WELCOME TO CBT ESSENTIALS FOR CHILDREN ADOLESCENTS

WELCOME TO CBT ESSENTIALS FOR CHILDREN & ADOLESCENTS!! LECTURE 5

Check in Comments/questions from last week? Quiz 4 Homework take up Attachment Considerations Secure attachments Benefits of secure attachment Sensitivity Insecure attachment styles Interventions to improve attachment

HOMEWORK CASE STUDY Mike presents to your agency for ‘counselling’. When doing intake with his parents you find out the presenting problem is that Mike is being aggressive at school near the swings – chasing kids, pushing them so they don’t get on, or pushing kids off when they are on the swings. You determine through the session that Mike’s older brother Zack used to ‘rough house’ with Mike at the park, which once resulted in Mike falling off the swing and hurting himself ‘really bad’ as mom tells. Mike’s dad says he was not hurt at all and he has encouraged Zack and Mike to continue acting the same as always. Mom presents as very anxious about Mike even being around swings, an argument ensues between parents as you meet with them. Which family member behaviours are contributing, reinforcing or maintaining Mike’s behaviour? What role/level of involvement would you engage parents within? What would your intervention look like?

HOMEWORK Play with a child or adult this week, using the PRIDE principles of Parent Child Interaction Therapy. With a partner, practice also giving direction to an adult of how to use the PRIDE principles.

WHAT IS ATTACHMENT? The Attachment System represents a very basic and genetically anchored motivational and behavioural system that is in some biologically preformed, that serves survival function for the child, and that is activated after birth in relation to specific attachment figures. Bowlby Attachment is an emotional bond that develops during childhood but whose influence is not limited to this early developmental phase, but rather embraces all further stages of life. As such attachment represents an emotional base that extends into old age (Parkes, Stevenson. Hinde, & Marris, 1991). Caregiver and child are seen as participants in a self-regulating and mutually interacting system (Brisch 2011).

WHAT ARE THE INFLUENCES & BENEFITS OF ATTACHMENT? Survival Secure attachment developing in infancy is thought to have a protective function. Longitudinal studies show that when a child experiences secure attachment during early childhood over a longer period of time with at least one adult this experience may protect the person from developing psychopathology later in life despite subsequent traumatic experiences (Werner, 2007; K. E. Grossmann 2003) Adolescents – individuality and autonomy within stage of development BEST supported by a secure attachment, Brisch 2011 Direct correlation found between disorganized attachment and ADHD (Brisch 2011) Higher IQ and self esteem related to secure attachment

WHAT ARE THE INFLUENCES & BENEFITS OF ATTACHMENT? A link between disorganized attachment and structural abnormality in the dopamine receptor D 4 (Brisch 2011) A psychological mechanism appears to be at work that is responsible for the inter-generational transfer of caring behaviour and sensitivity from mothers to daughters (Silverman & Lieberman, 1999; Fleming, O’Dy & Kramer 1999). Cortisol levels in the infant brain (which is responsible for reaction to stress) is significantly influenced by the mother-child interaction (Schore, 1997) Later in life determines type of relationship you will have with a romantic partner and within your own care giving/receiving relationships

HARLOW & BOWLBY Monkeys separated from mothers Offered either a terry cloth surrogate mother OR a wire surrogate with milk Monkeys choose terry cloth surrogates Conclusion was that the need for affection/safety/connect ion stronger than the need for food

OUR ROLE As Cognitive Behavioural Therapists we want to: Understand the Attachment System Identify behaviours, cognitions and situations which indicate insecure attachments Provide interventions to improve secure attachment Do all this to improve mental health

INFLUENCES ON ATTACHMENT: SENSITIVITY OF THE CARE GIVER “Sensitive behaviour” by an attachment figure requires the ability to attune to the child’s signals (ie. Crying), interpret them correctly (ie. As proximity and contact seeking) and satisfy them promptly and appropriately. Ideally this sensitive behaviour occurs countless times in the interactions of daily life. (Brisch 2011) Sensitivity is the capacity for empathy – the capacity to identify with the intentions and motivations and the thoughts and feelings of another person, and to see that person’s inner world mirrored in one’s own – results from the activity of mirror neurons in the brain (Preston & de Waal 2002)

SENSITIVITY CONT’D … Any dyadic interaction activates these mirror neurons in the brain. When we see someone experiencing something neurons are activated in the motor and limbic system to correspond to the behaviour or experience of the other person. (Brisch 2011) These neurons help the observer: Identify with the emotional and experiential world of the other person Respond with consoling, caregiving or even saving the other person’s life Respond with compassion and empathy

AINSWORTH CHARACTERIZED SENSITIVE CAREGIVING BEHAVIOURS AS THE CAREGIVER BEING ABLE TO: Attune to the child’s signals with attentiveness (respond somehow) Appropriately interpret signals from the perspective of the child (crying from hunger, illness, pain, boredom) Respond appropriately to the signals Respond promptly, within a time period that does not cause harm to the child

WHAT ARE SENSITIVE BEHAVIOURS FOR OLDER CHILDREN, ADOLESCENTS & ADULTS?

SENSITIVE BEHAVIOURS AND RESPONSES NEED TO CHANGE WITH AGE Age High degree of emotional availability, responsiveness and connection required High degree of physical availability, touch responsiveness and connection required

Sensitivity differs from spoiling or over protectiveness in that sensitive parents support their child in her/his increasing autonomy and growing ability to communicate.

SECURE ATTACHMENTS OFFER: SAFETY PROTECTION WARMTH/LOVE AFFECTION RESPONSIVENESS AVAILABILITY (PROXIMAL, EMOTIONAL) STABILITY/CONSISTENCY What parental behaviours would interfere with the development of a secure attachment? What parental behaviours promote the development of secure attachment?

SECURE ATTACHMENTS ALSO OFFER: Highly empathetic responses High Structure (time, length, frequency) Consistency with frequency of interactions/behaviours of attachment Appropriate emotional distance, for example are available to be closer when individual reaches out, or setting boundaries with appropriate warmth A ‘safe base’ while also setting appropriate limits and bounds to that exploration Unconditional and positive regard and acceptance of the child (perhaps not the behaviours) Room for exploration and individuation A Hierarchy of attachment figures. Secure attachments allow for individuals to attach to others. , with appropriate responses with the greater the sense of threat, harm, pain or anxiety the more the child will seek out and insist the presence of the primary attachment figure Internal working Models that make the interactions between attachment figure and the child predictable. Children develop these Internal Working Models early in their development.

INSECURE ATTACHMENTS FORM WHEN CAREGIVERS OFFER: Increased risk of threat and harm Inconsistent affection, protection, love Neglect Rejection Conditional approval Blame

WHICH TYPE OF ATTACHMENT MIGHT THESE CORE BELIEFS RELATE TO? “I am incompetent. ” “I am ineffective. ” “I can’t do anything right. ” “I am helpless. ” “I am powerless. ” “I am weak. ” “I am vulnerable. ” “I am a victim. ” “I am needy. ” “I am trapped. ” “I am out of control. ” “I am a failure. ” “I am defective” [i. e. , I do not measure up to others]. “I am not good enough” [in terms of achievement]. “I am a loser.

WHICH TYPE OF ATTACHMENT MIGHT THESE CORE BELIEFS RELATE TO? “I am unlovable. ” “I am unlikeable. ” “I am bad [so others will not love me]. ” “I am undesirable. ” “I am unattractive. ” “I am unwanted. ” “I am uncared for. “I am different. ” “I am defective [so others will not love me]. ” “I am not good enough [to be loved by others]. ” “I am bound to be rejected. ” “I am bound to be abandoned. ” “I am bound to be alone. ”

WHICH TYPE OF ATTACHMENT MIGHT THESE CORE BELIEFS RELATE TO? “I am worthless. ” “I am unacceptable. ” “I am bad. ” “I am a waste. ” “I am immoral. ” “I am dangerous. ” “I am toxic. ” “I am evil. ” “I don’t deserve to live. ”

Grace Trevelyan

DEVELOPING HEALTHY ATTACHMENT Assessment of attachment (Attachment History Questionnaire) Assessment of interactions individual engages in with desired attachment figure Identification of strategies the individual can use to communicate needs Coaching with care giver/potential secure attachment figure Monitoring for ongoing, consistent healthy interactions

DEVELOPING HEALTHY ATTACHMENT Oxytocin The hormone oxytocin plays an important role with attachment. This hormone and neurotransmitter is released with skin to skin contact, like when caregivers provide this for new born children. Oxytocin is also released with other skin to skin contact, like hugs, when the skin makes contact for at least 30 seconds. Oxytocin also: increases bonding and pairing, is called the “Trust Molecule” because increased feelings of trust and attachment usually follow the release of this neurohormone , and leads to decreases in feelings of stress.

DEVELOPING HEALTHY ATTACHMENT Identify BIDS FOR ATTENTION, which come in all styles: Can be in the form of aggression if this is the inner working model the child has learned to get at least some sort of attention and contact Can be verbal: an ask for something, hinting at wanting something, wanting to ask for something but unsure and ‘beating around the bush’ Can be physical like hugs, kisses, approaching, cuddling, cheek to cheek or showing a desire for this Often come in the form of an invitation – to play, to join in, to go out somewhere, to do something Non verbal like sighs, groans, laughs, facial experessions May look like self harm or threats of suicide For attention, affection, security, help, support Sliding Door Moments

DEVELOPING HEALTHY ATTACHMENT Increase CARING BEHAVIOURS: Have individuals make lists of how they interpret caring to be and what that looks like Know love languages and what is received as love for the individual Incorporate and build on caring behaviours which strengthen the relationship the most

DEVELOPING HEALTHY ATTACHMENT Increase SENSITIVITY and Emotional Safety: Empathetic responses Identification and validation of the other individuals thoughts, emotions and internal experience Responsiveness to indications of having needs being met Through high communication with potential secure attachments Through programs like Parent Child Interaction Therapy Coaching care givers to respond like clinicians

DEVELOPING HEALTHY ATTACHMENT Increase: Consistency Stability Structure/schedule/format so it can be predictable Safe exploration and individuation Knowledge of attachment hierarchy/supports

GROUP WORK Identify the following from the case examples given: The behaviours which signify an insecure attachment and/or bid for attention from the child The maintenance cycle of the internal attachment working model of the child (what is caregiver doing/saying/thinking that contributes to child’s actions/thoughts etc) Suggestions/strategies to intervene to support a healthy and secure attachment

FOR ADULTS: IF YOU HAVE TENDENCIES TOWARD INSECURE ATTACHMENTS HERE ARE SOME TIPS: