Early Life Stages May Effect Life-Long Stress Outcomes: An Exploration into Attachment Theory and the Study of Psychoneuroimmunology (PNI)
Stress. It is one of the most discussed topics in modern society. How many times have you heard someone say, “I feel so stressed out!”? Almost daily, right? Yikes. But how does our relationship to stress develop? Examining the early stages of our life can bring us some understanding of how stressed—or not—we may feel in the world.
A theory called “attachment theory,” founded in the 1950s by psychologist John Bowlby, hypothesizes that one develops an “attachment style” by the types of social bonds experienced in early stages of life, which then determine how one’s stress response reacts to feelings of threat throughout life. [6, 7] However, Bowlby’s work was highly controversial, as the debate of nurture verses nature had gone on between researchers long before his hypothesis came to the research. (Oh, science! You have us in constant question.)
American pediatrician Arnold Gesell believed that the environment that children were raised in did not determine their outcome—he believed that our destiny is essentially predetermined before maternal bonding even begins. [7, 11] In contrary, behaviorist John B. Watson believed a child’s environment when growing up would fully determine their social bonds as adults. [7, 11] Centuries prior to Watson’s and Gesell’s debate, psychologist John Locke popularized the belief that mothers should be very wary of being affectionate mothers, as it creates hyper-dependent adults. [7, 11] Locke appeared to have made a convincing argument and his theory dominated American parenting styles for quite some time. Until Bowlby’s attachment theory research began in midcentury, a time when the field of pPsychology was evolving toward seeing the human experience as a collective energy system rather than separate (or individualistic) energy systems.
Bowlby believed that it is one’s first relationship, usually the relationship to one’s mother, that determines much of one’s health and well-being as an adult.  He categorized attachment style into three types: “secure attachment,” “avoidant attachment” and “anxious attachment.” Secure attachment style comes from responsive caregiving promoting emotional well-being through a sense of confidence and safety in the world—–a feeling as if you are not alone. [7,8] Avoidant attachment style comes from inconsistent or emotionally unresponsive caregiving and promotes excessive independence, emotional distance and comfortability with developing close intimate relationships later in life. [6,8] On the contrary, the anxious attachment style comes from unpredictable caregiving and promotes a hyper diligence of seeking for signals of abandonment or separation and an obsession for emotional connection.  Attachment theory brings a framework to possibly understanding more about how the human body reacts to psychosocial stressors. In the last 20 years, Bowlby’s foundational work has continued to take more shape in fields beyond psychology. As scientific research becomes more comfortable with a less reductionist, more holistic approach, fields such as psychoneuroimmunology (PNI) have emerged within the research.
PNI helps the attachment theory researcher to better understand the stress physiology of the body from a holistic perspective. PNI is an integrative study, founded in 1980 by Robert Ader, that defines how mental experiences and processes influence the function of the immune system. An exploration into stress, personality style, relational bonds, cognitive processing, systemic inflammation, mind-body health and immune function are all examples of areas that are explored through the PNI lens. For example, PNI has helped to better understand the influences between acute and chronic stress through studying nervous system functioning. “Allostatic load” has been identified as a permanent state of chronic stress.  These physiological studies have allowed for attachment theory research to be conducted at a more micro-level to better understand attachment behaviors in society . For instance, researchers are investigating cortisol production levels and cellular immunity levels to become more acquainted with human stress-responses. 2,6
Robert Karen’s research suggests that “one-third of children in middle-class American homes suffer from insecure attachment.” PNI has allowed for science to better explain the hypothesis of insecure verses secure attachment theory. Several themes have emerged from the research, such as how social bonds contribute to resilience to stress. Social bonds imply some form of connection or interaction has consistently occurred with another person. Furthermore, attachment theory believes that the very first relationships of one’s life may determine how the individual not only forms positive relationships to people throughout their adult life, but is also effective at coping with the stressors of the world and being supportive in interpersonal relationships.  PNI evidence demonstrates psychosocial factors, such as how depression, divorce and death change the immune system, therefore making one more susceptible to illness or disease. In 2010, a study  found that people who had experienced high blood pressure, strokes, ulcers or heart attacks were more anxiously attached as a child. Therefore, implementing attachment theory philosophy as a preventative health framework may be a solution for a healthier society. Several other research studies have begun to explore attachment theory through the PNI lens.
A study compared cortisol and immune cell levels of two groups: people of secure attachment with people of anxious attachment. An avoidance attachment group was not included in the study because chronic stress is not consistently associated with this attachment style. Eighty-five couples married more than two years participated in the study. To increase the validity of the study, any individuals who demonstrated a possible compromised health situation, such as high consumptions of alcohol and caffeine, high blood pressure or any endocrine or immune disorders (e.g., diabetes) were eliminated from the study. Couples were put into a controlled stress-free environment for three days. Questionnaires were given to identify attachment style, while cortisol and cellular immune markers were gathered four times throughout each day. The study concluded that participants who identified themselves as anxiously attached also tested higher cortisol levels and fewer T-cells than those who identified less anxiously attached. Therefore, this study suggests that attachment anxiety may influence health by contributing to a chronic stress-response and poor sleep quality.
Another study  hypothesized that anxiety in interpersonal relationships would interfere with health, such as sleep disturbance and quality of relationships. Two hundred and three participants were studied, with an average age of 19.8 years, and 98 percent reporting they were not in a committed relationship. Through relationship, sleep and wellness questionnaires, attachment style, sleep patterns and wellness habits were identified. The study concluded that insecure attachment styles, specifically avoidance attachment, were linked to fear of committed relationships. However, when an avoidant attachment style was in a relationship, they tended to choose a partner who demanded care to potentially calm their fear of rejection. Fearfulness was also associated with riskier health behaviors, such as smoking, drinking or poor nutrition, resulting in poor sleep quality. This study suggests that chronically ill individuals may be engaging in risky health behaviors due to insecure attachment.
A group of 257 adult females, ranging from 17–45 years of age, participated in a study about personality and health behaviors, specifically the barriers to cervical screening. Using five questionnaires, attachment style, quality of relationships, pap test barriers, emotional state (e.g., neuroticism) and lifestyle behaviors (e.g., sexual activity) were measured. Results continued to demonstrate what previous studies were concluding:, that secure attachment identity significantly contributes to healthier behaviors as an adult. For example, the women who identified with anxious attachment were less likely to participant in pap tests regularly. The study was also able to further explore how psychosocial factors, such as sexual trauma, effect health behaviors by further concluding that attachment theory could better equip health care providers to empathize with their patients. Furthermore, awareness of the barriers of insecure attachment and PNI may encourage practitioners to refer their patients with insecure attachment to other health professionals, such as a psychologist.
Another study conducted also demonstrated that women with adult insecure attachment to their spouse were more likely to make poor health decisions—for example, in areas like diet and exercise.  The researchers were motivated to further explore this area because previous research suggested that depression, loneliness and anxiety led to lower intake of nutrients and a higher intake of “comfort foods.” However, there was no link to attachment theory in the literature. The sample included 1,031 married couples who completed a relationship evaluation, attachment behavior questionnaire and self-assessment of eating and exercise habits. The men (husbands) in the study did not associate secure attachment with healthy habits; however, findings suggested that women (wives) who engage in more secure attachment behaviors in their marriages tended to make healthier eating and exercise decisions. Attachment behaviors were characterized in this study as accessibility, responsiveness and engagement (e.g., actively listening and confiding in one’s spouse or being able to easily get the other’s attention when needed). This investigation took the research beyond health implications of childhood attachment experiences and explored the health implications of adult attachment in marriage.
Investigating adult attachment further, another study  demonstrated attachment theory may impact the quality of caregiving among spouses of individuals with cancer. Spousal participants of 400 cancer patients participated in the survey. Just as the previous attachment research studies, the attachment styles were also measured within the questionnaire. The survey questions focused on rating frequency of caregiving, for example, “I help administer medications: monthly, weekly, daily?” and difficulty of caregiving using a five-point scale, for example, “He or she wants me to be close more often than I feel comfortable?” Very little was connected to frequency in attachment style in quality of caregiving. However, there were numerous associations of insecure attachment behaviors when reporting on difficulty of care. Specifically, anxious attachment to a spouse, in both the wives and the husbands, resulted in difficulty with providing emotional, instrumental and tangible care. In relation to gender, the husbands who identified with avoidance attachment style most related to struggling with specifically emotional-type care. This evidence supports Bowlby’s original definition of avoidance attachment: one who experiences unresponsiveness from their original caregiver will experience emotionally withdrawn caregiving as an adult.
After reviewing the literature, it was clear that development of social competence and the formation of intimate relationships is critical to health and well-being.  Bowlby’s founding of attachment theory brought attention to the importance of social bonds, especially in the very early stages of life. Now attachment theory has expanded into exploring adult attachment relationships. Pairing the study of PNI with attachment theory is helping to explore how psychosocial factors affect the human stress-response. Several patterns rose from gathering information from multiple studies.
One major pattern observed in the review of the literature was the effect anxious attachment had on one gender: women. In thinking of the cervical screening study, the caregiving of an individual with cancer study and the diet and exercise study, there was clear findings that women’s health was more impacted than men’s when identifying with anxious attachment. This finding is also in line with the fact that more women than men report experiencing anxiety, depression and sleep disturbances.  This research could imply that the female infant requires more attention to create a positive, safe social bond in the early stages of life. The research could also imply that society expects women to be solely responsible for the emotional caretaking of relationships. Therefore, more research is needed in investigating social attachment independent from established societal expectations for gender.
Another pattern observed in the literature was that men were more often associated with the avoidance attachment than women. For example, the caregiving of an individual with cancer study demonstrated that emotional withdrawal was present in husbands with avoidant attachment styles. However, when men and women are compared, men are typically the more emotionally withdrawn gender. Again, this proposes the need to research attachment theory independent from established society gender norms. However, attachment theory may bring framework toward evolving dominant gender norms. For example, if people become aware of their childhood attachment style, they may be better equipped to navigate sometimes stressful social connections, such as marriage.
A final pattern observed in the research was the lack of diversity in the participants. All of the studies recruited participants who were middle-class and European American (white). It is important to note that research and education is often a privilege in society and when researchers are searching for candidates, working within their own culture system often occurs. Furthermore, the research could be bias as it may only be representing white privileged culture. If a more diverse population was recruited, the debate of nurture verses nature may have a much larger breadth of insight. For example, a single, low-socioeconomic mother may build strong evidence in prioritizing nature over nurture in her parenting style, as her situation had no other choice. Furthermore, more diverse research would provide strong evidence to how society needs to better support single parents and their children, not only financially but emotionally as well. Support solutions could include obvious coaching and counseling options such as support groups or one-on-one cognitive therapy. Such solutions may prevent mothers from experiencing chronic stress, anxiety and depression.
Many Americans today are living with a normal state of being anxious or being emotional withdrawn—stress! The research in attachment theory and PNI has helped to better understand the role of psychosocial stress and social bonds in health and well-being. However, many people who have not participated in psychotherapy are unaware of their own attachment style behaviors and of the physiology of the PNI systems. Moving this knowledge more into the general public may help to change predisposed health outcomes.
The holistic health field is a great fit for implementing the teachings of attachment theory and PNI, as it already spends a great deal of its efforts on reducing stress. Holistic health practitioners could enhance a practice through using attachment theory framework to ground and individualize the stress response experience for clients and patients. Furthermore, the PNI physiology helps to educate clients and patients about viewing the body as whole within a scientific framework. Both attachment theory research and PNI research have demonstrated an empowering insight: that new pathways are available to the body at all times, therefore it is never too late to implement new experiences to nurture the whole person, mind, body and spirit. Implementing some simple holistic health practices, such as meditation for people with anxious attachment behaviors or creative healing arts for people with avoidant attachment behaviors, could help someone establish a more secure attachment to the world. In turn, feel less stressed out! Imagine a society that hears, “I’m so stressed out!” as the exception, not the norm, because we honored the wisdom of attachment theory and PNI study.
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