The neuroscience of attachment: implications for psychological therapies

Correspondence: Professor Jeremy Holmes, Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter EX4 4QG, UK. Email: [email protected] *

J.H. wrote the first draft, subsequently added to by A.S.

Bowlbian attachment research¹ demonstrates the role of childhood experience in shaping adult life and the importance of security for affective freedom. As a meta-model, attachment-informed psychotherapy² (AIP) emphasises the centrality, specificity and continuity of relationships (including those with mental health professionals); the modulation of threat; and the need to anticipate and mourn inevitable separations. Applicable across a number of therapeutic modalities, it provides a frame for understanding the disruptions that bring individuals for therapy but also can challenge the therapeutic alliance. As we describe below, recent advances in relational neuroscience help make sense of these disruptions and elucidate potential mechanisms of change in AIP.

Relational neuroscience

Social species' brains do not exist in isolation. Relational neuroscience, a broad term, draws on a range of experiential, neuroendocrine and functional magnetic resonance imaging evidence to illuminate how early key relationships affect the development of brain architecture and functioning.³ We focus here on aspects relevant to psychological therapies.

Biobehavioural synchrony

In utero and postpartum, mother and baby are physiologically entrained, with patterns of heartbeat, hypothalamic–pituitary–adrenal activation and oxytocin levels mirroring and responding to one another.⁴ These form the basis of parental sensitivity, identified by attachment theory's co-founder Ainsworth as the defining feature of secure attachments. Security-providing parents intuitively know and are rewarded by their infants, skilfully regulating – neither controlling nor ignoring – their needs and affects. For insecure caregivers, negative affects in their own children and others evoke rejection and diminished oxytocin reward. Clinical⁵ and animal⁶ models show that attachment trauma in early life influences the developing brain with long-term psychopathological consequences, including the capacity to care for the next generation – a strong message for clinicians to focus on early life experiences, taking the history of the parents alongside that of the children.

Studies of the physiology of therapist–client attachment are scant, but it is likely that biobehavioural synchrony also plays a significant role in the success of psychotherapy, especially at mutative moments in sessions. Therapists vary widely in their effectiveness:⁷ like insecure mothers,⁸ they can ‘loom’...