Attachment anxiety moderates the relationship between childhood maltreatment and attention bias for emotion in adults
Introduction
Given that biases in attention for emotionally-valenced cues have been linked to anxiety disorders, depression, and PTSD (see Bar-Haim et al., 2007 for a review) and may even play a causal role in the emergence of some internalizing conditions (e.g., Osinsky et al., 2012), a growing body of research has focused on identifying factors that might precipitate their development. One such factor that has generated a great deal of interest in recent years is childhood maltreatment, which has been shown to relate consistently both to the development of mood and anxiety disorders (McCauley et al., 1997, Dube et al., 2001, Gillespie et al., 2009b) and to the emergence of biased socioemotional processing (Dodge et al., 1990, Weiss et al., 1992).
Research focused explicitly on associations between attention biases for emotional cues and childhood maltreatment, however, has yielded conflicting results. In particular, findings regarding the direction and nature of attentional biases in individuals maltreated as children vary across studies. In one study, for example, children with documented maltreatment histories demonstrated a bias to direct attention away from threatening faces (Pine et al., 2005); another study found that young adults who retrospectively reported maltreatment during childhood demonstrated a bias to orient towards threat (Gibb et al., 2009). In a third study, Fani and colleagues (2011) found that adults with a retrospectively-reported child maltreatment history showed a bias to attend preferentially to happy faces, but no significant bias either toward or away from threatening faces.
One possible explanation for the discrepancies across studies is that research to date on attention bias and maltreatment has not identified and taken into account potential moderators. Both interpersonal and intrapersonal moderating variables, which affect the direction and/or strength of an association between two other variables (Baron and Kenny, 1986), have been shown to modulate associations between attention biases and outcome variables such as depression (Connell et al., 2013, Romens and Pollak, 2012). Less is known, however, about variables that moderate associations between attention biases for emotional cues and predictors, such as childhood maltreatment. A growing literature suggests that attachment style merits attention as one such variable.
Attachment theory (Bowlby, 1980, Main et al., 1985, Bretherton et al., 1990) postulates that individuals develop an attachment style—a cognitive-behavioral representation of an internal working model of attachment—based on early life experiences with their primary caregivers. These internal working models of self and others guide later interpersonal beliefs, behavior, and information processing abilities. The attachment system is activated in times of need or threatening situations, with the primary goal of establishing close proximity to the attachment figure. Secure attachment with a caregiver has been shown to increase one׳s ability to regulate emotions in an appropriate manner (Thompson, 2008) and may buffer against the negative consequences of stress (Ahnert et al., 2004, Gilissen, 2008, Alink et al., 2009). In cases of child maltreatment the development of a secure attachment system is particularly threatened when the primary adult that the child turns to for security is also the source of threat or fear for the child (Schuengel et al., 1999, Cassidy and Mohr, 2001, Bradley et al., 2011). Research has repeatedly demonstrated that children who develop in environments characterized by physical and emotional abuse and neglect are more likely to develop an insecure attachment style than are children who grow up in safer contexts (Lyons-Ruth and Jacobvitz, 1999, Cicchetti et al., 2006, Cyr et al., 2010).
Attachment representations are believed to direct feelings and behavior, as well as cognitive processes, towards information that agrees with established mental frameworks (Main et al., 1985, Van Emmichoven et al., 2003) found that attachment representations influence processing of social information, especially in tasks that demand attention and memory. Although it is not entirely clear how this path of influence develops, internal working models of attachment may act as a filter for new information, directing attention towards schema-congruent material (Dewitte et al., 2007). For example, insecurely attached six-year old children in one study were more likely to attribute hostile intent to ambiguous stimuli than were securely attached children (Cassidy et al., 1996).
In adults, anxious attachment style is associated with a tendency to over-emphasize the presence and seriousness of threat and to attend preferentially to cues of negative emotion (Shaver and Mikulincer, 2007). In contrast, individuals with avoidant attachment models attempt to block negative emotions such as fear, anger, shame or guilt. These tendencies could directly relate to the formation of attention bias. It has been previously observed that impairment on tasks of attention and memory among individuals with varied insecure attachment styles are specific to attachment-related themes (Edelstein, 2006, Dewitte et al., 2007, Edelstein and Gillath, 2008). Research suggests that in both children and adults, avoidant and anxious attachment styles are associated with aversion of attention away from attachment-relevant stimuli (Ainsworth, 1978, Main et al., 1985, Dewitte et al., 2007) that may be either positive or negative in emotional valence (Kirsh and Cassidy, 1997). This pattern may reflect a tendency among insecurely attached individuals to experience anxiety in the face of any emotionally-charged interpersonal cues, which activate the attachment system whether they are positive or negative. In contrast, securely attached individuals, for whom interpersonal cues appear less anxiety-provoking, may be more open to attending to and processing both positive and negative social information, because neither type of data activates problematic schemata.
Thus, recent research and theory suggest that social information processing, which includes but is not limited to attention biases, unfolds as a function of both the type of information presented and the quality of a person׳s attachment style (for a complete review see Dykas and Cassidy, 2011). In the present study, we examined relationships among child maltreatment, level of anxious and avoidant attachment as measured by the Experiences in Close Relationships inventory (ECR), and attention bias in response to both threatening and happy facial stimuli using an adult, clinical population. We hypothesized that both avoidant and anxious attachment styles as measured by the ECR would interact with self-reported child maltreatment history to predict attention bias away from both happy and threatening facial stimuli.
Section snippets
Procedure
Subjects in this study were enrolled in a NIH-funded study of risk and resilience factors related to PTSD (Binder et al., 2008, Bradley et al., 2008, Gillespie et al., 2009a). Participants were recruited from the General Medical and Obstetric/Gynecological Clinics at a publicly funded, nonprofit healthcare system that serves a low-income population in Atlanta, Georgia. Participants completed a battery of self-report measures assessing trauma history, childhood maltreatment, and associated
Relationship of childhood abuse with level of anxious and avoidant attachment
Consistent with prior research on this sample, we found high rates of childhood physical, sexual, and emotional abuse. Data from the CTQ show that 27.9% of the sample reported moderate to severe levels of childhood physical abuse, 37.9% of the sample reported moderate to severe levels of childhood sexual abuse, and 25.0% of the sample reported moderate to severe levels childhood emotional abuse. When we aggregated across the three types of abuse, 51.4% of the sample reported at least one type
Discussion
In our sample of adults, levels of insecure attachment differed between those with and without self-reported histories of childhood maltreatment, such that insecure attachment was more common in those reporting high maltreatment levels. This finding is not surprising; attachment insecurity, an expected response to abuse in early life (Bowlby, 1951), constitutes a vivid example of the influence that early trauma has on later social functioning. We found partial support for our hypothesis that
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