Trauma, Memory, and Attachment

1

• Trauma, Memory, and Attachment
• Gail S. Goodman
• University of California, Davis

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Research Topics

• Can Attachment Theory help us understand
  childrens memory for stressful events?
• Alexander, Quas, Goodman, 2002
• Goodman Melinder, 2007

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Memory for Traumatic/Stressful Events

• Controversial Area of Study
• Is Memory for Stressful Events Particularly
  Accurate (Christianson, 1992)
• Better memory for main stressor
• Worse memory for peripheral information
• Is Memory for Stressful Events Particularly
  Inaccurate? (Deffenbacher et al., 2003)
• Worse memory for highly stressful events
  (defensive response)
• Better memory for optimally arousing event
• (orienting response)

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Childrens Memory for Stressful Medical Procedures

• Inoculations
• The more distressed children recalled more and
  were more resistant to misleading questions
• Not all studies found a positive relation

5
Individual Differences

• Perhaps there are individual differences For
  some people, memory might be better for
  traumatic/highly stressful material but for other
  people, memory might be worse
• We turned to Attachment Theory. Threat is
  believed to activate the attachment system.

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John Bowlby (1907 - 1990)

• The theory of attachment was originally developed
  by John Bowlby, a British psychoanalyst who was
  attempting to understand the intense distress
  experienced by infants who had been separated
  from their parents. Bowlby observed that
  separated infants would go to extraordinary
  lengths (e.g., crying, clinging, frantically
  searching) to either prevent separation from
  their parents or to reestablish proximity to a
  missing parent. Bowlby speculated that these
  behaviors may serve an evolutionary function.

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John Bowlby andMary Ainsworths Theory

• Internal working models of self and attachment
  figures are formed depending on the caregivers
  responsiveness to the baby
• The attachment system essentially "asks" the
  following fundamental question Is the attachment
  figure nearby, accessible, and attentive? If the
  child perceives the answer to this question to be
  "yes," he or she feels loved, secure, and
  confident (positive internal working models)
• If the child perceives the answer to this
  question to be "no," the child experiences
  anxiety (negative internal working models)

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(THREAT)
Felt security, love, confidence
Playful, less inhibited, smiling, sociable
Yes
Is the caregiver near, attentive, responsive,
etc.?
No

Maintenance of some proximity while
avoiding close contact
Separation distress and anxiety
Defensive-ness
Attachment behaviors are activated to some
degree, ranging from simple visual monitoring to
intense protest, clinging, and searching
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Secure
Felt security, love, confidence
Playful, less inhibited, smiling, sociable
Yes
Is the caregiver near, attentive, responsive,
etc.?
No
Avoidant

Maintenance of some proximity while
avoiding close contact
Separation distress and anxiety
Defensive-ness
Anxious
Attachment behaviors are activated to some
degree, ranging from simple visual monitoring to
intense protest, clinging, and searching
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Child Maltreatment

• D Category (Disorganized Attachment)
• About 80 of maltreated infants are insecure,
  including a high percentage of avoidant and D
  babies (Cicchetti)
• Caregiver with unresolved trauma/grief
• Their parents also tend to have high rates of
  insecure attachment
• The children tend to have more behavioral and
  mental health problems

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Ainsworths Strange Situation

• 8 Step Procedure
• Most Important Part is how Baby reacts when Mom
  re-enters the room (reunion)
• Is child easily comforted by mom? Does child
  avoid mom? Does child reach for mom but hit her?

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Individual Differences in Attachment
Organization (Ainsworth)

• Secure. 63 Seems confident that parent is
  accessible and responsive. Soothes easily. Shows
  early empathy, communicates clearly about
  feelings. (Origin sensitive, empathic
  caregiving coherent discussion of emotions.)
• Anxious/ambivalent. 10 More crying, separation
  anxiety, and anger. Lacks confidence that
  parent will be accessible and responsive.
  (Origin parental anxiety and uncertainty,
  insensitivity to childs signals, intrusiveness,
  inconsistency.)
• Avoidant. 27 Cries relatively little during
  separation and actively avoids parent upon
  reunion. Defensively avoids activation of the
  attachment system. (Origin parental rejection,
  coolness, discomfort with negative emotions.)
• Disorganized. 10 Tend to show strange behavior
  at reunion (lie down on floor stiff as a board,
  start to approach and then look like they are
  going to scream and walk backwards). D babies are
  especially prone to later mental health problems
  (e.g., dissociation) (Origin parental history of
  trauma/child abuse or unresolved grief.)

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Adult Attachment

• Attachment relationships are proposed to be
  important across the lifespan, including in
  adulthood
• According to adult attachment theory,
  parent-child and adult attachment function in
  similar ways because they are both shaped by the
  "attachment system"
• There is disagreement, however, as to how
  attachment should be measured in adulthood
• We have relied upon Self Report Measures (Hazan
  Shaver), as opposed to the Adult Attachment
  Interview (Main)

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Hazan Shaver

• A. I am somewhat uncomfortable being close to
  others I find it difficult to trust them
  completely, difficult to allow myself to depend
  on them. I am nervous when anyone gets too
  close, and often, love partners want me to be
  more intimate than I feel comfortable being.
• C. I find it relatively easy to get close to
  others and am comfortable depending on them. I
  dont often worry about being abandoned or about
  someone getting too close to me.

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Attachment Anxiety and Avoidance

• One critical variable has been labeled
  Attachment-Related Anxiety.
• People who score high on this variable tend to
  worry whether their partner is available,
  responsive, attentive, etc.
• People who score on the low end of this variable
  are more secure in the perceived responsiveness
  of their partners.
• The other critical variable is called
  Attachment-Related Avoidance.
• People on the high end of this dimension prefer
  not to rely on others or open up to others.
• People on the low end of this dimension are more
  comfortable being intimate with others and are
  more secure depending upon and having others
  depend upon them. A prototypical secure adult is
  low on both of these dimensions.

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Dimensional Approach
Low Avoidance
Preoccupied
Secure
Low Anxiety
High Anxiety
Fearful Avoidant
Dismissing Avoidance
High Avoidance
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Attachment and Memory for Stressful Events

• Some assumptions
• Many traumatic/stressful events trigger the
  Attachment System
• Internal working models act as sets of
  expectations that may influence the level of
  distress and memory
• Parental attachment is relevant to how children
  cope with stressful situations during and after
  they occur

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Individual Differences In Trauma Memory
Attachment Theory

• Assumptions
• Individual differences in attachment may be
  important moderators of the extent to which
  threatening information is attended/processed
• Avoidant individuals, who are uncomfortable with
  closeness and intimacy, are theorized to limit
  the processing of potentially threatening
  information, so as to prevent activation of the
  attachment system Defensive Exclusion

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Attachment Memory

• Attachment Avoidance
• Minimizing strategies
• Predict emotional memory deficits
• Attachment Anxiety
• Hypervigilance
• Inconsistently related to emotional memory

(e.g., Fraley, Garner, Shaver, 2000 Mikulincer
Orbach, 1995)
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Attachment and Childrens Memory For Stressful
Medical Procedures

• Studies of Childrens Memory for VCUG

Goodman Quas, 1996 Goodman et al., 1997 Quas,
Goodman, et al., 1999)
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Voiding Cystourethrogram Fluoroscopy (VCUG)

• Patient lies on a table
• X-rays are taken
• Genitals are cleaned
• Catheter is inserted through the urethra into the
  bladder
• Bladder is filled with a contrast medium
• X-rays are taken
• Patient is instructed to void

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A Strange Situation

• The VCUG procedure has certain similarities to
  Ainsworths Strange Situation

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Research Questions

• Are there age-related changes in the completeness
  and accuracy of childrens memory for stressful
  genital contact?
• Are there important individual differences in
  childrens reactions to and memory for stressful
  experiences?

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Childrens Memory for VCUG Methodology

• Subjects (N 46)
• 17 3- to 4-year-olds
• 16 5- to 6-year-olds
• 13 7- to 10-year-olds
• Number of VCUGs (range 1-6)
• 29 children 1 VCUG
• 8 children 2 VCUGs
• 9 children 3 or more VCUGs

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Childrens Distress and Parental Attachment

• Compared to other children, those of avoidant
  parents were the most distressed when they first
  entered the room
• All children were distressed during the
  catheterization
• Children of anxious parents cried the most when
  the parent left the room
• rs .30 to .60

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• Memory Questions
• 1. Free Recall and Cued Recall Questions
• Tell me what happened the time you had the test
  with the tube.
• 2. Specific Questions
• Did anyone hold you down during the test?

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Short-Term Study Recall Questions
Units of Information
Childrens Age
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Short-Term Study Specific Questions
Proportion
Childrens Age
29
Childrens age
-.35
Childrens memory incorrect
Childrens crying at outset
.38
Parent secure to avoidant
.34
p 30
Parental Attachment and Parent-Child Communication

• Post-VCUG Communication Questionnaire
• Parents indicated whether or not they
• explained VCUG to child
• discussed VCUG with child
• physically comforted child
• had no time to attend to child

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Insecure (especially Avoidant) Parents

• Didnt prepare their children for the VCUG
• Spent less time after talking to their children
  about it
• Spent less time after helping their child cope
  with their emotional reaction

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Conclusion

• Parental Attachment was an important predictor of
  the childrens distress, parental communication,
  and childrens memory
• Would our findings generalize to a different
  stressful event?
• Could we directly observe parents supportiveness
  or lack of supportiveness during the medical
  procedure?

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Adult Attachment, Parental Responsiveness, and
Childrens Reactions to Inoculations

• Children and their parents were observed while
  receiving an inoculation at a county immunization
  clinic
• Inoculations were videotaped and coded
  independently for childrens distress and
  parental responsiveness
• Edelstein, Alexander, Shaver, Schaaf, Quas,
  Lovas, Goodman (2004). Attachment and Human
  Development

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The present study

• Is adult attachment style related to parental
  responsiveness during this procedure?
• If self-report measures of adult romantic
  attachment reflect a more general orientation
  toward close relationships, then the self report
  measure might predict behavior toward children

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Participants

• Children (n 38)
• 19 girls 19 boys
• Mean age 5.26 (SD .96, range 3.7 7.2)
• Ethnicity 58 Caucasian, 24 Hispanic, 13
  African American, 5 other
• Parents
• 34 mothers 4 fathers
• Mean age 32.61 (SD , 7.43, range 22 48)
• SES mean 3.5, range 1 (high) 5 (low)

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Procedure

• Session 1 immunization clinic children and
  their parents were videotaped while children
  received an inoculation. Videotapes coded to
  assess child distress and parent responsiveness.
• Session 2 laboratory visit parents completed
  self-report measures

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The relation between childrens distress and
parental responsiveness
0
Lines are plotted for individuals 1 SD above and
1 SD below the mean of Avoidance
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Parents Reactions

• For avoidant parents, as the child gets more
  distressed, the parent gets meaner
• For secure parents, as the child gets more
  distressed, the parent gets nicer

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Memory for the Inoculation

• Q Did Parental Attachment Predict Memory for the
  Inoculation?
• A Yes, the same interaction was significant for
  memory.
• Alexander, Goodman et al. (2002). Journal of
  Experimental Child Psychology

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Child Memory for Inoculation Interaction of
Stress and Parental Avoidance for Free Recall
Correct
Memory Z-score
____High Avoidance ------Low Avoidance
-1
0
1
Childs (Distress Z-score)
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Child Memory for Inoculation Interaction of
Stress and Parental Avoidance for Correct to
Yes-No Questions
Memory Z-score
____High Avoidance ------Low Avoidance
-1
0
1
Childs Distress (Z-score)
42
Summary

• Parental Avoidance was related to childrens
  distress during the inoculation and to the
  childrens memory
• For children with more secure parents, their
  memory was better as the stressfulness of the
  event increased. For children of avoidant
  parents, their memory was worse as the
  stressfulness of the event increased.
• Children of avoidant parents might have been
  attending to the parents reactions.

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Adult Attachment and Long-Term Memory for Child
Sexual Abuse

• What is the role of negative emotion?
• Are avoidant individuals memory deficits more
  pronounced for especially emotional material,
  such as severe child sexual abuse?
• What is the underlying mechanism?
• Are avoidant individuals less likely to discuss
  emotional experiences with others?
• Edelstein, Ghetti, Quas, Goodman, Alexander,
  Redlich, Cordon (2005)

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The Present Study

• Hypotheses
• For more secure adults, memory will be most
  accurate for severe abuse
• Avoidant individuals will be less accurate
• Avoidant individuals will be particularly
  inaccurate about severe abuse
• Avoidance X severity interaction
• What is the role of post-event discussion?

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Method

• Time 1 A study of short-term effects of criminal
  court involvement (Goodman et al., 1992)
• 218 3- to 17-year-old children
• Documented information on demographics, mental
  health, and abuse and court experiences
• Prosecutors files, police reports
• Interviews with nonoffending parent
• CBCL on children at start of prosecution and
  later
• Measures on children waiting to testify
• Observed children testify in court

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Participants

• 218 initial participants
• 175 interviewed
• 142 disclosed documented case
• 2 did not answer questions about the abuse
• 38 did not complete second phase of study

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Participants

• N 102 documented child sexual abuse (CSA)
  victims
• Previously involved in a study of legal
  involvement (Goodman et al., 1992)
• Relocated and interviewed approximately 14 years
  after abuse (11 to 19 yrs later)

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Sample Characteristics
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Abuse Characteristics
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Current Interview

• Memory items
• Age when abuse began
• Age when abuse ended
• Extent of sexual contact
• Exhibitionism to penetration
• Frequency of sexual contact
• 1 time, 2-3 times, more than 3 times

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Current Interview

• How often did you discuss the abuse with friends
  and family members?
• Adult attachment assessed with Relationships
  Questionnaire (RQ Bartholomew Horowitz, 1991)

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CSA Memory Accuracy
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Results Post-Event Rehearsal

• Frequency of Discussion
• Avoidance, r -.21
• Anxiety, r -.07
• Abuse Severity, r .05
• Memory Accuracy, r .26

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Discussion

• What is the role of emotion/distress?
• Avoidant individuals were least accurate about
  severe, emotional incidents
• Emotion/distress enhanced memory only among less
  avoidant participants
• What is the role of post-event rehearsal?
• More frequent discussion predicted better memory

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Memory in Adults with CSA Histories Individual
Differences

• CSA victims who score high on avoidance indicate
  they have talked to others less about the
  victimization
• This may indicate defensive avoidance at the
  rehearsal level
• Some individuals may have a defensive response in
  the face of or after trauma/negative events,
  whereas others may have a more orienting/attentive
  response

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Practical Implications

• Many maltreated children will have a basic
  distrust that adults will be responsive to their
  needs
• Special interviewing techniques may be needed to
  promote accuracy in insecurely attached
  children/children of avoidant parents
• Rapport building may be particularly important
  for insecurely attached children
• Most of the children are quite accurate about the
  main features of the events regardless of
  attachment history

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Attachment Collaborators

• Jodi Quas Jenn Batterman-
• Phillip Shaver Faunce
• Annika Melinder Robin Edelstein
• Kristen Alexander Nikki Baumrind
• Jennifer Schaaf Yoojin Chae
• Jianjian Qin Anne H. I. Borge
• Else-Marie Augusti Rakel Larsen
• Tim Brennan Deb Alley
• Michelle Culver Ross Thompson