As common sense might tell you there could be a link between trauma and attachment. This is highlighted in the literature (Cyr, et al. 2010: Tocker, et al. 2017 and Twaite & Rodriguez-Srednicki, 2004). The link between attachment insecurity and mental health difficulties is also in the literature (Mikulincer & Shaver, 2012). But, do we need to do anything special to improve attachment in traumatized clients?
Eline Rimane and colleagues attempted to examine the question, does trauma focussed therapy change attachment?
They used developmentally adapted cognitive processing therapy (D-CPT).
They examined two aspects of adult attachment.
1) attachment-related avoidance, and
2) attachment-related anxiety.
Attachment-related avoidance can refer to two things.
1) discomfort with closeness or
2) a reluctance to become intimate with others.
Attachment-related anxiety is associated with anxiety and vigilance about rejection and abandonment.
Findings
Rimane and her team studied adolescents and young adults (aged 14–21 years). These participants had experienced, child sexual and/or physical abuse. The participants in her study had PTSD as a primary diagnosis. However, there was a lowered threshold for avoidance symptoms . Only two symptoms instead of three as defined in the DSM-IV-TR.
They found that changes in attachment-related anxiety occurred in treatment and control groups. From baseline to 3-month follow-up the effect size was d = 0.60 for D-CPT and d = 0.44 for their control group.
For attachment-related avoidance, only participants in D-CPT improved significantly. From baseline to 3-month follow-up effect size was d = 0.75.
Summary
Attachment and trauma, do I need to do anything special?
The answer was given by Rimane and colleagues:
“Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.” (p1591)
References
Cyr, C., Euser, E., Bakermans-Kranenburg, M., & Van Ijzendoorn, M. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22(1), 87-108. doi:10.1017/S0954579409990289
Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World psychiatry : official journal of the World Psychiatric Association (WPA), 11(1), 11–15. https://doi.org/10.1016/j.wpsyc.2012.01.003
Rimane, E., Steil, R., Renneberg, B., & Rosner, R. (2021). Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. European child & adolescent psychiatry, 30(10), 1591–1601. https://doi.org/10.1007/s00787-020-01637-x
Tocker, L., Ben-Amitay, G., Horesh-Reinman, N., Lask, M., & Toren, P. (2017). Predictors of Clinical Outcomes in Sexually Abused Adolescents. Journal of child sexual abuse, 26(4), 487–505. https://doi.org/10.1080/10538712.2017.1300204
Twaite, J. A., & Rodriguez-Srednicki, O. (2004). Childhood sexual and physical abuse and adult vulnerability to PTSD: the mediating effects of attachment and dissociation. Journal of child sexual abuse, 13(1), 17–38. https://doi.org/10.1300/J070v13n01_02
