23/10/24, 16:43 Modifying insecure attachment style with cognitive bias modification - ScienceDirect

Journal of Behavior Therapy and Experimental

Psychiatry
Volume 73, December 2021, 101664

Modifying insecure attachment style with

cognitive bias modification
Emma L. Doolan, Richard A. Bryant

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Highlights

• Attachment styles bias how people interpret attachment-related

events.

• We used a cognitive bias modification paradigm to shift attachment

biases.

• Cognitive bias modification led to more secure interpretations of

ambiguity.

• Modifying attachment biases could benefit emotion regulation.

Abstract

Background and objectives

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23/10/24, 16:43 Modifying insecure attachment style with cognitive bias modification - ScienceDirect

Attachment theory suggests that internal working models developed from early experiences
with attachment figures biases cognitive appraisals a person makes of themselves and
others. The current paper investigates whether attachment-related interpretative biases can
be altered using Cognitive Bias Modification (CBM-I).

Methods
Eighty anxiously attached participants were randomly assigned to receive either secure or
insecure CBM-I training. To measure training effects on attachment-related interpretation
bias, participants read scenarios involving attachment figures whereby the availability of
the attachment figure was undetermined, followed by test sentences that assigned an
attachment-secure or -insecure interpretation to the situations. Participants rated the
similarity of these sentences to the previously read ambiguous situations.

Results
Participants who received secure CBM-I training ascribed higher similarity ratings to secure
sentence interpretations of ambiguous scenarios compared to insecure sentence
interpretations. Attachment anxiety increased after CBM-I training for those who received
insecure training, but did not differ for those who received secure training.

Limitations
This study was limited to healthy participants and did not include clinical participants.
These findings need to be replicated by assessing the effects of CBM-I over an extended
period.

Conclusions
CBM-I training may provide a viable means of modulating attachment anxiety. If validated
with more potent strategies for secure attachment training, this approach could have
significant implications for the treatment of affective disorders characterized by insecure
attachments.

Introduction

Attachment theory proposes that early experiences with attachment figures leads to the
development of internal working models of oneself and one's relations with others (Bowlby,
1969). These internal working models can reflect secure attachment systems (i.e. secure
attachment style), typically arising from a history of available and consistent attachment
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23/10/24, 16:43 Modifying insecure attachment style with cognitive bias modification - ScienceDirect

figures, or insecure systems (i.e. anxious attachment and/or avoidant attachment style) that
tend to develop following inconsistent or unavailable attachment experiences during
childhood. It is proposed that during times of threat or need, the attachment system is
activated and one seeks out actual or symbolic proximity to attachment figures (Mikulincer,
Gillath, & Shaver, 2002). Whereas this attachment seeking typically requires actual
proximity during infancy, mental representations of attachment figures can play this
function as one develops. There is much evidence that securely attached people activate the
attachment system when threatened (Mikulincer et al., 2002), and benefit from enhanced
emotion regulation when representation of attachment proximity is primed (Ben-Naim,
Hirschberger, Ein-Dor, & Mikulincer, 2013; Bryant & Chan, 2015; Bryant & Hutanamon,
2018). In contrast, those with insecure attachment styles tend to rely on secondary coping
strategies (Mikulincer & Shaver, 2016) and do not benefit from attachment proximity
(Bryant & Chan, 2017; Bryant & Foord, 2016; Mikulincer, Hirschberger, Nachmias, & Gillath,
2001; Mikulincer, Shaver, & Rom, 2011). The difficulty that insecurely attached people have
in benefiting from attachment proximity is reflected in evidence that these individuals have
poorer distress tolerance and higher risk of developing affective disorders (see Gillath,
Karantzas, & Fraley, 2016 for a review).

This situation points to the potential benefits of enhancing people's attachment security as
a means of improving their mental health. The stability of attachment style and internal
working models from infancy to adulthood has been examined across a number of
longitudinal studies and meta-analyses, demonstrating a moderate degree of stability (e.g.
Pinquart, Feuβner, & Ahnert, 2013). However, these and other studies also highlight factors
that contribute to the discontinuity of attachment styles, including experiences and events
that do not align with already formed working models (Chopik, Edelstein, & Grimm, 2019;
Fraley, Roisman, Booth-LaForce, Owen, & Holland, 2013; Khan et al., 2019). Bowlby and other
attachment theorists (Collins, 1996; Collins & Feeney, 2004) postulate that individuals tend
to attend to and interpret attachment-related information in manner that is line with their
existing internal working models (Bowlby, 1969). However, Bowlby also argued that
individuals have the capacity accommodate new information that challenges their pre-
existing models (Bowlby, 1969). This tendency points to the possibility that shifting biases
in how a person interprets attachment-related information could alter unhelpful internal
working models and enhance attachment systems in adults.

There is a growing body of research demonstrating how cognitive bias modification

techniques targeting interpretations (CBM-I) can shift long-standing biases in individuals
with emotional disorders. In one of its earliest applications, Mathews and Mackintosh
(2000) demonstrated how CBM-I can influence healthy individuals to interpret emotionally

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23/10/24, 16:43 Modifying insecure attachment style with cognitive bias modification - ScienceDirect

ambiguous scenarios in either a threatening or benign way, and this has been adapted to
modify interpretative biases across a broad array of clinical disorders (MacLeod & Mathews,
2012). Previous studies have adapted CBM-I to alter attachment-related biases, all of which
were conducted in child samples (Bosmans, Verhees, & De Winter, 2019; De Winter,
Bosmans, & Salemink, 2017; De Winter, Salemink, & Bosmans, 2018; Verhees et al., 2020).
Results of these studies showed CBM-I to be effective in training children to interpret
hypothetical ambiguous scenarios related to the availability of their mother in a secure
manner. A similar paradigm is yet to be tested in adults. Accordingly, the current study
aimed to investigate whether an adapted version of CBM-I could shift attachment-related
cognitive biases, and thus enhance attachment security, in adults. Specifically, participants
were trained to interpret scenarios depicting interactions with attachment figures in either
a secure or an insecure manner. It was predicted that following CBM-I training, participants
who completed secure training (compared to those who completed the insecure training)
would demonstrated a greater tendency to make secure interpretations of attachment-
related scenarios, and demonstrate increased attachment security. The current research
program utilized a non-clinical sample with heightened self-reported attachment anxiety.
The decision to focus on attachment anxiety was based on the premise that these
individuals tend to hyperactivate the attachment system as a response to their appraisals
that attachment figures are insufficiently available.

Section snippets

Participants

Eighty undergraduate psychology students from the University of New South Wales
participated in the study in return for course credit. Participants were initially screened on a
shortened version of the Experiences in Close Relationships Scale (ECR; Olssøn, Sørebø, &
Dahl, 2010) on which participants responded to six items that measured attachment anxiety
(1 = strongly disagree, 7 = strongly agree). Those who scored high in attachment anxiety (≥4.5)
were eligible to enroll in the current study.

Materials

CBM-I Training. Sixty-four training scenarios were sequentially presented on a computer

screen. Each scenario depicted a situation involving an attachment figure (close friend or
parent) with the availability of the attachment figure remaining undetermined until the
final word. For example:
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23/10/24, 16:43 Modifying insecure attachment style with cognitive bias modification - ScienceDirect

Your car has just broken down and you have an important event to attend. You message
your friend and ask for help. Your friend replies and says they are (coming/unavailable).

The final word was presented as a

Participant characteristics

Table 1 presents the participant characteristics. CBM-I training conditions did not
significantly differ in terms of age, t (78) = 0.68, p = .50, DASS Depression, t (78) = 0.42, p = .67,
DASS Anxiety, t (78) = 0.11, p = .92, DASS Stress, t (78) = 0.49, p = .62, ECR Anxiety, t (78) = 0.99,
p = .33, ECR Avoidance, t (78) = 0.51, p = .61, or baseline PANAS scores, PA: t (78) = 0.79, p = .43;
NA: t (78) = 1.28, p = .20. Further, the distribution of gender was not significantly different
across

Discussion

This current study tested whether a CBM-I paradigm that uses repetitive computerized
training could shift interpretations of attachment-related information in individuals high in
attachment-anxiety. Results showed that participants who received secure CBM-I training
ascribed higher similarity ratings to secure sentence interpretations of ambiguous scenarios
compared to insecure sentence interpretations. Alternatively, there was no difference in
similarity ratings for participants who received

CRediT authorship contribution statement

Emma L. Doolan: Conceptualization, Methodology, Data curation, Funding acquisition,

Formal analysis, Writing – original draft. Richard A. Bryant: Conceptualization,
Methodology, Writing – original draft.

Declaration of competing interest

No authors are declaring a conflict of interests. No funding supported this study.

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