceptable to people experiencing psychosis.

Childhood interpersonal trauma and paranoia in psychosis: The role of disorganised attachment and negative schema

Paranoia is associated with significant distress and is associated with childhood trauma. Understanding the mechanisms responsible for this association is important for informing psychological interventions. Theoretical proposals suggest that negative schema and insecure attachment may be important mechanisms in the development of paranoia. Disorganised attachment may be particularly relevant. The current study is the first to examine whether the relationship between childhood interpersonal trauma and paranoia is mediated by disorganised attachment, and the impact of disorganised attachment on negative self and negative other schema.A large online sample of 242 people with self-reported psychosis completed measures of childhood trauma, attachment, self and other schema, paranoia and psychosis symptomatology.Path analysis indicated that childhood interpersonal trauma was associated with disorganised attachment, which in turn was associated with negative self-schema, negative other schema, and paranoia. Negative schema about others, but not self, was associated with paranoia. Disorganised attachment and negative other schema fully mediated the relationship between trauma and paranoia. Negative other schema partially mediated the association between disorganised attachment and paranoia. Results were found when controlling for depression, hallucinations and age.Results suggest that interventions that aim to modify disorganised attachment patterns and negative schema about others can potentially alleviate the impact of trauma on paranoia. Findings provide justification for longitudinal studies to confirm the direction of effects, and intervention studies that aim to manipulate disorganised attachment and negative schema about others and observe the impact of this on paranoia.

Disorganized Attachment pattern affects the perception of Affective Touch

Touch, such as affective caress, can be interpreted as being pleasant. The emotional valence that is assigned to touch is related to certain bottom-up factors, such as the optimal activation of C-tactile (CT) afferents. Tactile processing with a hedonic or emotional component has been defined as affective touch—a component that CT fibers are likely to convey. Tactile deficiencies are frequent in the psychiatric population but also in healthy people with disorganized attachment; accordingly, it is likely that affective difficulties in adults with disorganized attachment are reflected in altered perception of affective touch. To test this hypothesis, we combined methods from clinical psychology, psychophysics, and neuroimaging. We found that people with a history of traumatic parental bonds and a disorganized attachment pattern perceive a “caress-like” stimulus as being unpleasant, whereas participants with organized attachment consider the same tactile stimulation to be pleasant. Further, unlike in organized adults, the responses of disorganized adults to CT and non-CT stimulation activated limbic and paralimbic structures in a fight-or-flight manner, suggesting that early experiences with parental deficiencies shape the physiological responses of peripheral CT fibers and central nervous networks.

Callous-Unemotional Traits and Disorganized Attachment: Links with Disruptive Behaviors in Toddlers.

Children with callous-unemotional (CU) traits and children with disorganized attachment patterns are at heightened risk of poor psychological outcomes but little is known about the overlap between these constructs and their unique contributions to conduct problems in early childhood. This study examined associations between CU traits, disorganized attachment, and conduct problem (CP) severity in a sample of clinic-referred toddlers with behavioral problems. Mother-child dyads (n=56; mean child age 19.50 months) completed parent-report questionnaires, a dyadic play session, and the Strange Situation Procedure to assess child attachment pattern. Significant positive associations were found between CU traits and disorganized attachment, independent of CP severity. CU traits but not disorganized attachment predicted CP severity. Results indicate that among toddlers with clinic-referred disruptive behavior problems, there are clear links between CU traits and attachment disorganization. Of the two constructs, however, CU traits appear to be most salient in the expression of CPs.

Heart rate variability in response to the recall of attachment memories

ABSTRACT Internal Working Models of the attachment system modulate emotional responses and the Disorganized attachment pattern is characterized by the breakdown of such regulation. Vagally-mediated heart rate variability (vmHRV) is an index of flexible emotional responding. This study investigated vmHRV in non-clinical adults with an Organized or Disorganized attachment pattern before, during, and after the recall of attachment memories via the Adult Attachment Interview (AAI). Whereas the Organized group exhibited a typical decrease in vmHRV during the AAI and asubsequent return to a baseline-like pattern, the Disorganized group unexpectedly showed a sustained increase in vmHRV during the AAI which also persisted during the recovery phase. Results suggest that while Organized face the recollection of attachment memories by showing the adaptive stress response characterized by parasympathetic withdrawal and immediate recovery, individuals with Disorganized attachment need to keep regulating their emotions effortfully both during and after the recall of potential traumatic events.

Predictors of psychological recommendations in child protection evaluation.

Child protection matters from an important social and legal challenge, in which psychologists may be called upon to address a series of questions relevant for judicial decision-making. In an explorative manner, the current study investigates variables that influence psychological evaluators' recommendations in child protection cases. The data is based on a quantitative content review of 103 psychological evaluation reports, conducted at an institute of forensic psychology in Germany. Using bivariate and logistic regression analyses, the following predictors were analyzed in this study: Child-related factors, familial risk factors, and general custody criteria. The outcome measure was the evaluator's recommendation regarding long-term placement of the child and long-term custody arrangements. Evaluators were more likely to recommend permanent foster placement if the child showed insecure or disorganized attachment patterns, especially when combined with developmental delays, or if the child was temporarily in institutional or foster placement at the time of evaluation. The results support the conclusion that the most important factors for psychological expert recommendations refer to the "harm of the child" criterion in terms of developmental and psychological maladaptation.

Early Interventions Can Avert or Reduce Disorganized Attachment

Disorganized attachment patterns in infants and children have long been associated with subsequent psychological and behavioral problems, from

Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions.

BackgroundDisorganised attachment patterns in infants have been linked to later psychopathology. Services have variable practices for identifying and providing interventions for families of children with disorganised attachment patterns, which is the attachment pattern leading to most future psychopathology. Several recent government reports have highlighted the need for better parenting interventions in at risk groups.ObjectivesThe objective of this review and meta-analysis was to evaluate the clinical effectiveness of available parenting interventions for families of children at high risk of developing, or already showing, a disorganised pattern of attachment.MethodsPopulation: Studies were included if they involved parents or caregivers of young children with a mean age under 13 years who had a disorganised classification of attachment or were identified as at high risk of developing such problems.Included interventions were aimed at parents or caregivers (e.g. foster carers) seeking to improve attachment.Comparators included an alternative intervention, an attention control, treatment as usual or no intervention.The primary outcome was a disorganised pattern in childhood measured using a validated attachment instrument.Studies that did not use a true Randomised Controlled Trial (RCT) design were excluded from the review. Both published and unpublished papers were included, there were no restrictions on years since publication and foreign language papers were included where translation services could be accessed within necessary timescales.ResultsA comprehensive search of relevant databases yielded 15,298 papers. This paper reports a systematic review as part of an NIHR HTA study identifying studies pre-2012, updated to include all papers to October 2016. Two independent reviewers undertook two stage screening and data extraction of the included studies at all stages. A Cochrane quality assessment was carried out to assess the risk of bias. In total, fourteen studies were included in the review. In a meta-analysis of these fourteen studies the interventions saw less disorganised attachment at outcome compared to the control (OR = 0.50, (0.32, 0.77), p = 0.008). The majority of the interventions targeted maternal sensitivity. We carried out exploratory analyses to examine factors that may influence treatment outcome but these should be treated with caution given that we were limited by small numbers of studies.ConclusionsParenting interventions that target parental sensitivity show promise in reducing disorganised attachment. This is limited by few high quality studies and the fact that most studies are with mothers. More high quality randomised controlled trials are required to elucidate this further.

Mental collapse as “disorganized attachment”: A dynamic understanding for clinicians

Unresolved loss and unresolved trauma in adult mothers, and the commonly disorganized attachment pattern developed by their infants, have been repeatedly reported in longitudinal research literature as a crucial correlate or precedent of severe pathology. We describe and illustrate how unresolved loss and unresolved trauma are manifested in verbatim-transcribed language and how they are to be detected, so that psychoanalysts and clinicians in general are able to distinguish them and understand how such “states of mind” evidence the process of fragmentation they involve. We follow each example with a resolved transcript so it can be contrasted with a nonresolved case. We then describe excerpts of a taped “disorganized infant” – an example of infants who are usually babies of unresolved mothers, as shown during the Adult Attachment Interview. The analyst’s ability to identify and understand these “states of mind” and the subsequent sensitive reflection on the transcendental role of primary traumatic relations, which are involved in fear and the destructive dynamics of mental fragmentation – as seen in empirical research on attachment – can facilitate a resourceful integrative analytic scrutiny of the processes gone through by patients, and encourage the discovery of alternatives for working through the disturbing experience.

Psychotherapy with People who have Disorganised Attachment Patterns in a Psychodynamic and Attachment Theory Informed Setting

The story of my work with a woman who has a dissociative disorder is presented from an attachment perspective. Someone with a disorganised/disoriented attachment status requires a different approach. Within an attachment and psychoanalytic psychotherapy approach I describe how by centring on issues of selfregulation (dissociative withdrawal) and interactive regulation, when the patient was in a highly helpless and frightened state, an enactment emerged that mirrored the interactions she had had with her parents. Within our growing mutual understanding of the mosaic of the transference–countertransference matrix a pattern was discernible: each time the therapist felt pressured to act she was caught in a repetition of earlier frightening and perverse relationships. Thinking and reflecting on these enactments enabled the patient to differentiate between past and present and helped her to verbalise her unmentalized feelings.

La filiation adoptive à l’épreuve du traumatisme

IntroductionIn recent years, in order to respect the principles of the 1993 Hague Convention, international adoption has focused on children with “special needs”. These children are difficult to adopt because of their personal situation or their state of health. International adoption leads adoptive parents to move to a foreign country with unknown language, customs, culture and administrative formalities, leading to a feeling of loss of control, placing them in a vulnerable position. Some international adoptions cause real suffering for both the adopted child and his/her parents, especially when trauma disrupts the filiation process. ObjectivesThe objective is to understand, from a clinical vignette, how filiation process is implemented in case of trauma. It means, to understand how parents can integrate the real child and recognize themselves in him or her and how the adopted child with traumatic injuries can build a bond of love and trust to others. Material and methodsClinical observation concerns a girl, abandoned at birth by her mother and who was victim on the second day of life, of an attempted murder with machetes. The child has been placed in an orphanage since that day. The aggression had serious after effects, not only physically but also psychologically. Thus, since the age 3 years, she has developed self-destructive behaviors with endangerments, including life-threatening situations. The first meeting between this child, aged 6, and her adoptive parents takes place at the orphanage. Not supported in this approach, parents are confronted with the relational difficulties of their adoptive daughter. Very isolated in a foreign country, they feel a deep uneasiness and they question the validity of the adoption process, causing shame and guilt and even suicidal ideation. Once in France, the girl adapts quickly to the culture of her new country. Psychotherapy undertaken to put into words the emotions and the behaviors allows an appeasement in the family relations and the disappearance of violent agitations. But the process of filiation, still hampered by the trauma of this violent first meeting, requires the pursuit of psychotherapy to allow parents to accept the loss of the object, here the imaginary child and the parental ideal. ResultsFrom this clinical observation, it appears that the first interactions between parents and adopted child play an important role in the construction of relationship. The parents welcome the child with a set of fantastical representations that reveal the place that has been given to him. Adaptation will be done by psychic movements, by comparing and relativizing the imagined child with the real child. It is a double movement of adaptation of both parents and child. In the mourning of the imaginary child, there is also the mourning of the perfect parent; it is in the articulation of these two losses that the depressive state of the baby blues arises. This baby blues can evolve into psychotrauma in case of confrontation with the violence of reality. Thirty percent of adopted children have, at the time of adoption, disorganized attachment patterns; but adoption would most often enable recovery through the mobilization of parents’ psychic abilities and their own attachment patterns. Hence, a necessary assistance for parents. ConclusionIn the current context of international adoption, it is important to provide prevention with specialized places and trained teams in order to recognize critical situations, help families and enable filiation process to take place.

Evidence-Based Parenting Interventions to Promote Secure Attachment: Findings From a Systematic Review and Meta-Analysis.

Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years). This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research.

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis.

Services have variable practices for identifying and providing interventions for 'severe attachment problems' (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review. A total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012. Papers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies - version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted. The initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65; p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test-retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach's alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities. There are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers. Maternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption. This study is registered as PROSPERO CRD42011001395. The National Institute for Health Research Health Technology Assessment programme.

Attachment Representation in Institutionalized Children: A Preliminary Study Using the Child Attachment Interview

The experience of being removed from one's home and the transition to a residential care system pose enormous challenges for a child. Substantial evidence has been found regarding severe developmental effects due to early exposition to extreme psychosocial and affective deprivation. The research on Bowlby's theoretical proposals has highlighted the link between insecure, disorganized and atypical attachment patterns and children both living in foster care facilities and adopted out of those institutions. The goal of this pilot study is to investigate the attachment representation in an Italian sample of children in middle childhood (9-13 years old) who have been removed from their homes. Two compared groups of children participated in this study. The first group was composed of 24 Italian children who had been removed from their homes. The second group, considered as the control group, was composed of 35 Italian children who had never been in foster care placement. The quality of children's attachment to their primary caregivers was assessed by the Child Attachment Interview, an innovative semi-structured interview that seeks to bridge the measurement gap identified in middle childhood The children in foster care placement show a higher percentage of insecure and disorganized attachment representations and lower scores on the Child Reflective Functioning Scale. The clinical implications and enhancements to effective intervention for foster children's caretaking are discussed.

Transforming Disorganized Attachment Through Mentalization-Based Treatment

A disorganized attachment pattern is found among several mental disorders, most notably among severe personality disorders (PD). It is characterized by profound mentalizing deficits, which makes relations to self and others highly problematic. There is no evidence of any preferred mode of psychotherapy to heal this condition. In this article we describe the successful treatment of a female (28) with schizotypal and avoidant PD with additional borderline features as well as substance use dependency. She participated in the mentalization-based treatment project of the Bergen Clinic Foundation, Norway. We discuss the therapeutic strategies and interventions that most probably mediated the change for this patient, highlighting the mentalizing stance, working in the transference, managing countertransference and repairing alliance ruptures.

Aspects of Internal Self and Object Representations in Disorganized Attachment: Clinical Considerations in the Assessment and Treatment of Chronic and Relapsing Substance Misusers

In clinical theory and practice we rarely find an isomorphic fit between early patterns of attachment and discrete clinical disorders or syndromes. Although a linear equivalence is not implied here the author draws out parallels between early disorganized attachment patterns, the internal world of the substance abuser and the ways in which such psychodynamic processes invariably shape and influence the therapeutic encounter. Exploring further Main and Hesse's (1990) assertion that the essence of disorganized attachment can be summed up as fright without solution, the author develops the idea that active and repeated drug use represents attempts to anaesthetically freeze the self, and in so doing to disable and paralyse internal object imagos that induce feelings of panic, terror and dread. In addition the ingestion of drugs, as other writers on the subject have observed (Rosenfeld, 1965), often provides a type of internal inflation of the fragile self, leading to a sense of omnipotent and omniscient superiority on behalf of the substance abusing patient.

General Commentary: Rethinking the role of animals in human well-being

Recent reports highlight the emerging idea that ownership of companion animals can significantly affect human health: Two articles in Frontiers in Psychology report that dogs provided superior social support to children with disorganized attachment patterns than did other humans (Beetz et al., 2012a), and that the neuropeptide hormone oxytocin is likely involved in the formation of these human-animal bonds and their ability to protect or buffer us from the debilitating effects of stress (Beetz et al., 2012b). In 2013, the American Heart Association endorsed a Scientific Statement on pet ownership and cardiovascular disease risk, stating that pet ownership, and in particular that of dogs, should be considered as a means to reduce cardiovascular risk factors and improve survival in individuals with existing cardiovascular disease (Levine et al., 2013). The belief that animals could influence human well-being is one that extends back thousands of years to when shamans or “witch doctors” could be called upon to induce either sickness or healing through the evocation of animal “guardian spirits”. Since the late eighteenth century, companion animals have been used as agents of rehabilitation to treat social ostracism, loneliness, and recidivism of the mentally ill, chronically infirmed, and criminal, respectively. An expert none other than Florence Nightingale once remarked that a pet “is often an excellent companion for the sick, for the long chronic cases especially” (Nightingale, 1860). Thus, it could be said that humans have always suspected an ability of animals to improve the human condition. This premise has been applied in a wide variety of conditions including pervasive developmental and psychiatric disorders, victims of sexual abuse, dementia, fibromyalgia, and stroke (Dietz et al., 2012; Munoz Lasa et al., 2013). The therapeutic potential in these and other disease conditions should not be overlooked. There are more than 43 million households in the US that own one or more dogs and over half of US households own some species of pet (American Veterinary Medical Association, 2012). Sixty-three percent of these households regard their pets as full-fledged family members. Thus, pets, and the dog in particular, are ubiquitous members of our social environment. It is well-established that social support systems benefit patients with chronic diseases, and whether dogs can either fulfill or enhance this support structure merits additional study. We have previously hypothesized that the “salutary effect of social support should apply to any positive social relationship; any relationship in which a person feels cared for, loved, or esteemed” (Serpell, 2000). Despite the growing evidence that companion animals may contribute socially to human well-being, this field of investigation has still received very limited medical recognition. In 2011 consumers in the US spent over $230 billion dollars for prescription drugs (National Health Expenditure Account, 2011). An equivalent cost-benefit analysis of pet ownership to improve well-being merits closer consideration. In the past, animals have been regarded as a test bed for new therapies or as models of human disease. We would encourage consideration of companion animals as therapy for disease. This premise deserves serious consideration by the mainstream medical community and research funding agencies.

Effects of social support by a dog on stress modulation in male children with insecure attachment.

Up to 90% of children with special education needs and about 40% of children in the general population show insecure or disorganized attachment patterns, which are linked to a diminished ability to use social support by others for the regulation of stress. The aim of the study was to investigate if children with insecure-avoidant/disorganized attachment can profit more from social support by a dog compared to a friendly human during a stressful task. We investigated 47 male children (age 7–11) with insecure-avoidant or disorganized attachment. Social stress was elicited via the Trier Social Stress Test for Children (TSST-C). For one group of children a friendly therapy-dog (n = 24) was present, for one control group a friendly human (n = 10) and for the other control group a toy dog (n = 13). Stress levels of the children were measured via salivary cortisol at five times (t1–t5) before, during, and after the TSST-C and subjective reports. The physiological stress response was significantly lower in the dog condition in comparison to the two other support conditions at t4, t5 and the overall stress reaction from t1 to t5 (Area Under the Curve increase; Kruskal–Wallis H-Test, pairwise post hoc comparisons via Mann–Whitney U-Tests). Cortisol levels correlated negatively (rs) with the amount of physical contact between the child and dog. We conclude that male children with insecure-avoidant or disorganized attachment profit more from the presence of a therapy-dog than of a friendly human under social stress. Our findings support the assumption that the increasing practice of animal-assisted education is reasonable and that dogs can be helpful assistants in education/special education, since stress interferes with learning and performance in students.