Uncovering Trauma's Role in Creating Anxious Attachment
Dr. Dawn-Elise Snipes traces how inconsistent caregiving creates anxious attachment and dysregulates the stress response system. Infants move through protest, despair, and detachment when their needs aren't met. This early pattern links to PTSD, depression, chronic pain, and personality disorders later, but attachment can shift at any age with safe, responsive relationships.
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Foreign. I'd like to welcome everybody. Today's presentation on attachment theory and trauma and implications for treatment. I'm your host, Dr. Donnelly Snipes. In today's presentation, we're going to review attachment theory, identify the stages of distress, discuss the benefits of secure attachment and the effects of insecure attachment, learn about different attachment styles and their associated problems, and hypothesize interventions to help people create secure attachment in their lives, regardless of their age. So we've got a lot to cover. Let's start out at the very beginning. What is attachment? Attachment is the quality of the relationship with the caregiver, characterized by trust, safety and security. Now remember, when we talk about trauma, what do we have? We have a person who feels unsafe and disempowered and like they can't trust other people. So attachment is kind of the opposite of that. So attachment serves as a wonderful buffer against stress and against trauma. The quality of the infant parent attachment is a powerful predictor of a child's later social and emotional outcome. When children are young, even infants, they pick up on clues. They determine. They start learning whether their caregivers are trustworthy. And if you go back to Eric Erickson stages of psychosocial development, you'll see that the trust versus mistrust is in the infancy stage, the preverbal stage. And the child, when they cry, determines whether they're going to get their needs met and whether their caregivers are safe or dangerous. A person's attachment and the infant's attachment is often determined by the caregiver's response. When the infant's attachment system is activated, when they have a need, when they are afraid, when they're cold, when they're hungry, when they're in pain, when they're sleepy. Those are five big issues for a lot of children. The progressive stages of activation or distress start out with protest. The child cries, screams and protests angrily. When the caregiver leaves or doesn't show up, they will try to cling on to the caregiver to stop them from leaving. So we see some attachment or separation issues here. We also see the same protest when the child is uncomfortable. They're hungry, they're wet, they're sleepy. You know, the child will start to cry and they are basically beckoning the caregiver to come fix it. And that's the only way they can communicate when their cries are not met with an appropriate response and, and I do mean appropriate, just putting a bottle in a baby's mouth every time it cries, regardless of why it's crying is not an appropriate or sensitive response. So when the baby's cries are not met with a solution, when the baby doesn't feel safe or comfortable, then they may progress to despair. The child's protesting begins to stop and they appear to be calmer, although they're still upset. The child refuses others attempts for comfort and often seems withdrawn and uninterested in anything. Now this is something that happens over time. If the child is crying for a long, long time. And we can see it in sometimes, sometimes in children, when they get to that place where you're trying to get them to sleep on their own, for example, and there's a school of thought that you're supposed to let them, quote, cry it out. Well, they cry until they get to this point of despair and they go to sleep and they're just mentally, physically, emotionally exhausted. And then detachment. If separation continues, the child will start to engage with other people again and they will reject the caregiver on their return and show strong signs of anger. So the child or the infant is basically saying, you missed the boat, you weren't there when I needed you, so thanks, hit the curb. And turning to other people for, for comfort. The infant may obviously they can't say hit the bricks. They may turn their head, they may start to cry, they may become irritable when their caregiver tries to interact with them and they may be soothed when other people interact with them. So we do still see this behavior in in infants preverbal. Beginning at 6 months old, infants come to anticipate their caregivers responses to their distress and that shape their behaviors accordingly. That means they start developing strategies for dealing with distress in the presence of a caregiver. If you have a caregiver who responds with anger and frustration or just dismissal, it's here kid, take a bottle, go sit in your swing, you know, whatever, you'll get over it. Those types of reactions that the child will start to anticipate and they may again avert their gaze, they may quiet down, they may become inconsolable because they're hoping somebody else is going to come along. There are a lot of different reactions from children, but those reactions are triggered or prompted when the primary caregiver shows up. It's the child in their preverbal way trying to communicate, this person is dangerous. Or at the very best, this person doesn't make the pain go away, they make it worse and I don't want to be around them. When a caregiver is sensitive, responsive and loving, the child Develops a secure attachment. Well that makes sense if you have a need. Think back to when you were a kid and you had a need, you skinned your knee or you know, because most of us don't remember when we were pre verbal, you skinned your knee or you were hungry or you had a nightmare and your caregiver came in and comforted you. That was a consistent responsive action on their part that said, hey, I'm here, we've got this together. On the other flip side, caregivers that are insensitive and that can mean they don't pay attention, or that can mean that they keep doing things that are painful or troublesome for the child, maybe they don't even realize it. Maybe when they get upset and they get angry, they yell loudly and it scares the child. But they don't recognize, they don't see the connection with children who are neuroatypical. And this is more than just on the spectrum. There are a lot of different things associated with neuroatypicality. But especially in the preverbal stage when children are neuroatypical, there may be some things that a neurotypical child would find comforting and helpful. A neuro atypical child does not. For example, swaddling. A neuro atypical child may find that that is too constraining or too uncomfortable or certain clothing that the caregiver keeps putting them in the bath water. What the caregiver sees as lukewarm, the child may feel as burning hot or, or too cold. But the caregiver doesn't understand this. So they think, oh, the child just doesn't like taking a bath. The caregiver may be trying to be sensitive, but they don't understand. So insensitive is a pretty broad term and generally it means not meeting the child's needs as the child understands them to be rejecting. Pretty self explanatory. I don't have time for you. I'm going to sit here and scroll on my tablet. You go do something. I don't remember what actor it was that said get away from me kid, you bother me. But sort of that sort of thing. Or the child that has a problem, they get scared or they fall down and skin their knee and their caregiver says what are you crying about? Get over it. All of those things tell the child, hey, you don't understand my needs or you're not willing to meet my needs and I don't know who will. For a child, that's a life or death issue that's terrifying to Feel con constantly unsafe and not know who you can turn to to help you feel safe and empowered. So, so that creates that insecure attachment. They're desperately seeking someone that they can connect with that's going to help them feel safe. Types of attachment the attachment figure that is inconsistently responsive is often going to produce anxious attachment. This rewards persistence and attachment seeking attempts because sometimes they succeed. If the caregiver think of a caregiver who has an addiction or a mental health issue. They have good days, they have bad days and on their good days they're responsive. On their bad days, not so much. So the child tries to figure out what is it that I can do in order to make you pay attention on your bad days. In behavior modification we call this an extinction burst. But that that's irrelevant right now. Ultimately the child is rewarded because they keep trying different things and trying harder. Eventually the caregiver is going to have a good day and be responsive. But you don't know, am I going to get Jekyll? Am I going to get Hyde? Am I going to get somebody who pays attention or not? Am I get going to get somebody who is helpful or not? Anxious attachment is associated with dependent, histrionic and borderline personality disorders and behaviors. And we are going to talk about how we might be able to recharacterize that as complex post traumatic stress. Because the behaviors that are developed are, are developed by the child as a way to survive. They are not dysfunctional. At that point in time the child's going, I'll do whatever it takes to make sure that someone's going to take care of me. Covert narcissism is characterized by self focused attention, hypersensitive hypersensitivity to other people's evaluations and an exaggerated sense of entitlement. The child, because of the inconsistent caregiver, has learned to pay attention to themselves. It's like the only way anything's going to get done and done right is if I do it. And I am going to be hyper aware, hyper vigilant to other people's evaluations of me. And I will be hypersensitive to clues of rejection. They may have socially destructive outbursts of anger. Emotional disregulation is, you know, what we call it clinically they because their stress response becomes disregulated as they are small children. Then when they get overwhelmed, they don't learn how to identify their emotions. They don't learn how to manage their emotions. So they may have these outbursts of anger. We're going to talk about all how all this pieces together in the next section. And they may be impulsive and have demanding behavior toward their relationship partners. I need you to do this for me. I need you to prove to me that you're not going to leave. I am hyperv vigilant to you abandoning me. The child as a. As a young child with that primary caregiver, learn to be hypervigilant to the clues about whether caregiver was having a good day and was going to be there or was having a bad day and was not. People scoring high on attachment anxiety tend to rely on hyperactivating strategies to force the other person to pay attention. So they're basically in fight mode. I feel scared. I'm uncomfortable about something. Now I need you to help me, and I'm going to fight to make sure that happens. So hyperactivating our fight strategies. Unfortunately, when the person does that, there's a little voice in the back of their head saying, you know, this probably ain't going to work anyway and they're going to reject you. Then when that comes to pass, or if it comes to pass, they may react with resentment and anger outbursts. Now, going back to the work I've done on inner child, and I have a whole series of videos on those. As the person gets older, that wounded inner child that didn't get their needs met is still feeling unsafe. So the person, as they get older, is still reacting from the position, if you will, of that scared child. That is just like, why in the heck does my caregiver not pay attention? I don't understand. In anxious attachment, people seek high levels of intimacy, approval, and responsiveness from partners and may become overly dependent on their partners. They're seeking that a secure attachment, that is, that they. They wanted to have in childhood. That secure attachment that doesn't need words, that the person is always there. And unfortunately, when we, as we get older, especially once we become adults, the primary caregiver kind of takes the back seat and we start developing adult attachment. So this can feel very dysfunctional in adult relationships. To the other person who's like, I can't be there to meet your every need and read your mind all the time, they tend to be less trusting. Well, they never learned how to communicate their needs or they're not getting their needs met from other people. But they don't recognize that that's their fault for not communicating them, and they blame others. Now, remember, the infant can't communicate, and the infant expects that the caregiver is going to kind of read their mind and if you've had an infant around, you know, sometimes it's like, okay, I've checked your diapy, you just ate, I tried to burp you. You know, you go through this checklist of things if you're trying to figure out what's wrong with what's wrong with the baby. But as we get older, as we become verbal in a secure attachment, we learn to start articulating our needs so other people don't have to play this guessing game. People who are anxiously attached have less positive views about themselves and their partners. They tend to view their partners as being insensitive and unpredictable, just like they viewed their caregivers. And their caregivers may well have been. And they don't see themselves as worthy of love because their caregivers didn't provide it. And now other people aren't providing, providing it. Now again, pre verbal, they couldn't help it. The caregiver needed to step up their game. Once you're verbal, it's important to start articulating your needs before you start expecting people to meet them. Because we truly can't read each other's minds, they may exhibit a high level of emotional expressiveness, worry and impulsiveness in their relationships. They're terrified of abandonment. That inner child that didn't get their needs met, that was always scared, is still there and still scared. And helping that person as the verbal person that they are, whether it's a teenager or an adult, helping them recognize in the present that they are safe, they are empowered, they are worthwhile, is going to be important. Helping them understand where some of this pent up rage and resentment and fear is coming from. Process that grieve the fact that I didn't have the relationship that I deserved, I did not have the caregivers that I deserved and I did not get my needs met like I deserved. Focusing on their deservingness. I know that's not a word, but they may overreact to the anticipation of separation or the actual separation from their attachment figure. And this can be the primary caregiver. Or in adult relationships, it can be their primary attachment. If that person is getting ready to go away on a business trip for a week, it may be terrifying to the person who is anxiously attached. And they often look way too far into things, whether it's a text message or a face to face conversation, because they're hypervigilant for those dog whistles that hey, you're getting ready to be abandoned and rejected. They overthink things and their partner may come home and be in a bad mood and they start evaluating, what did I do? And does this mean they're going to reject me? Are they going to leave? Oh, my gosh. And then it becomes a spiral and they become resentful and angry and terrified and it becomes a big thing. In avoidant attachment, the person has developed strategies to cope with an attachment figure who disapproves of and punishes closeness. The child that wants to sit on your lap and be read a story who was told, no, I don't have time, why don't you go watch tv? Ouch. The child that desperately wants to play with their caregiver. And the caregivers too obsessed with their mobile device or not even there or drunk or something else. But they, it's not that they're just inattentive. They actually punish this. It's like, why are you so stinking clingy? Grow up, you know, go play by yourself. And that is harsh for a lot of people, let alone a small child. And they also disapprove of expressions of need or vulnerability. Whether the child is saying, I'm scared or I'm in pain or I need a hug. No, you know, that's. You don't do that. You suck it up, buttercup, and you move on. We don't show weakness, we don't show pain. We, we don't show this or that. And that's extremely dysfunctional in and of itself. But think about how a child perceives that when they say, oh my gosh, I'm hurting. And the caregiver says, no, you don't need anything. You just need to get over it. Avoidance is a flight reaction. Remember, anxious attachment was a fight reaction. Avoidance is a flight reaction from a caregiver who's seen as emotionally unavailable. The child learns to hide or suppress the expressions of emotions that the caregiver does not tolerate and deals with threats and dangers all by themselves to avoid the frustration caused by lack of support. Avoidant attachment is associated with schizoid and avoidant disorders. Overt narcissism and grandiosity and denial or suppression of emotions and presenting a facade of security and composure. The person who has been regularly punished by their caregivers. I'm not going to love you if you show weakness or if you show you have a need. Well, they grow up being people who are going to, you know, do their best to be loved for what they do, hide any weaknesses and make sure that they are bringing the spotlight on themselves and getting accolades from others to prove their worthiness. Avoid an attachment style desire a high level of independence, often appearing to avoid attachment altogether. They view themselves as self sufficient, not needing close relationships. Passively avoid relationships when they feel as though they're becoming too close. So if they start feeling a little something for somebody, they may stop returning phone calls, stop returning text messages there. They may not overtly avoid the person or break up, but they're going to start putting distance between them. People who have avoidant attachment often deal with conflict by distancing themselves from others who they often judge harshly. Now remember, they got judged harshly, so now they minimize any of their mistakes. It couldn't have been me. And they judge the others, they blame other people and distance themselves. They often have a great amount of distrust in in others, but trust in themselves. Remember, they had to solve their problems by themselves because their caregiver wasn't going to be responsive to weakness or inadequacy. And they maintain their self esteem based on personal achievements rather than acceptance from others. Sounds very narcissistic Esque. Then you have the ancient anxious, avoidant attachment style, which is a combination of both. They often have mixed feelings about close relationships, both desiring and feeling uncomfortable with emotional closeness. They tend to mistrust others. Get a theme here. They view themselves as unworthy, seek less intimacy and suppress their feelings. So it's kind of the worst of both worlds. But this is a person who probably had a caregiver who may show up and may be attentive and sensitive 20% of the time. And then 40% of the time they were insensitive and dismissive. They weren't rejecting and openly hostile, but they just weren't there. And then the other 40% of the time they were mean and they said, you know what, suck it up, buttercup. So the person grew up with the same caregiver not knowing which person was going to show up to meet their needs that day. Secure attachment is created by a caregiver that cares. Imagine that. Now this is the mnemonic that we've talked about many times before. The caregiver is consistent when they are present with the child. They're mindful, they're present, they're in the moment, they are, you know what to expect. It's not this, am I going to get Jekyll or am I going to get Hide today? You know what you're going to get. So they're consistent, they're attentive, they pay attention to the child's needs, what the child's interests. It's not just reactive attentiveness. But it's proactive attentiveness. They're responsive to the child. When the child has a good day, they say, hey, tell me about it. You know, I see that, you know, you've got, you got an A on your report card, or I see that, you know, this thing went well, tell me about that because I'm excited for you. And the child goes, hey, somebody wants to pay, pay attention to me. I'm worthy of their energy. And when they have a bad day, the caregiver says, hey, I see that you, you're acting kind of down. You seem like you're feeling kind of down. You want to tell me what's going on? And that helps the child start developing their emotional vocabulary and being able to communicate. Oh, imagine that. Communicate their needs to others. The caregiver is encouraging. They don't do everything for the child. They're not enmeshed. They acknowledge they're, they consistently are aware of kind of what's going on with their kid. They are attentive to the child's needs. They're responsive when a response is required, but they don't do it. It's like, okay, well, you had a fight with somebody at school or somebody's being a bully to you at school. What are your options? And then they encourage the child to start taking actions, to start problem solving, to take the next step instead of jumping in and doing it for them. And I know, I've been there, I've gone through mama bear phase. And sometimes it's really hard to step back and encourage the child and let them go ahead and do it and take a chance as opposed to just doing it yourself. And then the caregiver is safe. If you have a bad day, if you have a good day, if you fail, if you succeed, if you are, you know, looking great or, you know, you look like you're haven't taken a shower in a week, whatever, it doesn't matter. You, your caregiver provides a safe home base. No matter what's going on, you can always come home. You can always come to me. Please like and subscribe and help us get the word out and share this video or the channel with at least one person you know. Or better yet, share it on social media. You can easily search all 1700 plus of my videos at docsnipes.com doc snipes-AI so please remember to like if this is helping you. So let's talk about the functions of attachment. This is more the interesting part, in my opinion. Remember Erickson's Stages of psychosocial development. Trust and mistrust. Autonomy versus shame and doubt. Can I take initiative? Well, I try not to use that word. Can I be autonomous? Can I think for myself? Or do I have to follow somebody else's rules? And then initiative versus guilt. Can I take initiative? Can I try to do things? Or if I try to be independent, am I going to get in trouble for it? We also have to remember that children's thinking, and I mean early child, early elementary school and earlier, it's dichotomous, tends to be all or nothing. And they form memories, they form schemas, and they understand the world at that age in all or nothing terms. You love me or you hate me, I can trust you or not. They can't say, well, mom had a bad day, that's why she bit my head off. It's like, oh, gosh, I guess mom's not safe right now. And children's thinking at this age is egocentric. The way they perceive things is the way they assume you perceive things. They have a tummy ache. You must know they have a tummy ache. Why wouldn't you know that? They don't understand different perspectives. And through secure attachment through the CARES behaviors, children start to learn to be self aware as well as other aware and start recognizing the difference between what I know and who I am and what you know and who you are. Children's attachment with their primary caregiver leads to the development of an internal working model which guides future interactions. If they're interacting with this person on, you know, throughout the day, on the daily, as infants and young children, then they start to figure out, well, if I do this, it gets rewarded. If I do this, not so good. And that helps them start to understand human interactions. Three main features of the internal working model. A model of others as being trustworthy. If I need something, you're going to take care of it. A model of the self as valuable and deserving of love. So if I need something, then you're actually willing to spend your energy on me because I'm worthy of your time and energy and love. What a concept. And the model of self as effective and empowered. And this is where the encouraging and safe comes in in the CARES mnemonic. Because children are going to try things and sometimes they're going to fail. But when they come back and they, you know, receive love and acceptance with open arms and their caregiver says, okay, well, let's drop back and look at that and figure out what you could do differently the next time Helps the child develop problem solving skills and learn how to be more effective at managing life. Now, when children are exposed to adverse childhood experiences, we colloquially call these aces now adverse childhood experiences, it creates an environment where there is chaos and emotional and physical neglect most of the time, if not also abuse. So let's look at those really quick. And there were I believe, nine of them, but I've distilled them down into three big groups. If there's mental health or substance abuse issues in the family, in the household, that can be an adverse childhood experience. Not always. You know, sometimes there's somebody with an issue in the household, you know, maybe grandmom lives there and she's got dementia or something. And, and yes, it can be chaotic at times, but the child again feels like their needs are noticed, important and met and they don't feel insecure. Whereas if there's somebody in the household that has an addiction or has depression or something else, and that takes the entire focus of the caregiver's attention, then the child's going, me, hello, me. Anybody gonna pay attention here? So it feels chaotic. They don't know when the person with the illness is going to have a good day or a bad day. They don't know when they're going to actually be in line to get attention. It's chaotic. If there's domestic violence, of course we know those are chaotic relationships. And the child is, even if the abuser is not the primary caregiver, they're seeing their primary caregiver get abused, which says primary caregiver may not be able to be there for me. Terrifying. So that's another thing. If there is abuse or neglect. And neglect, as I mentioned earlier, can be unintentional. A very well meaning parent may unintentionally fail to meet the child's needs because they just don't understand what the child's needs are. And this is especially true with people who are neuro atypical with in terms of sounds, smells, textures of materials, temperatures of food or bath water. You know, there's a lot of things that a person who's neuroatypical may find either over or under stimulating. But if this is going on in the house, if the child is feeling like their needs aren't getting met, they don't feel safe, then that's a, an adverse childhood experience. And divorce or abandonment, whether the caregiver dies, goes away for long periods, goes to jail, you know, whatever, the caregiver leaves all of a sudden, poof, caregiver gone. That can feel very chaotic to the child. And that's not to say that every family that goes through a divorce is going to create an adverse childhood experience. Sometimes the divorce is the solution to an adverse childhood experience. But it is important to be aware of how these things impact the child and their belief that they've got somebody they can rely on until they can rely on themselves, which, you know, how old is that? When somebody is regularly exposed to these things, and we've talked about this in trauma videos, it causes anger, a undercurrent, at the very least of constant stress. The child is constantly afraid of abandonment, of not getting their needs met, of being injured or whatever, and that causes their stress response, their HPA axis, to become disregulated. The caregiver is responsible for helping people develop or their child develop in all pieces of their life. And pieces is a mnemonic for physical, interpersonal, emotional, cognitive, environmental, and spiritual. Now, obviously, I can't go into depth on all of these things because we'd be here for a week. But let's hit the highlights. Physically, the caregiver is responsive to the child's needs by ensuring they get adequate rest and nutrition for their body, gut, and brain health. A sleepy child, a hungry child, they are not going to be able to learn as well, interpersonally or in school. They're not going to be able to manage their emotions as well, which is going to lead to more dysregulation, more stress. So the caregiver says, hey, I recognize that you have this little body factory going on, and, and it's my responsibility to make sure that that factory has what it needs to run appropriately. The caregiver teaches distress tolerance skills. And I have this up here because distress tolerance is literally down, regulating that stress response, activating the vagus nerve and the relaxation response. This is not something that is innate to children. Most of us never learned distress tolerance skills. Sometimes we may have been told to take a few deep breaths, but I always rolled my eyes at that. I was like, what? That's stupid. Helping children understand when you breathe in and you hold and you breathe out, it slows your heart rate and can help you get into your wise mind. They may not understand all those words at first, but we can introduce those as young as toddler, toddler years. Blowing bubbles with bubble stuff or even bubble gum is a great way for kids to trigger that vagus nerve when they're feeling stressed. There are a lot of other tools that I have in my video on distress tolerance, but the caregiver has to Teach the child those when you're feeling out of control, here are some tools you can use to feel like you can think clearly. And they teach impulse control. And that's just a behavioral response to distress. And the caregiver has to help the child learn. We don't hit, we don't bite, we don't throw things across the room. And through helping the child acknowledge their emotions, what's going on and the response of the caregiver in that responsiveness, the caregiver can say, okay, you're angry that mommy's spending time feeding your baby brother, which is why you threw your shoe at me. You feel jealous and you feel angry. So let's talk about what a more helpful response would be because throwing your shoe is not acceptable. Interpersonally, in developing that secure attachment and being attentive and responsive, the caregiver helps the child learn to trust them as well as trust themselves. When the child feels scared, the caregiver says, okay, you're scared. I'm not going to tell you that you're wrong because you are scared. Even if I think you know, I know there's no monsters under your bed, but you feel like there are. So let's work together to figure out in the facts in context, are there any monsters under your bed? Let's take a look. So the child learns to identify and trust their feelings, trust their spidey senses and trust others. At least select others. The child develops self awareness and self esteem. They start to through the the caregivers words. When the caregiver says, you seem angry right now. Would you like to talk about it? Then the child starts learning, okay, when I feel this way, this, this is angry. This is what angry feels like. So they start developing awareness of their internal sensations of anger, fear, happiness, other things and what to do about them. What is it that's causing this and what do I need to do in order to start feeling happy again? It helps them develop other awareness and empathy. When the child receives responses from the caregiver and is that are kind and are loving and accepting. I saw a video on, I think it was on Twitter the other day where the child was sitting on the on the sofa and the caregiver came over and said, can I lay my head down on your lap? And the chat. The child raised their arms, the caregiver laid down in their lap and the child started stroking their hair and leaned over and gave them a kiss on the forehead. Now the caregiver wasn't in distress or anything, but the child had seen that. And the child said, okay, this is what I do. Remember, we talked about that internal working model. And the child started becoming aware of what others, they thought others needed. They learned setting boundaries. And this comes a lot later, usually. But going back to that fear of monsters under the bed, the caregiver may say, you know what? I believe there are no monsters under the bed. But you. I see that you believe that there are. So let's look at it. Let's approach this together. So the caregiver is saying, I have my beliefs and they're. They're mine. They're okay. And you have your beliefs and they're yours. And I'm not going to contradict them because they're yours. I'm going to respect that boundary. And. And then let's get some more information and you can figure out what you believe. And they learn how to assertively communicate, which was kind of what I was just talking about. Assertiveness means recognizing my thoughts, feelings, and beliefs are mine and yours are yours. We may not agree. We don't have to. You don't have to agree with me. I don't have to agree with you. We. We. Stop right there. I can respect your difference of opinion and I can say, okay, well, you have the right to think this way and I have the right to think my way. And it's really important to start developing this in early childhood. Emotionally, the child starts feeling safe and empowered in their relationships with others, in their own skin, in their own head, or. Which is wonderful when they can start identifying emotions and solving problems. Oh, my gosh. They also develop emotional intelligence. And another mnemonic that I use a lot is Idea. They learn how to identify what they're feeling downregulate because we know that we, when we're in distress, we're in our emotional mind, not our wise mind. So they learn how to downregulate and get into their wise mind. They learned how to evaluate the triggers, what. What's causing their distress using fit cat facts in this context at this time. And then they can decide what action to take. And I know action taken doesn't quite fit, but in order to fit the mnemonic, you know, it's a little clunky, but children start learning how to do this, and that's emotional intelligence. Being able to recognize emotions, where they came from, what their purpose is. But we're not born with that knowledge. We need people, hopefully our caregiver, to help us start understanding, why is it that I feel this way? Why is it that I feel Angry or whatever. Cognitively trigger identification. The caregiver can help the child identify, you know, why did you get so upset over this, this particular time? Well, Sally did something that hurt your feelings and made you feel rejected. Okay, that's one trigger. You didn't get enough sleep last night, so you were already vulnerable. All right, we can consider that a trigger or a vulnerability. The caregiver can help the child go through that. And I remember going through these lists with my, my children, particularly when they were teenagers, helping them start to really wrap their heads around the importance of sleep and nutrition. But it's important for caregivers to use the Socratic method, not just lecture at them, but start saying, all right, let's take a look at what things may have contributed to your reaction. The caregiver helps the child develop motivation. If the child knows that they have a safe home base to come back to, they're going to be more likely to get outside their comfort zone. The caregiver helps them develop problem solving skills. The caregiver helps them with assimilation and accommodation, trying to figure out, okay, there's this new information, what do I do with it? Do I need to change my thinking or do I need to alter the perception of the situation? And they help the child develop resilience. The tools they need to bounce back. Environmentally, they provide a safe home base. And spiritually, they help the child feel a sense of connection even when they're not there. Remember when you had to go take a test at school and your caregiver said, you know, I know this is going to be a hard day for you, but I'll be there with you in spirit. I'll be there with you in my thoughts. And even though they weren't there, there was some connection that always made me feel more confident. In terms of attachment disruption, the primary attachment figure remains crucial for the approximately the first two years of life. And forming this attachment, according to Bowlby, is almost useless in if delayed until after two and a half to three years. Now we'll get to the re more recent research that says that's not quite accurate. If the attachment is broken or Disrupted between ages 1 and 5, the child may suffer irreversible long term consequences. In a 1992 study. Yeah, way back there, women who had lost their care, who had lost their caregiver through separation or death doubled their risk of depressive and anxiety disorders. The rate of depression was the highest in women whose caregivers died before the child reached the age of six. Well, that's pretty traumatic. When Your caregiver dies or is separated permanently from you when you are essentially a toddler. That's. Wow, that's scary. But not every person who experienced this went on to develop depression or anxiety. There was an increased risk, yes. It was a potentially an adverse childhood experience. Most likely, yes. But what else occurred as a result of the loss? Now, remember, adverse childhood experience experiences are additive. The more you have, the more likely you're going to have mental or physical issues. The future. And for this, the, this child, we've got to look and say, okay, after the caregiver died, we'll say what happened were they immediately met with a caring, responsive, attentive other person, whether it be a grandparent or their other parent or something, or did their life devolve into chaos for a period of time, which is even more terrifying to that child. So we've got to look and say, what else is going on? Why did only some women develop mood disorders? And there may be other things besides the environment that contributed to the development of these mood disorders later on. Now, ACEs, remember, are create an environment of chaos, emotional and physical neglect. A lot of times the child doesn't get their needs met in the way that they need them met. Aces may cause complex ptsd. I don't know what I can do about that. Can you. Can you rejoin the same? No, I can't. That's YouTube. That's not us. I think. It. Well, there has been updates for the plug thingies for a while, but. If I end stream, then I'm out of luck. I'm back. Okay. Yay. So hopefully I will stay back. I'll just start at the top of this slide. Aces. Chaos and adverse childhood experiences create chaos and potentially emotional and physical neglect for the child. Remember, this can be caused when there's mental health or substance abuse in the household, when there's domestic violence, child abuse or neglect, even if it's unintentional and divorce or abandonment. Now, not every child who experiences these things is going to have an adverse adverse experience, if you will. If their caregivers are still able to be consistent, attentive, responsive, encouraging and safe despite this stuff going on, then the child may not have a traumatic reaction. Now, domestic violence, I think, is the exception to that. And, and child abuse. If there's active abuse, no matter how responsive the caregiver is, the child's not going to feel safe. But divorce and mental health issues in the household definitely can be mitigated by a caregiver that cares. Now, it's my assertion that adverse childhood experiences may cause complex ptsd. Remember, the difference between PTSD and complex PTSD is that in complex PTSD there is prolonged or repeated trauma, such as child abuse or exposure to domestic violence, in which the person felt unsafe, powerless, and unable to escape. Can people develop secure attachment even with trauma or a lack of an initial attachment figure? The research says probably. Attachment patterns in infancy and early childhood show some stability over time, but they are open to change and tend to be linked to changes in caregiving and and other family circumstances. When the child is able to articulate their needs, when the child is in an environment in which they feel safe and empowered, when the child is in a relationship with someone they can trust, then attachment styles may start to change. If there are aces in the child's life, it is crucial for caregivers to to be responsive, to be there for the child to Instead of criticizing them for being moody or trying to minimize how they're feeling, recognize their behavior. Remember behavior, regardless of whether you're a child or an adult behavior, is communication. So the be child's behavior may become disorganized or chaotic or or withdrawn or something we want to examine or think about. What is that child trying to communicate to us and how can we be responsive in a way that the child feels safe and loved and has their boundaries respected? If they're feeling angry right now, if they're feeling angry at the caregiver, okay, they have that right and respecting that boundary is important. Adult attachment refers to expectations, beliefs and feelings about the availability and responsiveness of close others during times of distress. In adult relationships we typically don't have one person that does everything for us. Adult attachment relationships are characterized by a bi directional attachment, a give and take among a group of people in which people give and receive respect, encouragement, someone to confide in, reassurance, sick care, a sounding board for things that worry or upset them, etc. There's usually still one primary attachment person, one person that you turn to a lot of the time. It can be your best friend, your spouse, your sibling, or your childhood caregiver. If they're still alive, you may turn to them, but there are multiple secondaries when they're not available or maybe your issue is with them and you need to get support and respect from someone. You need to get clear your thoughts and then sometimes you may go to your best friend or you know, whatever else and I want you to think about who's your primary and who else do you rely on in times of distress, whether it's you need somebody to pick up your mail or you need somebody to cover for you while you run an go help your kid because they just got into a car wreck. I mean there are people that we trust that we rely on in our lives. Psychological problems can be caused by insecure attachment and can worsen insecure attachment. Davila et al found that late adolescent women who became less securely attached over periods of sleep 6 to 24 months or more likely than their peers to have a history of psychopathology. So if they have, if you have mental health issues, it may contribute to the development of attachment problems or it may come from attachment problems or both. Among soldiers with ptsd and the soldiers were just who were tested, we're not saying it only applies to soldiers. Attachment anxiety and avoidance increased over time and the increases were predicted by the severity of the PTSD symptoms. So the more symptomatic they were, the more withdrawn, the more irritable, the more flashbacks they were having, the more disconnected they felt from others, the more it negatively impacted their attachment. Totally makes sense. Insecure attachment is the vulnerability for a variety of health and mental health disorders with the particular symptoms depending on genetic, developmental and environmental factors. It's not just all about attachment, but attachment plays a big part. Attachment insecurity has been linked to addiction, anxiety, depression, codependency, the list of personality disorders especially, especially cluster B, ptsd, cptsd eating disorders and even schizophrenia. Schizophrenia is now conceptualized as a neurodevelopmental disorder and the neurological dysregulation, the HPA axis nervous system dysregulation caused by insecure attachment may contribute to the development of schizophrenia in vulnerable individuals. In terms of the impact of insecure attachment Physically, when people feel unsafe, when they fear abandonment, they don't sleep well. Their nutrition usually isn't great. But even if their nutrition is good, their gut microbiome is a disaster and they may not be absorbing the nutrients they need for health and well being. The vagus nerve. If people don't learn how to activate that vagus nerve through that initial attachment relationship, then they may not learn how to downregulate, tolerate distress in adulthood. So we can teach people this in counseling. We can help them learn the importance of sleep. We can help them learn how to get good sleep to feel safe in their environment. We can help them learn the importance of good nutrition. We for mental health. When people don't have good sleep, good nutrition, and they're stressed out all the time, we see an increase in systemic inflammation and illness and pain and muscle tension interpersonally. People who have insecure attachment, fear and don't trust others, so they don't have anybody to rely on and if they don't know how to do it themselves, they're like, oh, I'm screwed. There's a lack of self awareness because they never had anybody help them look inside and go, okay, let's think about what's going on on inside and learn how to put words to that. They probably have poor communication skills and poor boundaries because they never interacted with somebody who helped them learn how to articulate what was going on with them and recognize their feelings versus somebody else's. They may have difficulty making friends and connecting with others because they never learned how and may be more likely to evoke and perceive negativity from others. If they grew up in an inconsistent environment where they don't trust others, then they're probably going to sort of project that onto other people, which creates a self fulfilling prophecy, if you will. We can help people develop some of these skills even in adulthood and be more aware of what they're perceiving from others and whether that's based on the facts in context or that's based on assumptions from prior relationships. Emotionally, people tend to have a lot of dysregulation because their stress response, their HPA axis is just all out of whack. They have low emotional intelligence and tend to have high depression and anxiety. Cognitively, they have learning and attention issues. If you're feeling stressed, if you're hyper vigilant, you're not paying attention to learning calculus, you're trying to stay safe. They may have poor problem solving well, they're not thinking clearly, they're not sleeping well. We can understand why. And their cognitive distortions may be grounded in immature beliefs. Those beliefs that they formed in childhood, they were never told, hey, let's take a look at those all or nothing thoughts and consider. Are there other explanations for why your friend may have been mean to you at school today? They feel unsafe in their environment and lack a sense of connection to anybody else. They feel like they're out there alone, flapping in the breeze. Interventions secured. In addition to skills that we've talked about throughout this video, security priming includes subliminal pictures suggesting attachment figure availability. Having a picture of your attachment figure as your lock screen, you look at it, you feel warm and fuzzy inside. You open your phone and you start doing what you're doing. The names of people designated by participants as security enhancing attachment figures. Now, Jesus may not be an attachment figure for you, but it's an example of something that was popular back in the 90s. People wore these bracelets that said WWJD what would Jesus do? And that was sort of a subliminal security priming. When they felt distressed, they could look at their, look at their wristband or they could hold on to that and, and people felt a sense of security from that and guided imagery envisioning the availability and supportiveness of the attachment figure. Security priming improves participants moods even in threatening contexts and eliminates detrimental effects of threats on positive moods. So if you're getting ready to go into a hard test or a doctor's appointment and even if you just have that picture, you have that bracelet and, and you feel a connection to that security person, then it serves as a buffer. Additional tidbits grief and loss of the relationship the person should have had as a child or the relationship that went bad that they envisioned as an adult. They were in this relationship with somebody, things were going well, the other person developed an addiction or something and it all went to hell. They became, they developed an insecure attachment because of the abandonment. Okay, well now they've got to grieve all that in order to start being able to feel safe again. They need to go through that anger and depression and acceptance process. A lot of people who have insecure attachment have severe shame or guilt and they feel like they don't deserve to be loved because their caregiver didn't love them or, or their relationship person as an adult didn't love them and abandoned them. Additionally, attachment styles characterized by avoidance of emotional expression may predispose individuals to chronic conditions. If you internalize things, it's going to come out somewhere and generally that's in pain. Ineffective attachment deactivating and hyperactivating strategies that fail to result in secure attachment. So if I'm trying to make it work and it's not working and I'm still feeling scared, I'm still feeling anxious contributes to dysregulation of the stress system which leads to increased inflammation and pain. The relationship between PTSD symptoms and attachment anxiety was stronger for individuals with current PTSD symptoms associated with early life traumas compared to individuals with PTSD symptoms linked to adulthood traumas, which is kind of interesting. We've also found that PTSD symptoms tend to be or people are more likely to develop PTSD after a trauma if they have low cortisol levels and low cortisol levels can occur as a result of complex post traumatic stress. And finally postpartum depression. Insecure attachment style is an additional Risk factor for postpartum depression. Is my baby going to love me? Am I going to be able to be a good parent? Oh, my gosh, lots of anxiety. So having insecure attachment can make a person more vulnerable to postpartum depression. And postpartum depression itself is a significant risk factor for creating insecure attachment in the child. We need to be aware of this as clinicians, and I said the person because I do mean the person. Both genders of parents can develop postpartum depression, and both genders of parents do have hormonal changes after the birthing event. In attachment, the initial attachment relationship begins at birth, and there's a critical period between birth and 18 months where the child develops a sense of trust. Anxious attachment is associated with hyperactivating behaviors and is maintained by variable reinforcement. So the person keeps trying to get that caregiver's love and attention because every once in a while it works. And when it works, it's like, oh, my gosh, that feels so good. Avoidant attachment is associated with deactivating behaviors or avoidant behaviors. I don't have time for you. You're not safe. Go away. Both types of insecure attachment are associated with problems in mental and physical health and relationships. Chronic pain or mental health issues can both cause insecure attachments and be caused by them. So we need, if we're working with somebody who has a chronic pain issue or developed a chronic pain issue, we also need to be aware that it could have an impact on on their current attachments and encourage them to be aware of any impacts it's having. Security priming via visualization is one technique that can help clients feel safer and more secure in terms of treatment goals. People have to learn basic trust, have positive views of themselves, their partners, and relationships, learn how to maintain emotional balance, down regulate when they're feeling out of control, evaluate what's going on, and have that range of emotions. We're not trying to shut out or prevent ever feeling distress, but we want to have a balance. We want to help them feel confident and good about themselves. We want to help them feel safe and empowered. We want to help them generate a core set of beliefs and values about themselves, about the world, and about relationships. How, quote, should it be in their estimation? We want to help them feel comfortable with intimacy and independence and the ability to balance the two. I can feel close to you, but I can also let you have your space. We want to help them exchange support with their inner circle or secure relationships, develop resiliency skills, share their feelings, and develop the Ability to explore the environment with feelings of safety and security. All right, how. Does anybody have any questions? I apologize for that little blip or mid. Mid length blip in the middle. I'm not sure exactly what caused that, but we will certainly try to figure out if it was something on our end or if it was a YouTube sort of thing. And please remember to spread the word about all ceus about the channel. And I'm. I'll stick around for a few minutes to try to answer questions. Now, if you're in the class and you're going to take the quiz and you download the PowerPoint and you're like, OMG, there's 62 slides. We only talked about 31 of them. Yes, I know the rest of the slides. And it even says in there, I put this in there so you didn't freak out. They were just notes and things from my research that I thought were interesting, but they weren't important enough to make the cut for the one hour presentation. So I just kind of left the slides in there. If you're a research nerd like I am and want to know more, you can read about those. Alrighty, everybody. I think I've probably given you enough time to submit your questions and them to get to me. I don't want to cut this off if there's a question coming in, but it seems like everybody is done and I will see you next week. Same bat time, same bat station. Up. Come here. Come here. You know what bye bye means? Yeah. You know what bye bye means? Brewster says bye bye. Yes, Brewster says. Brewster, you gotta look at the camera. I know, loves. You gotta look at the camera. Look. Look at the camera. No, don't lick me in the face. Can I tell you where the. Where the link is? Go to allce.com I'm assuming you're asking about the link to take the. Take the class. Go to all ceus.com and log in and then you'll be able to click on the link for the live webinars and take the quiz for today's class. Brewster says, Ms. Adriana, I love you too. Okay, I gotta be careful or he's gonna slip me the tongue. That's gross. Everybody have a great day.
