Your text message made me feel :-)
Using technology to enhance attachment security

Daniel J Sonkin, Ph.D.
Licensed Marriage and Family Therapist
Sausalito, CA

“I received a text message from my wife, and before I even read it, I smiled!”

John Bowlby's attachment theory (1969, 1973, 1980) revolutionized developmental and social psychology (Cassidy and Shaver, 2008), and infant mental health research (Beatrice and Lachmann, 2013). More recently both researchers and clinicians have begun to explore its clinical application as well (Wallin, 2007; Fonagy, 2010; Obegi and Berant, 2010). Attachment theory has become a widely accepted concept, whose clinical appeal has grown over the past decade. Social and personality psychologists have also been interested in attachment theory, primarily in its application to adult relationships (Mikulincer and Shaver, 2010) and group dynamics (Simpson and Rholes, 1998). Two particular social psychologists, Mario Mikulincer and Philip Shaver (2010) through their collaboration, have greatly expanded our understanding of attachment in adult relationships, and in particular, the underlying cognitive and emotional processes that lead to particular attachment behaviors (Mikulincer, Shaver, Sapir-Lavid & Avihou-Kanza, 2009). What is most fascinating is their research on secure base priming which they have been conducting for the past 13 years (Mikulincer and Shaver, 2001). The implications of their findings, as well as the methodology they employed, are very applicable to our work as psychotherapists.

Secure Base Priming

In their original study, Mikulincer and Shaver were able to create a research methodology that asks the following question. Can we alter adult insecure attachment emotional, cognitive and behavioral patterns temporarily, so as to reflect secure attachment? In other words, can people with insecure attachment temporarily act like they have secure attachment? The answer turned out to be yes. And this methodology has been repeated many, many times over the past 13 years. This was done through a process called secure base priming. Secure base priming has been found to be correlated to a wide range of positive outcomes. It has been associated with increased compassion, altruism, and openness to different ethnic groups. It has been found to temporarily increase self-esteem (Carnelley and Rowe, 2010), reduce anger (Dutton, unpublished manuscript) and possibly even protect people from post-traumatic stress disorder (Mikulincer, Shaver & Horesh, 2006). Most of the studies have involved single priming exposure and the changes are generally short-lived (minutes or hours). There are only a few studies on the long-term effects of multiple priming experiences, which to date look promising (Gillath, Selcuk and Shaver, 2008).

Priming is a form of implicit memory. It is the mechanism through which we learn things through indirect observation, rather than a focused attempt to develop a skill - though it can also occur via a more deliberate process of attention. Mikulincer and Shaver used both subliminal and supraliminal priming techniques to activate "secure base" mental representations of individuals assessed as having insecure attachment as measured by an empirically validated assessment questionnaire (Fraley, Heffernan, Vicary, & Brumbaugh, 2011).

Typical priming techniques include the subliminal presentation of words (eg, love, hug, etc.) and images (parents and children, couples, etc) on a computer screen. It may also include visual imagery, such as recalling actual secure base experiences. In their original priming studies Mikulincer and Shaver also asked subjects to create (make up) a secure base story, which had the same effects as actual secure base memories. Subsequent studies have included subliminal presentation of the names and images of the subject’s attachment figures.

More recent imaging studies have determined that secure priming does affect particular brain structures, which suggests that secure attachment can be neurologically differentiated from insecure attachment (Canterberry & Gillath, 2012; Gillath, Adams, & Kunkel, 2012). These studies point to a number of physiological processes in the brain that may give rise to attachment security. Secure base priming appears to, in part, activate memories (ostensibly of positive attachment experiences) (Quirin, Gillath, Pruessner & Eggert, 2010) in conjunction with the simultaneous activation of structures related to the release of attachment-enhancing hormones, such as vasopressin, oxytocin and dopamine (Gillath, Shaver, Baek & Chun, 2008). It is theorized that when the brain is primed to activate positive memories (mental images), feelings and thoughts of attachment, these representations are more readily available when experiencing stress, distress or when there is an opportunity for dyadic soothing or problem-solving (Mikulincer, Shaver, Sapir-Lavid, & Avihou-Kanza, 2009).

Priming and Psychotherapy

Secure base priming techniques are very similar to what naturally occurs in psychotherapy. Therapists utilize words and their non-verbal expressions to express affection, caring, support and concern for their clients. They also suggest solutions to specific as well as general problems the client is experiencing. Often therapists will encourage clients to remember positive outcomes from the past, or imagine positive outcomes in the future (both of which result in the creation of mental images and expectations in the brain). All of these aspects of therapy both directly and indirectly experientially give clients secure base experiences. It is the hope of therapists, that these repeated positive experiences will result in change. One can say that clinicians are exposing their clients to repeated secure base priming.

However, there is a huge difference between temporarily changing attachment representations and/or affect in the laboratory via computer, and doing so in psychotherapy with a real live person. However, change in psychotherapy can be a long, arduous process that could take years to generalize in outside relationships. So a critical question is can therapists use the secure base priming research to enhance the security-boosting effects of psychotherapy?

Therapists often recommend adjunctive activities that clients can participate in that support change, such as medication, changes in lifestyle, and mindfulness or meditation training. Mindfulness meditation, in particular, has been shown to improve mood (reduce depression and anxiety) and promote positivity (states of well-being). Davidson (2004) found that individuals who meditated for 30 minutes a day, six days a week for two months changed the their activation ratio of their prefrontal cortex - from favoring withdraw emotions on the right to favoring approach emotions on the left. This change resulted in reduced anxiety and increased states of wellbeing. Secure base priming may also be a valuable adjunct to traditional psychotherapy.

Texting Can Make You Happy

In a recent study researchers explored whether texting secure base guided imagery exercises can increase self-reported feelings of “felt security” (Otway, Carnelley and Rowe, 2013). These researchers expanded the traditional view of felt security - feeling care, love and safety. They have included an energy component that can best be described as a “subjective vitality as feelings of aliveness and vivacity.” They differentiate this state as discretely different from an overall sense of positivity (Luke, Sedikides and Carnelley, 2012). Their rational for this particular experiment was their that it was logistically impractical to prime individuals only in the laboratory. Due to the wide spread use of smart phones, the researchers decided to explore whether or not texting could substitute for in-lab priming.

Subjects were assigned to either a secure or neutral priming condition before starting the priming process. During the first exposure (which was conducted in the laboratory), subjects were asked to either write a story about a security-inducing attachment figure or a neutral assignment (eg. a supermarket shopping trip). Twenty-four hours later, subjects were texted a 3-minute visualization task (either secure or neutral). Twenty-four hours later, subjects received another text with another 3-minute visualization task (secure or neutral). And again twenty-four hours later they received another text. They received a total of five primes over the course of a week every twenty-four hours. Felt security was measured with a 16-item scale (that was developed by the researchers) which assesses feeling secure and safe (eg, loved), as well as this sense of energy.

The findings were in line with other secure base priming studies. Secure base priming increased feelings of “felt security” as compared to the neutral primes. Most importantly, they found that the feelings of felt security stayed active for a number of days. This is important because it suggests that repeated priming may act as security boosters over time. The results suggest that texting can be used as an intervention with clients. CBT therapists have been using texting to facilitate treatment for a number of years now (Aguilera and Monoz, 2011). Why can’t attachment-oriented therapists do the same?

Secure Base Priming Program

Another way of delivering secure base primes to a client is through the Internet. The smart phones that are able to receive text messages also have access to online information via a web browser. I have developed a web site (www.securebasepriming.org) that is able to deliver three different types of primes to a user, which can be accessed by the client at any time. The three priming exercises are words (secure, support, care, etc.), images (mother/fathers and children, opposite and same-sex couples – all of different ethnicities) and guided imagery exercises. The three guided imagery exercises based on the concept of a Secure Base Script (Waters & Waters, 2006).

“If I encounter an obstacle and/or become distressed, I can approach a significant other for help; he or she is likely to be available and supportive; I will experience relief and comfort as a result of proximity to this person; I can then return to other activities.”

The first guided imagery exercise is simply an affirmation (saying the secure base script aloud). The second guided imagery exercise is the creation of a story that reflects the secure base script. And the third guided imagery exercise is the recalling of an actual secure base experience with a real-life attachment figure.

The web site is the basis of an online research study that will examine the effects of repeated secure base priming on attachment style, mood and relationship behaviors (as measure by the partner of subjects). Therapists, who are interested in referring subjects, are welcomed to try out the primes themselves and see what effects they may have on their mood and attachment style.

Conclusion

Utilizing technology for enhancing attachment security has potential, but more questions need to be answered before making any claims of beneficial effect to the public. First, we need to know whether or not repeated priming can have a lasting effect on enhancing attachment security. We know that the studies date have found short term effects, but it’s not clear whether or not those changes can be sustained over time. Like most brain-training programs, it is likely that the client will need to prime over a longer period of time in order to experience lasting effects. Plus, we don’t know if after a specified period, whether or not the effects will begin to plateau or wane altogether. We don’t know if clients need one type of prime or different types of primes over time. We also don't know what types of clients would most benefit from priming. Most importantly, we don’t know if there are any adverse effects of repeated priming. All of these questions and more need to be answered through research. However, in the meantime, there is no question that real relationships can enhance attachment security – this is already been demonstrated though longitudinal studies on attachment (Roisman, Padrón, Sroufe & Egeland, 2002). Whether or not these effects can be gained electronicly is yet to be determined.

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