Informational-contact Intervention: Promoting Secure Attachment

Interested in Attachment theory? Do you want to know more about attachment interventions? You have come to the right place!

This post will give you background information on attachment theory, implications of attachment style in later functioning, a review of previous interventions, and a proposed intervention that is aimed to promote secure attachment.

Parent and Baby's Hands and Feet

First of all, you might ask, how do you define attachment?

Attachment is the affectionate tie that a human or animal forms between himself and another (Ainsworth & Bell, 1970).

For the purpose of this proposal, attachment styles will be defined in four distinct categories: Secure, Avoidant, Ambivalent or resistant, and Disorganized/disoriented. A brief description of these can be found below in Table 1.

Table 1 SS JPEG

Click to enlarge

But why is this important?

It is essential to mental health for infants and young children to experience warm, intimate, and continuous relationship with their mothers (or permanent mother-substitutes) in whom both find satisfaction and enjoyment (Bowlby, 1951).

Deprivation of this can bring anxiety, excessive need for love, and powerful feelings of revenge, guilt, and depression (Bowlby, 1951).

In addition, the attachment style between a child and his or her caregiver during the first years of life has a great impact on the child’s later functioning (Hoffman et al., 2006).

There is a general expectation that a secure attachment predicts better later functioning (Thompson, as cited in Cassidy and Shaver, 1999) and ratings of disorganization in infancy have been found to predict psychopathology in late adolescence (Carlson, 1998; Ogawa et al., 1997, as cited in Cassidy & Shaver, 1999).

Therefore, it is vital to identify these problems and find ways to positively influence the relationship between the caregiver and his or her child.

Past interventions…

Informational Programs:

  • The Circle of Security (COS): tailored to meet the needs of each caregiver; uses educational and therapeutic components; aimed to decrease disorganized and insecure attachment (Hoffman et al., 2006)
  • Attachment and Biobehavioral Catch-up (ABC):  tailored to meet the needs of each caregiver; feedback provided to heighten sensitivity during home visits and video recordings (Bick & Dozier, 2013).

COS

Infant Contact Programs:

  • Soft baby carrier: carrier given at birth; allows infants and adults to be chest-to-chest, creating a protective, safe environment for the child; physical proximity creates bond between child and caregiver (Anisfeld et al., 1990).
  • Kangaroo Care: periods of skin-to-skin contact between a mother and her newborn; physical proximity improves attachment (Valizadeh et al., 2013).
  • Infant massage class: mothers and children who attend these classes will show a decrease in maternal depression and improve the mother-infant relationship (Onozawa et al., 2001).
Kangaroo care

Kangaroo care

So if all of these interventions are effective in promoting attachment, what are the most important variables within these interventions?

Age

  • Informational programs should begin after six months of age. It is suggested that this might be because the period immediately after birth is a demanding period for parents, during which it may be difficult for parents to be open to intervention (Bakermans-Kranenburg et al., 2005).
  • Contact interventions can begin at birth. Anisfeld et al. (1990) suggested that giving the mothers baby carriers at a sensitive, highly emotional period in their lives, right after they give birth, might influence her pattern of parenting in which the contact can lead to a healthier relationship.

Duration

  • Informational sessions should be short-term (i.e. 6-10 weeks). It is possible that parents may be more responsive to advice and feel like the guidance is helpful during a short-term intervention, rather than feeling like their parenting style is being ridiculed.
  • Contact Interventions may benefit from longer interventions, because a longer period of physical contact can only enhance the bond between the caregiver and his or her infant.

Parental Sensitivity

  • Parental sensitivity is the ability to accurately perceive his or her child’s signals and respond promptly and appropriately to these signals (Ainsworth et al., 1978 as cited in Bick & Dozier, 2013).
  • Interventions, both informational and contact based, were found to be the most effective when focusing on sensitivity.

So, you are probably thinking, “How can we use and combine this information to help those families in need?”

To find out the answer to this question, read on.

My proposed intervention

I would like to create an intervention that uses both an informational program and one that also promotes infant contact. Parents will receive a soft baby carrier while still in the hospital, which is intended to help foster physical contact, as described in Anisfeld et al. (1990). Upon agreeing to use this baby carrier for a year, the families will agree to participate in a ten-week informational session that meets for one hour every week. The first session will consist of an individual meeting between a therapist and the family where the therapist has a non-judgmental conversation with the family about variables such as time spent with the child, happiness of the child, sleep schedule, etc., while also video taping interactions between the parents and the child. The next eight sessions will be conducted in groups of four to five participants, where they will watch videos of examples of parents who respond positively to their children, and will also watch and review the details of their own interaction with their children through a non-judgmental dialogue between the caregiver and the therapist. During the final session, the parents and the children will participate in a lesson about massage techniques for the child.

This intervention has been created with the aim of increasing secure attachment in these children. If this can be obtained, it is thought that the children who are securely attached will show greater autonomy, peer relationships, social competence, and cognitive and socio-emotional functioning later in life.

How will this be tested?

I have created a study that will test whether this intervention is effective. Three hundred participants will be randomly selected from two hospitals in Boston, MA, two in Detroit, MI, and two in San Francisco, CA, and randomly split into three groups. The experimental group will receive the intervention as described above. The first control group will receive the informational sessions on parental sensitivity and massages, as described above, but will not be receiving a baby carrier. The second control group will not receive the baby carrier or sensitivity informational sessions, but instead participate in informational sessions regarding nutritional needs for infants and toddlers. These sessions will include lectures and videos on breast-feeding, baby food, vitamins, and other important nutritional information.

After the three groups have completed all ten sessions, they will participate in the Strange Situation procedure when their child is one year old. This will be conducted in a laboratory setting, in a small, carpeted playroom, in which toys are provided for the infant and chairs for the caregiver. The parent and the child will partake in eight three-minute episodes, which are outlined in Table 2 below. These episodes are arranged to create stress for the infant, so that the observers are able to see how the infant behaves around the caregiver, or the attachment figure, when distressed. The raters will observe these episodes through a one-way wall and categorize the infants into the appropriate attachment style (as described above in Table 1). If the intervention is effective, it is predicted that more children in the experimental group will show secure attachment, than those in control group 1 and control group 2.

Table 2 SS JPEG

Click to enlarge

The hope is to carry out this intervention, and help families benefit from both the short-term and long-term outcomes of secure attachment.

attachment-therapy

Do you have questions or comments? Please respond below! 

References

Ainsworth, M. D. & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by   the behavior of one-year-olds in a strange situation. Child Development, 41(1), 49-67.

Anisfeld, E., Casper, V., Nozyce, M., & Cunningham, N. (1990). Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment. Child Development, 61(5), 1617-1627.

Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26(3), 191-216.

Bick, J., & Dozier, M. (2013). The effectiveness of an attachment‐based intervention in promoting foster mothers’ sensitivity toward foster infants. Infant Mental Health Journal, 34(2), 95-103.

Bowlby, J. (1951). Maternal care and mental health. Bulletin of the World Health Organization, 3, 355-553.

Cassidy, J., & Shaver, P. R. (Eds.). (1999). Handbook of Attachment: Theory, Research, and Clinical Applications (265-316). New York, NY: The Guliford Press.

Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: The Circle of Security intervention. Journal of Consulting and Clinical Psychology, 27(6), 1017-1026.

Onozawa, K., Glover, V., Adams, D., Modi, N., & Kumar, R. (2001, March). Infant massage improves mother–infant interaction for mothers with postnatal depression. Journal of Affective Disorders, 63(1-3), 201-207.

Valizadeh, L., Ajoodaniyan, N., Namnabati, M., Zamanzadeh, V., & Layegh, V. (2013). Nurses’ viewpoint about the impact of Kangaroo Mother Care on the mother-infant attachment. Journal of Neonatal Nursing, 19(1), 38-43.

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