Who developed the Attachment and Health psychological model?
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Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Attachment-based therapy (children)
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Attachment theory, originally developed by John Bowlby, focuses on the importance of open, intimate, emotionally meaningful relationships. Attachment is described as a biological system or powerful survival impulse that evolved to ensure the survival of the infant. A child who is threatened or stressed will move toward caregivers who create a sense of physical, emotional and psychological safety for the individual. Attachment feeds on body contact and familiarity. Later Mary Ainsworth developed the Strange Situation protocol and the concept of the secure base.
Developmental psychology
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The broad theoretical framework for current versions of RAD is attachment theory, based on work conducted from the 1940s to the 1980s by John Bowlby, Mary Ainsworth and René Spitz. Attachment theory is a framework that employs psychological, ethological and evolutionary concepts to explain social behaviors typical of young children. Attachment theory focuses on the tendency of infants or children to "seek proximity" to a "particular attachment figure" (familiar caregiver), in situations of alarm or distress, behavior which appears to have survival value. This is known as a discriminatory or selective attachment. Subsequently, the child begins to use the caregiver as a base of security from which to explore the environment, returning periodically to the familiar person. Attachment is not the same as love and/or affection although they are often associated. Attachment and attachment behaviors tend to develop between the ages of six months and three years. Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some time. Caregiver responses lead to the development of patterns of attachment, that in turn lead to internal working models which will guide the individual's feelings, thoughts, and expectations in later relationships. For a diagnosis of reactive attachment disorder, the child's history and atypical social behavior must suggest the absence of formation of a discriminatory or selective attachment.
Reactive attachment disorder
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Internal working model of attachment is a psychological approach that attempts to describe the development of mental representations, specifically the worthiness of the self and expectations of others' reactions to the self. This model is a result of interactions with primary caregivers which become internalized, and is therefore an automatic process. John Bowlby implemented this model in his attachment theory in order to explain how infants act in accordance with these mental representations. It is an important aspect of general attachment theory.
Internal working model of attachment
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John Bowlby and Mary Ainsworth developed attachment theory in the 1960s while investigating the effects of maternal separation on infant development. The development of the Strange Situation task in 1965 by Ainsworth and Wittig allowed researchers to systematically investigate the attachment system operating between children and their parents. The Strange Situation involves separating infant-parent dyads and observing infant behaviours upon reunion. Infant behaviour tended to follow patterns, leading to the development of three attachment categories: Secure, Anxious-Avoidant, and Anxious-Resistant. In 1990, Ainsworth added a new category, championed by Mary Main, called Disorganized/Disoriented attachment, characterized by its less reliable pattern of behaviour.
Attachment and Health
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Attachment and Health is psychological model which considers how attachment theory pertains to people’s preferences and expectations for the proximity of others when faced with stress, threat, danger or pain. In 1982 the American Psychiatrist, Lawrence Kolb, noticed that patients with chronic pain displayed behaviours with their healthcare providers akin to what children might display with an attachment figure, thus marking one of the first applications of attachment theory to physical health. Development of adult attachment theory and adult attachment measures in the 1990s provided researchers with the means to apply attachment theory to health in a more systematic way. Since that time it has been used to understand variation in stress response, health outcomes and health behaviour. Ultimately, the application of attachment theory to health care may enable health care practitioners to provide more personalized medicine by creating a deeper understanding of patient distress and allowing clinicians to better meet their needs and expectations.
Attachment and Health
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Working models are representatives of the cognitive schema, or psychological structure (often unconscious), which underlie the different attachment classifications. Working models develop in children over time based on their experiences with their attachment figures. The cognitive schema for attachment consists of views of the efficacy of self and other to create security in times of distress.
Attachment and Health
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Following the publication of "Maternal Care and Mental Health", Bowlby sought new understanding from such fields as evolutionary biology, ethology, developmental psychology, cognitive science and control systems theory and drew upon them to formulate the innovative proposition that the mechanisms underlying an infants tie emerged as a result of evolutionary pressure. He realised that he had to develop a new theory of motivation and behaviour control, built on up-to-date science rather than the outdated psychic energy model espoused by Freud. Bowlby expressed himself as having made good the "deficiencies of the data and the lack of theory to link alleged cause and effect" in "Maternal Care and Mental Health" in his later work "Attachment and Loss" published between 1969 and 1980.
History of attachment theory
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Bowlby believed attachment to be a primary biological drive to achieve proximity with a caregiver that transforms across child development to also encompass a psychological drive to find security by achieving a preferred interpersonal distance with an important caregiver he called an attachment figure. Insecure attachment patterns develop when caregivers are experienced as inconsistent or unpredictable, which necessitates the development of different strategies to achieve a sense of comfort and safety within an interpersonal setting. Furthermore, he posited that attachment figures function as a "secure base" that facilitate environmental eexploration and that "attachment behaviours" are triggered by perceived stress, danger or pain, and are thus "state dependent".
Attachment and Health
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The health belief model (HBM) is a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model was developed in the 1950s by social psychologists at the U.S. Public Health Service and remains one of the best known and most widely used theories in health behavior research. The health belief model suggests that people's beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior.
Health belief model
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However, when Bowlby developed his attachment theory, cognitive psychology was still at its beginning. Only in 1967, Neisser proposed a theory of mental representation based on schemas which later led to the development of schema theory. It was said that these scripts might be the base of the structure of internal working models.
Internal working model of attachment