Beth Troutman

Attachment as an organizer of behavior: implications for substance abuse problems and willingness to seek treatment

BackgroundAttachment theory allows specific predictions about the role of attachment representations in organizing behavior. Insecure attachment is hypothesized to predict maladaptive emotional regulation whereas secure attachment is hypothesized to predict adaptive emotional regulation. In this paper, we test specific hypotheses about the role of attachment representations in substance abuse/dependence and treatment participation. Based on theory, we expect divergence between levels of maladaptive functioning and adaptive methods of regulating negative emotions.MethodsParticipants for this study consist of a sample of adoptees participating in an ongoing longitudinal adoption study (n = 208). The Semi-Structured Assessment of the Genetics of Alcohol-II [41] was used to determine lifetime substance abuse/dependence and treatment participation. Attachment representations were derived by the Adult Attachment Interview [AAI; [16]]. We constructed a prior contrasts reflecting theoretical predictions for the association between attachment representations, substance abuse/dependence and treatment participation.ResultsLogistic regression was used to test our hypotheses. As predicted, individuals classified as dismissing, preoccupied or earned-secure reported the highest rates of substance abuse/dependence. Individuals classified as dismissing reported significantly lower rates of treatment participation despite their high rates of substance abuse/dependence. As expected, the continuous-secure group reported lowest rates of both substance abuse/dependence and treatment participation.ConclusionThe findings from this study identify attachment representations as an influential factor in understanding the divergence between problematic substance use and treatment utilization. The findings further imply that treatment may need to take attachment representations into account to promote successful recovery.

Association between the serotonin transporter promoter polymorphism (5-HTTLPR) and adult unresolved attachment.

Research on antecedents of organized attachment has focused on the quality of caregiving received during childhood. In recent years, research has begun to examine the influence of genetic factors on quality of infant attachment. However, no published studies report on the association between specific genetic factors and adult attachment. This study examined the link between the 5-HTTLPR promoter polymorphism of the serotonin transporter gene and adult unresolved attachment assessed with the Adult Attachment Interview. Genetic material and information on attachment-related loss or trauma were available for 86 participants. Multivariate regression analyses showed an association between the short 5-HTTLPR allele and increased risk for unresolved attachment. Temperament traits and psychological symptoms did not affect the association between 5-HTTLPR and unresolved attachment. The authors hypothesize that the increased susceptibility to unresolved attachment among carriers of the short allele of 5-HTTLPR is consistent with the role of serotonin in modulation of frontal-amygdala circuitry. The findings challenge current thinking by demonstrating significant genetic influences on a phenomenon previously thought to be largely environmentally driven.

Case study : When restraints are the least restrictive alternative for managing aggression

This article discusses the controversial use of restraints with a persistently violent adolescent on a child and adolescent psychiatry unit. The authors present an individualized program that used a series of ambulatory restraints on a long-term basis and prophylactically to contain the aggression of a psychotic girl. Clozapine was used concomitantly to control her psychosis. The prophylactic use of mechanical restraints allowed this teenager to be integrated into the milieu and to receive multiple treatments that the standard protocol precluded. This case underscores the difficulties in managing aggression when youths do not respond to standard protocols and do not conform to our assumptions about the least restrictive alternative. It is concluded that prophylactic mechanical restraint provided the least restrictive alternative to personal freedom for this teenager and had therapeutic benefit.

A sibling adoption study of adult attachment: The influence of shared environment on attachment states of mind

Abstract This study extends existing research investigating sibling concordance on attachment by examining concordance for adult attachment in a sample of 126 genetically unrelated sibling pairs. The Adult Attachment Interview (George, Kaplan, & Main, 1985; Main, Goldwyn, & Hesse, 2003) was used to assess states of mind with regard to attachment. The average age of the participants was 39 years old. The distribution of attachment classifications was independent of adoptive status. Attachment concordance rates were unassociated with gender concordance and sibling age difference. Concordance for autonomous/non-autonomous classifications was significant at 61% as was concordance for primary classifications at 53%. The concordance rate for not-unresolved/unresolved was non-significant at 67%. Our findings demonstrate similarity of working models of attachment between siblings independent of genetic relatedness between siblings and generations (i.e., parent and child). These findings extend previous research by further implicating shared environment as a major influence on sibling similarities on organized patterns of attachment in adulthood. The non-significant concordance for the unresolved classification suggests that unresolved loss or trauma may be less influenced by shared environment and more likely to be influenced by post-childhood experiences or genetic factors.

Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and disorganized infant-mother attachment

Objective: To examine the quality of infant–mother attachment in a prospective case series of infants whose mothers took selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Background: SSRIs are prescribed to 2–6% of pregnant women. Recent articles on the use of SSRIs during pregnancy note the increased risk for problematic infant–mother relationships among mothers with untreated postpartum depression. However, little is known about the quality of infant–mother relationships among mothers who took SSRIs during pregnancy. Methods: Five mothers who took SSRIs during pregnancy were recruited from a community study of infant development. Mothers completed ratings of postpartum depression symptoms (Beck Depression Inventory) 4–6 times between 1 month and 1 year following the infant’s birth. At 1 year postpartum, quality of infant–mother attachment was assessed using the strange situation procedure. Results: Four of the five infant–mother dyads (80%) were classified as disorganised, a rate considerably higher than in postpartum depression samples. Conclusion: These results are used to raise questions about the clinical implications of research on in utero exposure to SSRIs, perinatal depression, and disorganised attachment. Specifically, this case series raises questions about using research on the link between postpartum depression and infant–mother attachment as a rationale for the use of SSRIs during pregnancy. Current research indicates use of SSRIs during pregnancy may: (1) increase risk for disorganised attachment, (2) decrease risk for disorganised attachment, or (3) have no effect on disorganised attachment.

Like a Refugee

In this chapter, I discuss parent coaching with dyads with disorganized/controlling attachment and parents with an unresolved state of mind. First, I describe characteristics of disorganized/controlling attachment. Second, I describe parenting behaviors and other factors associated with disorganized/controlling attachment. Third, I describe relevant research on disorganized/controlling attachment including research on interventions that are effective in preventing or ameliorating disorganized/controlling attachment. Fourth, unresolved/disorganized state of mind. Fifth, I review relevant research on unresolved/disorganized state of mind including interventions associated with reductions in unresolved/disorganized state of mind. Sixth, I discuss clinical observations and recommendations for coaching parents in disorganized/controlling dyads and parents with unresolved/disorganized state of mind.

Developmental aspects of child and adolescent depression

Depression is now recognized to occur in children and adolescents. However, developmental stage does appear to affect the expression, course, and pathophysiology of depressive episodes. These developmental differences restrict available treatments, and challenge our understanding of the causes and processes underlying depression across the life span.

Framework for Integrating Behaviorism and Attachment Theory in Parent Coaching

In this chapter, I provide a framework for coaching parents that incorporates behavioral management techniques and attachment theory. First, I describe the process of evaluating parent-child interactions from both an attachment and behavioral perspective. Second, I describe how to coach parenting behaviors consistent with secure attachment. Third, I describe “attachment-informed” behavioral coaching during child-led and parent-led play. Fourth, I present the rationale for tailoring parent coaching based on pattern of attachment and attachment state of mind.

What Does Not Kill Me Makes Me Stronger

In this chapter, I discuss parent coaching with dyads with avoidant attachment and parents with a dismissing state of mind. First, I describe characteristics of avoidant attachment. Second, I describe relevant research on avoidant attachment including research on interventions that are effective in preventing or ameliorating avoidant attachment. Third, I describe characteristics of dismissing state of mind. Fourth, I review relevant research on dismissing state of mind. Fifth, I discuss clinical observations and recommendations for coaching parents in avoidant dyads and parents with a dismissing state of mind.

Viewing Parent-Child Interactions Through the Lens of Behaviorism

In this chapter, I describe the application of behaviorism to parent-child interactions. First, I describe the development of problematic parent-child interactions and disruptive behavior from the perspective of behaviorism. Second, I summarize research on parent-child interactions based on behaviorism. Third, I describe behavioral parent training approaches. Fourth, I summarize research on behavioral parent management training with a particular emphasis on outcomes associated with a specific approach to behavioral parent management training, Parent-Child Interaction Therapy (PCIT).