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The Development of Protective
Strategies across the Lifespan
The DMM as a bio-psycho-social
model of adaptation
Postulates? Danger & dysfunction
Evolution of brain for danger
(Mather & Sutherland)
Parallel processing to produce multiple
dispositional representations (Damascio, Eagleton)
Relation of exposure to danger to psychiatric
disorder (Kindler et al.)
Centrality of maladaptive family functioning
(McLaughlin et al.)
Security? No, variability.
2
What is the Dynamic-Maturational Model
(DMM) of Attachment & Adaptation?
A comprehensive theory about
The effects of exposure to danger on
Psychological and behavioural functioning
3
Theories in the DMM
Bowlby
Evolutionary biology
Ethology
General systems theory
Psychoanalytic theory
Information processing
After Bowlby & Ainsworth
Piaget
Behavioral learning theory
Cognitive neuroscience
Vygotsky
Social ecology
Chaos (complexity) theory
Ainsworth
Gestalt theory
Empirical evidence
Genetics & epigenetics
ABC Strategies
Person-centered therapy
Strange Situation
Family systems theory
Developmental pathways
Epidemiology, etc.
The DMM is a bio-psycho-social model of adaptation.
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Systemic model of causation of
differences in adaptation
Biology
Genetic, Epigenetic
↕
Neurology
Biochemical, neuronal
↕
Psychology
Information processing
↕
Parent-infant, spousal, family
Relationships
↕
Community, ethnicity, culture
Context
The DMM is two models of
adaptation
Developmental model of individual differences in
adaptation & maladaptation
Treatment model for expanding adaptation
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Clinically the DMM can
Reframe disorder as dysfunction around
protection
Not symptom based (DSM, ICD)
Not based on disorganization (ABCD)
Reconceptualise causation in a systemic and
accurately complex manner
Lead to personalised mental health treatment
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Problems with Disorganization
Is theoretically incoherent
(Duschinsky, Rutter et al.; Slade; Thompson &
Raikes)
Is neurologically inaccurate regarding fear
(Le Doux; Leppänen
& Nelson; McLaughlin et al)
Accounts for too little variance
(2%, Friedman & Boyle; 5% vs 19%,
Spieker & Crittenden)
Fails to identify the function of behavior (Crittenden & Ainsworth)
Treats behavior as meaning rather than meaning
being generated dyadically (Hoffmeyer)
Assumes past is more powerful than present
Not explain what the mind is doing
(Crittenden)
Lacks clinical utility; dysfunction in 1 category
Overlooks development
(Crittenden & Ainsworth)
(Wilkinson)
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Organization vs Disorganization
9
A developmental model of
psychological dysfunction
Individual differences in
attachment across the lifespan
DMM Attachment is a theory about
protection from danger
Danger is normal & universal
(McLaughlin et al)
Danger experienced by one’s parents
Danger to oneself
Past
Current
Danger to one’s children
The DMM proposes that behaviour is
organized in response to threat.
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Psychological & behavioral organization
Protect the self
Select and protect a reproductive partner
Protect one’s progeny to their reproductive maturity
Safety & sex: That’s all there is!
12
Three aspects of attachment
Relationship with a protective person
Strategy for eliciting protection and
comfort from the attachment figure
Information processing that underlies
attachment behaviour
13
Life cycle development of attachment
relationships
14
Attachment as a protective
strategy
1. Type B: Communicate thoughts & feelings
openly & clearly; negotiate & compromise;
2. Type A: Don’t do the wrong thing; do the right
thing; hide your negative feelings;
3. Type C: Stick to your feelings; don’t negotiate
or compromise, don’t delay gratification;
deceive if you must.
15
DMM Self-Protective Strategies
in Infancy
B3
B1-2
Comfortable
Reserved
A1-2
C1-2
Avoidant
A+
precompulsive
B4-5
Reactive
Resistant/
Passive
A/C
precoercive
C+
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DMM Strategies
in the Preschool Years
B3
B1-2
Comfortable
Reserved
A1-2
C1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
Compulsively
Caregiving/
Compliant
B4-5
Reactive
A/C
C3-4
Aggressive/
Feigned Helpless
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DMM Self-Protective Strategies
in the School Years
B3
B1-2
Comfortable
Reserved
C1-2
A1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
Compulsively
Caregiving/
Compliant
B4-5
Reactive
A/C
C3-4
Aggressive/
Feigned Helpless
C5-6
Punitive/
Seductive
18
DMM Self-Protective Strategies in Adolescence
B3
B1-2
Comfortable
Reserved
A1-2
C1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
Compulsively
Caregiving/
Compliant
A5-6
Compulsively
Promiscuous/
Self-Reliant
B4-5
Reactive
A/C
C3-4
Aggressive/
Feigned Helpless
C5-6
Punitive/
Seductive
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DMM Self-Protective Strategies
in Adulthood
B3
B1-2
Comfortable
Reserved
B4-5
Reactive
A1-2
C1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
C3-4
A/C
Compulsively
Caregiving/
Compliant
Aggressive/
Feigned Helpless
A5-6
Compulsively
Promiscuous/
Self-Reliant
C5-6
Punitive/
Seductive
A7-8
Delusional
Idealization/
Externally
Assembled
Self
Psychopathy
AC
C7-8
Menacing/
Paranoid
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Empirical findings:
Secure, Type B attachment:
Safe and comforting contexts
Optimal child functioning.
Anxious, Types A & C attachment:
Exposure to danger and lack of comfort
Developmental risk.
22
Why do we assume that anxious
attachment is bad?
Danger is the problem.
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Anxious attachment is the solution!
It is the child’s strategy for eliciting
protection and comfort from the parent.
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An information processing model
of psychological dysfunction
Individual differences in the use
of affect and cognition
Information Processing
Sensory stimulation
⇓
Patterns of neurological activation
⇓
Representation
⇓
Disposition to behave
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Sensory Stimulation
⇓
⇓
⇓
Intensity of
arousal
Temporal
contingency
Intensity of
stimulation
⇓
⇓
⇓
Soma
Cognition
Affect
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Three Types of Prediction
Soma
Bodily state
Cognition
Affect
Learning of prior
temporal
contingencies
Unfocused,
context-elicited arousal:
anxiety
Integration
Mental integration of cognitive & affective information to yield more
accurately predictive information
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Transformations of information
Truly predictive
Erroneous prediction
Omitted from prediction
Distorted for prediction
Falsified for prediction
Denied prediction
Delusional prediction
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Parallel Arousal Systems
Arousal
•
•
•
•
•
Pain
Fear
Anger
Desire for comfort
Alert & comfortable
•
•
•
•
Bored
Tired
Sleep
Depression
Sexual Arousal
•
•
•
•
•
•
•
•
•
Sexual pain
Sexualized terror
Sexual aggression/submission
Romanticism
Affection
Satisfaction
Afterglow
Sleep
Numbness
Arousal enables us to adapt
to the demands of the context
1
2
3
4
1
3. Optimum state of arousal
2. High Level of Arousal
4.Low Level of Arousal
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Multiple Dispositional Representations
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Tulving & Schacter
DMM Self-Protective Strategies
in Infancy
Integrated
True Cognition
True Negative Affect
B3
B1-2
Comfortable
Reserved
A1-2
C1-2
Avoidant
A+
precompulsive
B4-5
Reactive
Resistant/
Passive
A/C
precoercive
C+
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DMM Strategies
in the Preschool Years
Integrated
True Cognition
True Negative Affect
B3
B1-2
Comfortable
Reserved
Omitted Negative Affect
& Distorted Cognition
False Positive Affect
A1-2
C1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
Compulsively
Caregiving/
Compliant
B4-5
Reactive
A/C
C3-4
Aggressive/
Feigned Helpless
Omitted True Cognition
& Distorted Affect
Distorted Negative Affect
34
DMM Self-Protective Strategies
in the School Years
Integrated True Information
True Negative Affect
True Cognition
B3
B1-2
Comfortable
Reserved
Omitted Negative Affect
& Distorted Cognition
False Positive Affect
C1-2
A1-2
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
Compulsively
Caregiving/
Compliant
B4-5
Reactive
A/C
Omitted True Cognition
& Distorted Affect
C3-4
Aggressive/
Feigned Helpless
C5-6
False Cognition
Punitive/
Seductive
35
DMM Self-Protective Strategies in Adolescence
Integrated True Information
True Negative Affect
True Cognition
B3
B1-2
Comfortable
Reserved
Omitted Negative Affect
& Distorted Cognition
False Positive Affect
A1-2
Compulsively
Caregiving/
Compliant
A5-6
Compulsively
Promiscuous/
Self-Reliant
Denied Negative Affect
C1-2
Omitted True Cognition
& Distorted Affect
Threatening/
Disarming
Socially Facile/
Inhibited
A3-4
B4-5
Reactive
A/C
C3-4
Aggressive/
Feigned Helpless
C5-6
False Cognition
Punitive/
Seductive
Denied True Cognition
36
DMM Self-Protective Strategies
in Adulthood
Integrated True Information
True Cognition
B1-2
Comfortable
Reserved
Omitted Negative Affect
& Distorted Cognition
False Positive Affect
True Negative Affect
B3
B4-5
Reactive
A1-2
C1-2
A3-4
C3-4
A/C
Compulsively
Caregiving/
Compliant
Aggressive/
Feigned Helpless
A5-6
Compulsively
Promiscuous/
Self-Reliant
Denied Negative Affect
Omitted True Cognition
& Distorted Affect
Threatening/
Disarming
Socially Facile/
Inhibited
C5-6
False Cognition
Punitive/
Seductive
A7-8
Delusional
Idealization/
Externally
Assembled
Self
Psychopathy
AC
C7-8
Denied True Cognition
Menacing/
Paranoid
Delusions of Repair
Integrated Transformed Information
Delusions of Revenge
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Symptoms & functions
Strategies lower in the circle have more
symptomatic behaviour
The symptoms can function protectively (e.g.,
deception in the context of danger) or not.
Some functions are overlooked clinically
Attention deficit (prevent perception of intolerable
threat)
Delusions (feel safe in the context of danger)
Psychoses (escape untenable conflict by enlisting help)
The function of symptoms can change with
development
38
Which strategy is best?
Each is the best for some problem.
None is best for every problem.
To be safe, we need them all!
39
A Dynamic-Maturational Model of
personalized mental health treatment
Matching treatment to individual differences
in information processing
Why do we need a new theory of
treatment?
Don’t we have enough?
Not
Not
Not
Not
developmental
sufficiently empirical
sufficiently systemic
sufficiently effective
We need a way to choose among ~1000
treatments.
Which is the best?
41
Treatment Efficacy Findings
40% drop out
65% short-term benefit
50% no treatment benefit!!
Is 15% effectiveness enough?
10-20% harmful
42
Treatment process
Assess: Danger, strategy, information processing
Somatic, cognitive, affective strategies
Types of transformation (true, false, omitted, distorted …)
Degree of conscious awareness (implicit to integrative)
Formulate the central issue regarding protection
Choose techniques to fit IP & formulation
Select & implement a treatment strategy
Assess the effect, reformulate, etc.
43
DMM assessments:
Interlocking lifespan series
CARE-Index: Infancy
CARE-Index: Toddlerhood
Strange Situation: Infancy
PAA: 2-5 years
SAA: 6-13 years
TAAI: 16-25 years
AAI: Adulthood
Parents’ Interview: Whole family
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Systemic formulation
Within a family, within cultural context
Functional explanations around protection &
reproduction
Relational understanding of dysfunction
Replace individual disorder with interpersonal
adaptation to threat.
45
Novel hypotheses & treatment
implications
Maltreatment (Crittenden, Grey, Seefeldt)
Domestic violence (Worley, Walsh & Lweis)
Post-natal depression (Crittenden)
Psychosis ( Crittenden & Landini)
Eating disorders (Dallos; Ringer & Crittenden; Zachrisson)
Autism (Crittenden, Dallos, Landini, Kozlowska)
ADHD (Crittenden , Dallos, Landini, Kozlowska)
PTSD (Crittenden & Heller; Kuo, Kaloupek,& Woodward)
Somatic, conversion, & pain disorders (Crittenden, Kozlowska et al.)
Pervasive developmental disorder (Crittenden)
Child sexual abuse & sexual offending (Baim; Crittenden)
Personalized mental health treatment
By history of exposure to danger
By protective strategy
By transformation of information
By extent of psychological processing
Through personal, unique relationship with
therapist/transitional attachment figure
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Attachment can affect treatment as
Information about current strategies &
information processing
Type A versus Type C
Extent of processing (implicit to integrative)
History of the development of the problem
Promote self-respect in client/patient
Suggest focus for treatment
Functional use of the therapist as a
transitional attachment figure to:
Highlight the context
Practice new behaviour
Reflect on outcomes
48
An array of treatments
Biology
Genetic, Epigenetic Tx
↕
Neurology
Biochemical, EMDR, Healing
↕
Psychology
Talk therapies
↕
Family Systems, Parent-infant
Relationships
↕
Professional development, Advocacy
Context
Attachment, adaptation, & hope:
Why the DMM has utility for clinicians
The DMM accepts all treatments as useful strategies
for resolving some problem.
It treats dysfunction as outdated attempts to stay
safe when exposed to danger.
It respects the strength needed to develop &
diversify strategies for surviving danger.
It is empirically testable.
It highlights the power of therapists to use
themselves to promote healing.
50
Take-away points
Danger is universal & elicits protective
organization.
Adaptation, even ‘anxious’ adaptation, to one’s
context is more important than security.
Our strength is flexible use of many strategies.
Change is most effectively established in a
transitional attachment relationship.
Personalized mental health treatment ties
protection & information processing to type of
therapy.
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pmcrittenden @gmail.com
For slides & references
[email protected]
54
Strengths approach
Flexibility of development & functioning is our species’
major strength.
Flexibility permits adaptation to many niches.
Plasticity permits individuals to adapt to changing
circumstances.
Individual differences are an advantage to a
population of humans.
55
Reallocation of resources
Epidemiological prevention
Modify service structures & providers, avoiding overuse of services
Use therapists as transitional attachment figures
Select therapeutic tools from full array
Act in the zone of proximal development for family
members
Focus on ‘critical cause’ (Crittenden & Ainsworth,
1989)
56
General treatment goals
Remove any current danger
Begin to establish a balanced transitional
attachment relationship
Teach observation & verbalization to make
personal & interpersonal functioning explicit
Interpret functioning from a strengths, self-,
partner-, or child-protective perspective
Define strategies by context
Repair ‘broken’ strategies & expand array of
strategies
Use reflective integration to enable behavioural
regulation
57
A Causal Model of Dysfunction
A systemic model of influences
on behaviour and adaptation
Dysfunction occurs when
One’s behaviour does not fit one’s current
context;
Distortions learned to protect the self in
the past create risk in the present for
oneself, one’s partner, or one’s children.
The ‘causes’ are varied, complex, &
interactive.
59
Systemic model of causation of
differences in adaptation
Biology
Genetic, Epigenetic
↕
Neurology
Biochemical, neuronal
↕
Psychology
Information processing
↕
Parent-infant, spousal, family
Relationships
↕
Community, ethnicity, culture
Context