J Child Fam Stud (2012) 21:709–717 DOI 10.1007/s10826-011-9522-8 ORIGINAL PAPER Attachment Theory and Mindfulness Rose Snyder • Shauna Shapiro • David Treleaven Published online: 30 August 2011 Ó Springer Science+Business Media, LLC 2011 Abstract We initiate a dialog between two central areas in the field of psychology today: attachment theory/ research and mindfulness studies. The impact of the early mother-infant relationship on child development has been well established in the literature, with attachment theorists having focused on the correlation between a mother’s capacity for self-regulation and connection (e.g., attunement) with children’s health and developmental outcomes. Because the transition to parenthood is often a stressful one, research has also focused on the importance of the mother’s external and internal support (e.g., self-awareness, recognition of needs) in promoting healthy motherinfant relationships. One promising field in relation to increased internal support is mindfulness, a practice shown to increase emotional regulation while decreasing stress and anxiety. Described as non-judgmental, present-moment awareness, mindfulness has received significant empirical attention over the past three decades and has recently been theorized as an important contributing factor in healthy mother–child relationships. Recognizing the potentially beneficial effects of mindfulness training on healthy attachment, this article reviews relevant literature in presenting a case for exploratory and empirical research into the dynamic relationship between mindfulness, attachment style, maternal health, and children’s development. Grounds for this convergence, as well as suggestions for future research, are presented. R. Snyder (&)
D. Treleaven California Institute of Integral Studies, San Francisco, CA 94103, USA e-mail: dr.rose.snyder@gmail.com S. Shapiro Counseling Psychology Department, Santa Clara University, Santa Clara, CA 95053, USA Keywords Attachment
Mindfulness
Affect regulation
Postpartum depression
Maternal stress Introduction The importance of the early mother-infant relationship on children’s development has been well established in the literature (e.g., Schore 1994; Siegel and Hartzell 2003; Sroufe 1988). Research has shown that a mother’s ability to attune, regulate, and appropriately respond to an infant has significant relational and developmental implications (Bowlby 1988; Brennan et al. 2000; Da Costa et al. 2000; Greenberg and Speltz 1988; Kendall-Tackett 2001; Sroufe 1988; Stern 1977). For example, depressed mothers with restricted affect, creating poor attunement, have more negative interactions with their children, leading to future behavioral problems (Brennan et al. 2000). Whereas, mother-infant dyads that include successful attunement and regulation have been linked with positive developmental outcomes and greater well-being for the children (Schore 1994). The transition to parenthood is a time of potential stress for mothers (Crnic et al. 1983; Feeney 2003). Although research has addressed the importance of external maternal support during this crucial time, the quality of the mother’s internal support (e.g., self-awareness, emotional regulation, and recognition of needs) has emerged as an increasingly important factor (Bialy 2006; Schore 1994; Siegel and Hartzell 2003). One promising focus of research in this area is the field of mindfulness. Mindfulness training teaches individuals to pay attention to their present-moment experience, enabling 123 710 practitioners to increase self-awareness and the ability to ‘‘reperceive’’ experiences to prevent habitual self-identified reactions (Orzech et al. 2009; Shapiro et al. 2006). Research on the impact of mindfulness programs has shown promising results in the areas of reduction of psychological distress and affective disturbance, increases in affect/emotion regulation, and decreases in overall stress and anxiety (Astin 1997; Kabat-Zinn et al. 1985; Shapiro et al. 1998, 2007; Speca et al. 2000, 2006). Hence, mindfulness has been increasingly viewed as a factor in influencing more optimal human functioning. In recent years, popular and empirical research has begun to explore the dynamic relationship between mindfulness and parenting. Topics have included the potential benefits of mindfulness during pregnancy (Duncan and Bardacke 2010; Vieten and Astin 2008), the impact of parents’ mindfulness practice on children’s behavior (Singh et al. 2006, 2007), and the impact of teaching mindfulness to new mothers with their infants present (e.g., Hassan 2008; Vieten and Astin 2008). Recognizing the potentially beneficial effects of mindfulness training on healthy attachment, we review literature in both areas to present a case for both exploratory and empirical research into the dynamic relationship between mindfulness, attachment style, maternal health, and children’s development. The overall intention is to promote dialog between these areas of research as an avenue for the promotion of well-being and flourishing for children and their parents. Overview of Attachment Theory Attachment theory, formulated by Bowlby (1988), is a psychological theory of human connection. Attachment theory suggests that (a) human beings are wired to connect with one another emotionally, in intimate relationships; (b) there is a powerful influence on children’s development by the way they are treated by their parents, especially by their mothers; and (c) a theory of developmental pathways can explain later tendencies in relationship based on such early experiences. Attachment theory regards intimacy as a basic component of human nature, present in germinal form from infancy onward. Human infants are hard-wired to develop a set of behavioral patterns that, given the appropriate environment, will result in keeping close proximity to those who provide care. Children’s earliest relationships—often with their mothers—are considered by attachment theorists to create a template that shapes our expectations for future relationships (Siegel and Hartzell 2003). According to Stern (1977), maternal behavior is ‘‘the raw material from the outside world’’ with which the infant begins to construct knowledge and experience of ‘‘all things human’’ (p. 23). 123 J Child Fam Stud (2012) 21:709–717 In this way, the mother serves as an initial template for human presence, the human face and voice, units of meaning of human behavior, and the relationship between one’s own behavior and someone else’s behavior (Stern 1977). This mother–child loop teaches the infant ground rules for relationships, including social pace, conversational guidelines, attunement, and self-regulation (Goleman 2006). In attachment terminology, the infant develops an ‘‘internal working model’’ for how relationships work and how one is to act within them through internalizing these early experiences with his mother (Schore 1994). Types of Attachment Four major categories of attachment, with corresponding characteristics, associated behaviors, and implications for later development, have been discerned for children: secure, (insecure) avoidant, (insecure) anxious/ambivalent, and (insecure) disorganized (Bretherton 1992; Schore 2001). Attachment patterns have generally been found to persist once developed, both because parents tend to treat children in the same way, and also because such patterns tend to be self-perpetuating (Bowlby 1988). Research has found that secure attachment leads to beneficial results, while insecure attachment presents developmental risks for the growing child (Bowlby 1988; Da Costa et al. 2000; Feeney et al. 2003; Greenberg and Speltz 1988; Schore 2001; Siegel and Hartzell 2003; Sroufe 1988). In a secure attachment, the child senses the parent is a secure base from which to venture and return to safety (Bialy 2006). The mother in this pattern can nourish the child physically and emotionally, she will comfort him when he is distressed, and she will reassure him when he is frightened. She will be there for her child when called upon (Bowlby 1988). According to Schore (2001), the basis of secure attachment comes from a healthy dyadic emotional process. This process includes attunement, empathy, affective resonance, gaze sharing, entrained vocal rhythms, and mutually shared pleasure primarily mediated by the right front brain and associated with positive affective states (Siegel and Hartzell 2003). A study in Minneapolis observed children who showed secure attachment patterns at 1-year-old and then followed them into nursery school. At age 4.5, these children were described as cheerful and popular; while the children who showed insecure attachment styles were seen as unhappy and alienated (Bowlby 1988). Studies following children with insecure attachment have found less optimistic results. Infant-parent dyads with compromised attachment bonds have demonstrated a greater likelihood for impaired social, psychological, and J Child Fam Stud (2012) 21:709–717 neurobiological functioning over time (Schore 1994, 2001). This in turn has increased the chances for the children to develop psychopathology throughout their lifespan (Da Costa et al. 2000; Greenberg and Speltz 1988; Sroufe 1988). Insecure attachment has been linked to depressive symptoms and less constructive responses in stressful situations (Feeney et al. 2003). Children with insecure attachments are less likely to be cheerful, often find intimate relationships difficult, and tend to be vulnerable in conditions of adversity (Bowlby 1988). They are also likely to have difficulties if they want to marry and have children of their own (Bowlby 1988). Intergenerational Transmission of Attachment These various styles of attachment are deeply influenced by a mother’s personal experiences, especially with her own parents (Bowlby 1988). Hence, the influence from mother to child begins very early, possibly even prenatally (Brazelton and Cramer 1990). The finding that many children show attachment patterns that are the same as their mothers’ has given rise to the concept of ‘‘intergenerational transmission’’ of attachment styles (Siegel and Hartzell 2003). From this perspective, mothers interact with their infants in much the same way as their mothers interacted with them; and therefore, they ‘‘pass on’’ the same type of attachment pattern. Intergenerational transmission of attachment patterns has been shown to occur frequently in families, with a meta-analysis of 18 studies and a combined sample of 854 parent–child dyads reporting the effect size of the correlation to be ‘‘quite strong’’ (at d = 1.06 or r = .47) between parents and their infants (Van Ijzendoorn and Bakermans-Kranenburg 1997). Intergenerational transmission, however, is not considered to lead to permanent results for mothers and their children. In fact, theorists have written about ‘‘earned security,’’ a term describing how an individual with an insecure attachment style can ‘‘earn’’ a secure attachment style over time (Siegel and Hartzell 2003; Van Ijzendoorn and Bakermans-Kranenburg 1997). According to Bowlby (1988), our course of development is never entirely fixed: we can be affected negatively by adversity at any time, but we can also be impacted by favorable influences at any time as well. Two key factors in people who have earned security are supportive relationships that have helped heal old wounds and a capacity towards self-understanding (Siegel and Hartzell 2003). If a mother with a difficult past can make sense of her history, she can tell a coherent narrative of her life. This narrative requires a level of self-reflection and self-awareness, and it is considered to be a marker of secure attachments (Bowlby 1988; Siegel 2007; Siegel and Hartzell 2003). One way that this type of self-awareness can 711 be cultivated is through mindfulness practice, which will be further discussed below (Siegel 2007; Wallin 2007). The fact that a mother’s style of attachment can change bodes well for her children. This implies that if she is able to engage in activities that support healthy, secure attachment, she will likely interact differently with her children; and they, too, will reap the benefits (Bowlby 1988; Siegel and Hartzell 2003). As aforementioned, because the transition to parenthood is a time of added stress and therefore a heightened experience of attachment patterning, it is also a time of great potential for relational change (Feeney et al. 2003). This is a time when the mother’s working models of attachment may be particularly malleable and, therefore, it is a crucial time in the life cycle of relationships (Bialy 2006; Feeney et al. 2003). Though this will be addressed in greater detail in this article, it is important to note here how mindfulness practice might aid a mother in ‘‘earning’’ a secure attachment. Siegel (2007) delineated how mindfulness practice strengthens the very areas of the brain associated with healthy, secure relating. Through practicing mindfulness, one is thought to develop a greater sense of self-awareness, insight, and understanding, as well as the possibility for deeper and healthier relating. For example, research conducted by Carson et al. (2004) indicated that mindfulness practice enhances healthy relating in couples. In general, it has been proposed that engaging in a mindfulness practice may be one way an individual can develop a secure attachment with herself, attending to her moment-tomoment experience with awareness and compassion. This secure self-attachment can then be the platform from which she engages in relating with her children. Affect Regulation and Parenting Another important topic discussed in the attachment and child development literature is ‘‘affect regulation.’’ In regards to parenting and attachment, a mother provides her infant with a template for affect regulation through her ability to regulate her own affect in daily life (Schore 1994). Siegel and Hartzell (2003) explained that parental communication in such moments impacts the child’s prefrontal cortex, associated with self-awareness, attention, and emotional communication, and the neocortex, associated with reasoning, motivation, and instincts. Successful affect regulation in mother and in child is associated with positive relational and developmental outcomes (Schore 1994, 2001), whereas unsuccessful affect regulation is correlated with various long-term negative outcomes (Krakowski 2003; Schore 1994, 2001). Affect regulation is also important because of mothers’ increased vulnerability to difficult emotions. Research has 123 712 shown that maternal stress/anxiety and maternal negative mood/depression affect children’s attachment security and future development (Brennan et al. 2000; Crnic et al. 1986; Kendall-Tackett 2001). While birth is generally viewed as a positive experience, it can also be accompanied by negative life changes such as financial strains, less time for oneself, isolation, changes in sleep patterns, and possible job and income loss (Crnic et al. 1983; Kendall-Tackett 2001; Paris and Dubus 2005). Women at this time have been found to have an increased risk for mood disorders such as anxiety and depression (Field et al. 1985; Hopkins et al. 1984; Ogrodniczuk and Piper 2003; O’Hara 1995; O’Hara et al. 1984; Paris and Dubus 2005). Mothers suffering from such difficulties have also been shown to have less positive feelings towards their infants and to lack the ability to adequately mirror their infant’s emotional states and respond to their cues (Bialy 2006; Crnic et al. 1983; Field et al. 1985; Schore 1994; Stern 1977). This can, in turn, lead to a negative feedback loop in which the infant begins to provide less clear cues, the mother experiences heightened stress in not knowing what the infant needs, and the negative loop intensifies (Crnic et al. 1983). Therefore, it is important for mothers to develop skills for selfawareness and emotion regulation, in order to interrupt this pattern. Mindfulness practice is one avenue for selfawareness and emotion regulation that may be of significant benefit to new mothers. Mindfulness: Description and Definition Mindfulness, defined by Kabat-Zinn (1994) as ‘‘paying attention in a particular way: on purpose, in the presentmoment, and nonjudmentally’’ (p. 4), is an increasingly prevalent concept in research literature and clinical programs. It is a complex, multifaceted construct. In a more recent article, Shapiro and Carlson (2009) described three core elements of mindfulness: (1) intention, (2) attention and, (3) attitude. Intention provides the purpose for why one is paying attention and it sets the direction for the practice. Attention is said to refer to the conscious attention towards the ‘‘here and now’’ of one’s moment-to-moment experience. By focusing one’s attention on present-moment sensations and experiences, the practitioner can learn to see through her habitual reactions and cultivate healthier, more adaptive ways of responding to life circumstances (Shapiro et al. 2005; Teasdale et al. 2000). Finally, attitude refers to how one pays attention, infusing the attention with a quality of acceptance, openness, and discernment. The attitude cultivated in mindfulness practice has been described as an ‘‘approach-based strategy,’’ in the sense that one stays with, or even moves towards each experience whether enjoyable or not. The practitioner suspends the 123 J Child Fam Stud (2012) 21:709–717 ordinary tendency to alter experiences that are painful or aversive, and, ironically, through this deep acceptance of what is happening, is released from much suffering (Siegel 2007). Mechanisms and Benefits of Mindfulness Various theories have been proposed as to the underlying mechanisms that lead to the benefits of mindfulness practice. One area of research that has recently received much attention is the impact of the practice on the nervous system. Mindful awareness is a form of experience that appears to promote neural plasticity, implying that practicing meditation can actually change the structure of the brain (Siegel 2007). In one study, Davidson et al. (2003) found significant increases in anterior activation in the brains of meditators compared to non-meditators. This anterior activation was associated with positive affect and compassion and with reductions in anxiety and negative affect. These changes in the brain were found for at least 4 months following the intervention. In another study by Lazar et al. (2005), mindfulness meditation was shown to lead to alterations in the brain in the areas that are responsible for empathy and self-observation. A related way to think of the mechanisms of mindfulness is to look at the cognitive shifts that happen when an individual practices over time. Many researchers have described mindfulness as promoting a ‘‘metacognitive’’ ability, in which the practitioner develops the capacity to observe her own mental processes (Baer 2003; Bialy 2006; Bishop 2002). This metacognitive ability has also been termed ‘‘decentering’’ (Bondolfi 2005; Teasdale et al. 2000) and ‘‘reperceiving’’ (Shapiro et al. 2006). In this metacognitive process, the meditator learns to observe thoughts as ‘‘thoughts,’’ as opposed to ‘‘reality’’ and is therefore freer to ‘‘respond’’ to potentially anxiety-provoking situations with greater effectiveness rather than to ‘‘react’’ with escalating panic or fear (Miller et al. 1995). Shapiro et al. (2006) described this process as such: ‘‘If we can see a situation and our own internal reactions to it with greater clarity, we can respond with greater freedom of choice’’ (p. 381). The authors suggested that this shift in perspective changes one’s relationship to her thoughts and emotions, resulting in greater clarity, perspective, objectivity, and equanimity. As an example, when an individual is having a difficult emotional experience, she can step back from the experience to see it clearly as simply an emotional state that is arising and will in time pass away. The knowledge of the impermanence of all phenomena can allow for a greater tolerance of unpleasant states of being. Some of the overall findings from studies of Mindfulness-Based Stress Reduction, the most popular and most J Child Fam Stud (2012) 21:709–717 researched mindfulness-based program, showed pain reduction (Kabat-Zinn et al. 1985); improved body image (Kabat-Zinn et al. 1985); decreased mood disturbance and psychological symptomatology, including depression and anxiety (Astin 1997; Brown and Ryan 2003; Kabat-Zinn et al. 1985, 1986, 1992; Miller et al. 1995; Shapiro et al. 1998, 2005, 2007; Speca et al. 2000); and increased positive states, including resilience, self-esteem, compassion, and overall well-being (Astin 1997; Feldman et al. 2007; Kabat-Zinn et al. 1985; Shapiro et al. 1998, 2005, 2007). Beneficial results from participation in MBSR have been found in both clinical and non-clinical populations. Several other mindfulness-based programs have also shown beneficial results. Mindfulness-Based Cognitive Therapy has been shown to be effective in the treatment of relapse prevention for depression (Teasdale et al. 2000, 2002). Acceptance and Commitment Therapy has also been shown to be at least as effective as traditional cognitive therapy for treating anxiety and depression (Forman et al. 2007). Finally, clients who received Dialectical Behavior Therapy, which teaches ‘‘core mindfulness skills’’ to its severely emotionally distressed participants, were found to have fewer incidences of self-harm and less medically severe self-harm, they were more likely to stay in individual therapy, and they had fewer inpatient psychiatric days than patients who experienced treatment as usual (Linehan et al. 1991). Mindfulness and Relationship An important area beginning to receive attention in mindfulness literature is the impact of mindfulness on interpersonal relationships. In some ways, this concept seems counterintuitive, as the word ‘‘meditation’’ conjures images of solitude. However, the practice of meditation and the cultivation of mindfulness have been proposed to greatly impact interpersonal relationships (Siegel 2007; Wallin 2007). The intrapersonal and interpersonal aspects of mindfulness, and the way they relate with one another, are discussed in this section. Research presents a number of reasons supporting why mindfulness may promote healthy relating. One is the quality of presence that is fostered through mindfulness practice. According to Siegel (2007), presence in a parent, teacher, or psychotherapist connotes one’s availability to receive whatever the other person brings to her, to sense her own participation in the interaction, and to ‘‘be aware of her own awareness’’ (p. 263). Through this experience of presence, the parent/teacher/psychotherapist is open to bear witness, to connect, and to attune to the other. This presence ultimately promotes a level of presence and selfawareness in the other as well (Wallin 2007). Hence, in 713 order to give another individual the gift of our deepest attention, we must have the capacity to be truly present to our own process and to his. Another way that mindfulness can directly impact the ability to attend to another individual is in the cultivation of the capacity to respond versus react. This capacity is facilitated by the practice of self-observation, such that an individual develops a ‘‘space’’ between her perceptions and her response in any given situation (Bishop et al. 2004). In this way, self-reflection and self-awareness allow choice and the ability to respond as opposed to using projections and reactions. Siegel and Hartzell (2003) described the processes as the ‘‘low road’’ versus ‘‘high road’’ capacities of our minds. In low road functioning, we are merely reacting without awareness or thinking as to why we are acting a certain way. In high road functioning, which is promoted by self-awareness, we can become aware of particularly charged situations and our reactions to them, and we can then choose from this mindful/centered place as to how to respond. Further, mindfulness training increases one’s ability to tolerate strong affect and therefore helps the practitioner not act or react unless appropriate (Bialy 2006). As an example, a mother might become frustrated as her child makes multiple attempts to ‘‘get her attention’’ while she is busy trying to complete other tasks. She may experience her child as demanding and irritating, and she may even be triggered by memories of feeling this way in other circumstances. This would all be ‘‘low road’’ functioning. However, with mindfulness, the mother can shift into ‘‘high road’’ functioning. She might become aware of her frustration, notice her physical tension and other sensations, and she may also become aware of her train of thought. This metacognitive capacity may then allow her to take a moment of pause between her initial reaction of irritation and her moment of responding. She may even be able to insert a sense of compassion for herself in this stressful situation, and also for her child, who is ultimately looking for connection and contact. As practitioners develop self-awareness through greater mindfulness, Siegel (2007) also proposed that they practice what he termed ‘‘self-attunement.’’ He wrote, ‘‘mindful awareness is a form of intrapersonal attunement. In other words, being mindful is a way of becoming your own best friend’’ (p. xiv). Siegel made this claim based not only on theory and his own personal experience, but also on the fact that mindfulness practice impacts the same areas of the brain that are affected in relationships. In particular, the mirror neuron system has been implicated, which is a system that takes in information and signals from another person and then adjusts our limbic and bodily states in order to match those of the other. He suggested that mindfulness involves a form of internal attunement that may harness these social circuits associated with mirroring and empathy to create a 123 714 state of neural integration and ‘‘flexible self-regulation’’ (p. 132). In other words, the impact of mindfulness practice on the brain is quite similar to that of healthy, secure attachment. Bringing these ideas together, Siegel (2007) proposed that mindfulness can be seen as ‘‘a way of developing a secure attachment with yourself’’ (p. 180). From this internal secure base, safety is established from which the practitioner can open her awareness and attention to whatever arises in the field of on-going experience. This creates a ‘‘receptive reflective state of awareness’’ towards all arising events (p. 132). In the example presented above, the mother would be able to attend to both her child’s expressions and also her own reactions. Her very attending to her own experience would act as a way to not only recognize, but also have understanding and compassion for her state in the moment. From this place, she can respond more effectively. From Siegel’s (2007) point of view, intrapersonal and interpersonal attunement likely reinforce each other in a loop, promoting attunement and connection: (a) through meditation practice, the practitioner develops a stronger capacity to detect and understand her lived experience; (b) this observation and understanding then allow her to have more understanding for others (empathy and compassion) through an enhanced ability to perceive nonverbal emotional signals and an increased ability to sense the internal worlds of others; and (c) she is then able to offer this state of attuned, understanding presence to those with whom she is in contact. The same areas of her brain are being impacted by both types of attunement and are reinforcing each other. In relationship, she will be paying attention to both her internal experience and that of the other with whom she is relating. In terms of parenting, and as hinted at above, the capacity to self-attune can promote a type of ‘‘earned security’’ for the mother (Siegel and Hartzell 2003; Van Ijzendoorn and Bakermans-Kranenburg 1997). As she cares for herself and experiences her own secure base, she can heal past attachment issues and offer a base of secure attachment to her child. As Siegel (2007) wrote, a mindful parent can sense the entire situation enough to know when repairs are needed in relationship (following a rupture). This is the foundation of secure attachment. The neural integration and reflective capacity promoted in mindfulness practice are similar to those of a parent with a secure attachment, whether from childhood or ‘‘earned’’ (Siegel 2007; Wallin 2007). Both forms of attunement (interpersonal and intrapersonal) promote the capacity for intimate relationships, resilience, and well-being. As Surrey (2005) wrote, ‘‘Mindfulness and the attuned relationship seem to support each other’’ (p. 95). Finally, Siegel (2007) noted that the outcome measures for studies of secure attachment 123 J Child Fam Stud (2012) 21:709–717 and those for mindful awareness practices have ‘‘markedly overlapping findings’’ (p. 26). Empirical Research: Mindfulness and Interpersonal Relationships Over the past decade, several studies have addressed the impact of mindfulness in different kinds of relationships. In 2004, Carson et al. conducted a randomized wait-list control study of the program Mindfulness-Based Relationship Enhancement. Participants of this program showed increases in measures of relationship satisfaction, autonomy, relatedness, closeness, and acceptance of one another, and decreased relationship distress, both right after the program and at a 3-month follow-up period. Further, those who practiced meditation more actually had better outcomes, such that mindfulness practice on a given day was associated with improved relationship happiness and stress coping efficacy and was also associated with lessened relationship stress and overall stress on that particular day. In a study of couples in romantic relationships by Barnes et al. (2007), higher trait mindfulness was found to predict higher relationship satisfaction and a greater capacity to respond constructively to relationship stress. Further, state mindfulness was correlated with better communication quality during a discussion/argument. Regarding mindfulness in the parent–child relationship, three studies have been conducted in the last 5 years with particularly interesting findings. In a study by Singh et al. (2006), three mothers of autistic, aggressive children were taught mindfulness skills, and behavioral incidents were recorded extensively before, during, and after the mindfulness training of the mothers. Results showed a decrease in all of the children’s aggression, noncompliance, and self-injurious behaviors and an increase in the mothers’ satisfaction with their parenting skills and interactions with their children. Of particular interest in this study was the finding that the mothers’ mindfulness practice impacted the children’s behaviors, even though the children were not taught any different behaviors per se. Another study by Singh et al. (2007) with four mothers showed similar findings, including decreased aggressive behaviors, less parental stress, increased parental satisfaction, and increased positive social interactions with siblings. The mothers noted that with continued mindfulness practice, they were able to begin responding in a calm and positive manner without conscious thought, which had the effect of preempting maladaptive behavior and encouraging positive social behaviors in their children and other family members. They also reported that the transformation experienced was in part due to changes in the way the mothers related to all events in their environment, rather J Child Fam Stud (2012) 21:709–717 than to acquiring a set of parenting skills in order to change their children’s behaviors. Finally, in a third article by Singh et al. (2010), two mothers of children with ADHD diagnoses were taught mindfulness skills. Findings from this study included an increase in the children’s compliance and mothers’ reports of increased satisfaction with their interactions with their children and happiness with parenting. Two additional studies regarding mindfulness in pregnancy/the perinatal period have also been recently published. In the first study, a small, randomized trial (n = 31) of mothers who received a mindfulness-based intervention during pregnancy showed significantly reduced anxiety and negative affect during the third trimester in comparison to those who did not receive the intervention (Vieten and Astin 2008). Though these mothers were trained in mindfulness during pregnancy and with their babies yet to be born, one could speculate that the reduced maternal anxiety and negative affect might benefit the mother–child relationship based upon theory presented above. In a second pilot study, 27 women participated in a Mindfulness-Based Childbirth and Parenting program during their third trimester of pregnancy (Duncan and Bardacke 2010). Both quantitative and qualitative methods were used, with quantitative results showing a statistically significant increase in mindfulness and positive affect and a decrease in pregnancy anxiety, depression, and negative affect on pre- to post-tests. Qualitative statements supported these results and showed the majority of participants reporting perceived benefits of using mindfulness practices during the perinatal period and early parenting. The authors proposed future research using a randomized controlled trial design and hypothesized that such an intervention may improve birth outcomes, attachment and child development outcomes, partner well-being, and the quality of family relationships. Future Research and Integration Attachment theory and mindfulness have received significant empirical attention in the past three decades. Research has broadened and deepened our understanding of both attachment processes and the benefits of mindfulness. It is clear that early relational experiences between infants and their caregivers create ‘‘internal working models’’ for future relationships that deeply impact children’s development. If mothers are able to understand their own internal experiences and history, they can modulate their own emotions and affect, providing a beneficial environment in which to develop a secure attachment relationship. Since early motherhood can be a time of heightened stress, 715 it is important to consider ways to support mothers (and their children) through this process. Mindfulness intervention may be one way to support mothers in developing the skills necessary to navigate the stressor of early motherhood and develop secure attachments with their children. Research has shown that mindfulness training significantly increases one’s ability to cope with stress, regulate emotions, and attune to others (Shapiro and Carlson 2009). Further, it has been shown to decrease anxiety, depression, and overall psychological symptomatology (Astin 1997; Brown and Ryan 2003; Kabat-Zinn et al. 1985, 1986, 1992; Miller et al. 1995; Shapiro et al. 1998, 2005, 2007; Speca et al. 2000). Finally, it has also been associated with increased positive states, including resilience, self-esteem, compassion, and overall well-being (Astin 1997; Feldman et al. 2007; Kabat-Zinn et al. 1985; Shapiro et al. 1998, 2005, 2007). As discussed in this article, several preliminary studies have been conducted in the last 10 years specifically exploring the impact of mindfulness practice on interpersonal relationships. These studies have shown promising results, yet further exploratory and empirical research is needed to help elucidate the impact of mindfulness training on interpersonal relationships. In particular, mindfulness practice for mothers is an area that deserves more attention, as it has been proposed as a potentially helpful practice that may enable secure attachments to form (Siegel 2007; Wallin 2007). It has been suggested that mindfulness research could expand to include not only a focus on symptom reduction but also include the positive and beneficial qualities that may be cultivated by the practice (Shapiro and Carlson 2009). As Bialy (2006) suggested, ‘‘Mindfulness has something more to say than how to cope with illness,’’ (p. 75). For example, Carson et al. (2004) suggested research that examines how mindfulness may lead to closeness, empathy, and other positive experiences that lead to relationship satisfaction. Easterlin and Cardena (1998) stated that one of the ‘‘unexplored areas’’ in meditation research is the ‘‘effect of this practice on interpersonal relationships,’’ and they promoted this as a future direction for research (p. 79). Siegel (2007) proposed the need for further studies as well, as he proposed questions and hypotheses to ‘‘explore exactly how mindfulness supports interpersonal well-being’’ (p. 358), such as: ‘‘Are sensitivities to the non-verbal signals of others enhanced? Does mindfulness improve the capacity to be compassionate—to feel another’s feelings—as well as to be empathic—to understand another’s point of view?’’ (p. 358). As Siegel stated, at this point, we are ‘‘left with preliminary empirical findings supportive of the impression that mindfulness may nurture healthy relationships’’ (p. 358). 123 716 A convergence of ideas and disciplines is increasingly occurring, in which neuroscientists, clinical psychologists, attachment theorists, and mindfulness researchers and practitioners are beginning to link various theories and concepts pointing towards the importance of mindful presence in relationships. It is hoped that this article will serve to encourage more investigation in this area, with particular attention being given to mindfulness within the earliest relationship, which sets the stage for all others. It is hoped that this further investigation will promote wellbeing in mothers and their children, and will therefore facilitate more optimal levels of human functioning across the lifespan. Acknowledgment We would like to thank Andrew Harlem, Ph.D. for his help in conceptualizing this article. References Astin, J. A. (1997). Stress reduction through mindfulness meditation. Psychotherapy and Psychosomatics, 66(2), 97–106. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. Barnes, S., Brown, K. W., Krusemark, E., Campbell, K. W., & Rogge, R. D. (2007). The role of mindfulness in romantic relationship satisfaction and responses to relationship stress. 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New York: Guilford Press. 123 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Young Minds: The Important Role of Brain Science Caring Relationships The Heart of Early Brain Development J. Ronald Lally and Peter Mangione O f all that brain science has taught us over the last 30 years, one of the clearest findings is that early brain development is directly influenced by babies’ day-to-day interactions with their caregivers. Even before birth, babies have a built-in expectation that adults will be available and care for their needs (Shonkoff & Phillips 2000). Their very survival depends on this availability. If babies’ expectations for protection and nurturance are met, their brains experience pleasure and delight. These pleasurable early interactions stimulate the brain, motivating the baby to relate to those who care for them with confidence and ease. If their expectations are less than adequately met, their confidence in getting their needs met through relationships may be challenged. When this occurs, emotional and social development suffer, and, because babies’ emotional base is the foundation for all other learning, so do intellectual and language development (Greenspan 1990; IOM & NRC 2015). May 2017   Young Children 17 A baby’s early experiences in relationships, whether at home or in an early education environment, set the stage for future brain functioning. The information gathered in these early relationships is at the heart of a rich and complex brainbuilding process. As babies experience responses from their caregivers, their brains start to form expectations for how they will be treated and how they should respond. For example, when a baby fusses or cries, consistent adult responses that provide comfort help the child anticipate similar responses in the future. As the expectations are strengthened by similar experiences being repeated, babies’ brains construct perceptions of the social and emotional world in which they live. Those perceptions influence how babies understand their environment, relate to others, and engage in learning. When those experiences are primarily positive, children 18 perceive the behaviors and messages of others in positive ways and are motivated to explore more and more of the world (including people and things). When babies have repeated adverse early experiences, they come to expect the behaviors and messages of others to be negative, and they start to perceive new experiences with others in a negative way. In early brain growth, experience creates expectation, which alters perception. Whether babies’ early relationships are largely positive or negative significantly impacts their ability to manage stress. From birth to age 3, stress can have an especially adverse effect on brain development (NRC & IOM 2009). When children have positive early relationship experiences, they develop emotionally secure attachments with their caregivers that can buffer stress at various levels of intensity. If stress is severe and persistent, it becomes toxic and the emotional buffers provided by secure relationships are crucially Young Children   May 2017 important (Center on the Developing Child 2007). When children have to cope with tolerable (less intense and temporary) stress, emotionally secure relationships help children regulate their responses and, once the stress subsides, refocus on exploration and learning. What we have learned from brain research in the last 30 years is that the “tender loving care” advocated by early childhood educators for many decades is not only the kind way to treat children but a crucial part of early brain development. Healthy early brain development from birth to age 3 During the first three years of life, children go through a period of “prolonged helplessness,” dependent on others for safety, survival, and socialization (Gopnik 2016). Because babies’ brains are programmed to learn from their caregivers, this period of helplessness is a strength, not a weakness. Infants’ and toddlers’ time with others wires their brains for survival in anticipation of future functioning (Hamburg 1995). The brain builds crucial structures and pathways that serve as the foundation for future social, emotional, language, and intellectual functioning (Schore 2005; Drury et al. 2010). Therefore, the relationships a child experiences each day and the environments in which those relationships play out are the building blocks of the brain. By participating in learning experiences with their caregivers, babies shape their brains to function in the particular physical, social, and linguistic environments of those who care for them. Babies learn, largely by attending to their caregivers’ modeling, how to feel, think, and act. Simple, daily interactions have an enormous impact. For example, a caregiver who performs routines in a gentle way and uses language to help the child anticipate what will happen next teaches the child to learn about caring relationships and supports language development. During this formative period it is critically important for caregivers to create a climate of care with healthy brain growth in mind. Simply stated, young children develop and function well when provided care in safe, interesting, and intimate settings where they establish and sustain secure and trusting relationships with knowledgeable caregivers who are responsive to their needs and interests (Lally 2006). May 2017   Young Children The infant brain is at once vulnerable and competent; both of these attributes need to be addressed simultaneously for healthy brain development. The vulnerable baby is dependent on relationships with adults for physical survival, emotional security, a safe Preconception and Prenatal Development When do caring relationships start to influence the development of the brain? Earlier than most of us think. Although this article primarily focuses on relationships established during the time period from birth to age 3, the developing brain before birth—and even before conception—deserves some attention. (For more information on supporting growth during preconception and pregnancy, see chapters three and seven in For Our Babies: Ending the Invisible Neglect of America’s Infants [Lally 2013].) A woman’s health and habits before becoming pregnant shape the development of the embryo. From at least three months before conception, the prospective mother’s food, drinks, drugs, toxins, stresses, and other experiences influence the early womb environment in which the brain develops; this may affect the child’s future learning. Since many women become pregnant while in poor health or while engaging in unhealthy habits, the connection between preconception (particularly from three months before conception to awareness of conception) and healthy brain development needs to be addressed (Atrash et al. 2006; Kent et al. 2006). In addition to a public education campaign for all citizens about the preconception risks to the development of the brain, the United States should provide a safety net of preconception services to women of childbearing age and universal screening for depression and other mental health issues. Once conception occurs and brain development starts in the womb, the fetal environment may positively or negatively influence the developing brain. Brain growth is more rapid during this period of life than any other, with neurons being produced at an astonishing rate. The neurons then migrate to the area of the brain where they will reside for a person’s entire life, beginning to form connections and differentiate brain functions. Fetuses use information—such as the kind and amount of nutrients received, the stress experienced, and the languages and voices heard—to shape their brains and bodies to anticipate experiences once born. Just two-thirds of the way through pregnancy, a good portion of the basic wiring of the brain is already completed (Thompson 2010). 19 Both the vulnerable and competent nature of a baby need simultaneous caregiver attention. base for learning, help with self-regulation, modeling and mentoring social behavior, and information and exchanges about the workings of the world and rules for living. Yet at the same time, the baby comes into the world with great competence as a curious, motivated, self-starting learner—an imitator, interpreter, integrator, inventor, explorer, communicator, meaning seeker, and relationship builder. For the brain to grow robustly, it needs a context of caring relationships that simultaneously provide emotional predictability for the baby’s vulnerable side and a climate of intellectual novelty for the competent side (Lally 2013). in ways that elicit interest and increase the likelihood of contact and closeness (Marvin & Britner 2008). Based on the feedback babies receive from early exchanges, they direct attachment behaviors toward developing secure relationships with their primary caregivers. Research has shown that this attachment-seeking fits with the finding that during the first two years of brain development, emotional wiring is the dominant activity. The brain builds crucial structures and pathways of emotional functioning that serve as the base for Birth to 9 months: Caring relationships and the brain during the attachment period During the first stage of development outside the womb, much of babies’ initial attention focuses on forming and strengthening secure connections with their caregivers. Rather than passively receiving care, babies actively seek it out. They come into the world with physical skills and social competences that prepare them to play an active role in their development. They are wired to react to those around them 20 Young Children   May 2017 attachment, future emotional and social activity, and the language and intellectual development that will follow (Schore 2000). In this earliest stage, babies start using messages from caregivers to develop perceptions of the extent to which they are loved. Infants then use these perceptions to create an initial working model for how to engage with others. Thus, the care babies receive during these early exchanges directly affects the quality of attachment they form with their caregivers and influences the emotional stance they will take in interactions with others. Young babies need relationships with caregivers who are: ■■ Sensitive to their needs and messages ■■ Timely in responding (especially to messages of distress) ■■ Accurate in the reading of their cues ■■ Understanding of appropriate levels of stimulation (Bornstein 2012) Seven to 18 months: Caring relationships and the brain during the exploration stage Between 7 and 18 months of age, babies are driven to search out their local environment, objects, and people; to build a primitive definition of self; and to test the strength and use of relationships. Using their emerging motor skills to explore, they venture from the safety of the physical closeness of their caregivers and test the strength of relationships. They come and go while carefully observing their caregiver’s attentiveness and emotional availability. They are, in a sense, practicing independence (Calkins & Hill 2007; Eisenberg, Hofer, & Vaughan 2007). Also at this stage, babies’ brains are preparing for a life that does not revolve entirely around physical proximity to the caregiver. Based on their caregivers’ reactions to their actions, babies and toddlers begin to hold in mind lessons learned, such as which independent explorations are considered socially appropriate and May 2017   Young Children which are not, and what activities are dangerous, like playing near an ungated stairway. Babies’ communication and language skills increase dramatically during the exploration stage. Although babies can say only a few words, they come to 21 understand many more (Thompson 2011). The words they hear from adults stimulate the language development pathways in the brain. It is not only the words that matter, but also the larger patterns of communication—not just what is said, but how it is said and received (Pawl & St. John 1998). After repeated exchanges with their caregivers, infants start to build a primitive sense of self. They come to expect: ›› “I am listened to or not.” ›› “What I choose to do is valued or isn’t.” ›› “How I express my emotions is accepted or isn’t.” ›› “I am allowed to explore or not.” ›› “Mostly my needs are met or not.” The thoughts, emotions, and shared experiences that the developing brain processes in interactions with adults have a profound impact on the developing child’s self-perception and actions. Fifteen to 36 months: Caring relationships and the brain during the self-definition stage During the third stage, young children are developing an awareness of their separateness from their caregivers and peers as well as a sense of themselves as individuals (Vaughn, Kopp, & Krakow 1984). They begin to exhibit self-conscious emotions, are particularly sensitive to others’ judgments, feel shame and embarrassment easily when others critique their behaviors and appearance, and start to develop a conscience. This stage is also characterized by an explosion of brain growth in several areas of development (in addition to the emotional development that was dominant earlier). Intellectually, children hold ideas in their minds briefly, engage in pretend play, and become increasingly able to focus their attention on topics, people, and objects introduced by others. Their use of spoken language increases greatly. They use many new words and complex sentence structures. Children develop perceptual and motor skills that allow them to run fast, climb high, and 22 hit hard—making the development of self-control especially important (Brownell & Kopp 2007). Fortunately, this self-definition stage also brings the early emergence of executive function skills, which include the development of working memory, mental flexibility, and self-control (Center on the Developing Child 2012). These emerging skills influence all areas of development, increasing children’s capacity to explore and learn about their social environment—and to navigate conflicts with others. As children gain a clearer understanding of independent, separate interests, they realize they have choices, which is quite liberating. However, with choices—particularly those involving caregivers and peers—comes a dawning awareness of responsibility. This choice–responsibility tension is central to the drama of this stage. Once again, caring relationships play a prominent role in how the young brain becomes structured. How adults react during this tension filled period of life greatly affects how young children come to see their rights and others’ rights. Interactions children have with their caregivers, peers, and others shape their brains’ social and emotional future. What toddlers experience in their day-to-day lives forms their expectations for what constitutes appropriate behavior toward others (Barry & Kochanska 2010). These early experiences provide lessons for developing moral and ethical codes, gaining control of Young Children   May 2017 Caring Behavior During the Stage of Self-Definition Predictable routines in safe, clearly defined environments; respectful responses; and consistent guidance provide the kind of care that strengthens self-regulation and the beginnings of executive function. impulses and emotions, and learning and adapting to the rules of their family, culture, and society. As young children experience a growing sense of independence and self-control, their brains’ capacity to regulate their behavior continues to develop; but they still need guidance from adults, and this guidance most often comes through caring relationships. The young brain needs adults to act in ways that honor the child’s rights to desire, hope, explore, and show preferences, while also helping the child learn to honor the similar rights of others. Although the child is growing older and more independent, the young brain remains vulnerable. Caring relationships, with clear rules for behavior that are consistently applied in reasoned ways, provide safety while the brain is still being formed, ensuring that individuation experiences and socialization lessons occur in a fair and predictable environment. Conclusion What we are learning from brain science helps us better understand the multiple factors that influence young children’s development and provides us with caregiving strategies that are in harmony with the developing brain. In essence, brain development is about the whole child, from the health of the mother to the child’s early experiences in the culture and language of their family, their community, and their early learning program. The foundation of brain development is social and emotional development grounded in caring relationships. If caregivers are mindful of how a child’s whole experience—particularly the emotional tenor— influences the developing brain, they can provide caring relationships that help the child feel secure and open up to an engaging world of exploration and learning throughout the early years. May 2017   Young Children References Atrash, H.K., K. Johnson, M. Adams, J.F. Cordero, & J. 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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: National Academies Press. Pawl, J.H., & M. St. John. 1998. How You Are Is as Important as What You Do … in Making a Positive Difference for Infants, Toddlers, and Their Families. Washington, DC: ZERO TO THREE. Schore, A.N. 2000. “Attachment and the Regulation of the Right Brain.” Attachment and Human Development 2 (1): 23–47. Schore, A.N. 2005. “Attachment, Affect Regulation, and the Developing Right Brain: Linking Developmental Neuroscience to Pediatrics.” Pediatrics in Review 26 (6): 204–17. Shonkoff, J.P., & D.A. Phillips, eds. 2000. From Neurons to Neighborhoods: The Science of Early Child Development. Washington, DC: National Academies Press. Thompson, R.A. 2010. Connecting Neurons, Concepts, and People: Brain Development and Its Implications. Policy Facts series. New Brunswick, NJ: National Institute for Early Education Research, Rutgers Graduate School of Education. Thompson, R.A. 2011. “The Emotional Child.” Chap. 2 in Minnesota Symposia on Child Psychology: The Origins and Organization of Adaptation and Maladaptation, eds. D. Cicchetti & G.I. Roisman. Hoboken, NJ: Wiley. Vaughn, B.E., C.B. Kopp, & J.B. Krakow. 1984. “The Emergence and Consolidation of Self-Control From Eighteen to Thirty Months of Age: Normative Trends and Individual Differences.” Child Development 55 (3): 990–1004. About the authors J. Ronald Lally, EdD, is the codirector of the Center for Child and Family Studies at WestEd, a research development and service agency based in San Francisco. He codirects the Program for Infant and Toddler Care and is one of the founders of ZERO TO THREE: National Center for Infants, Toddlers, and Families. Peter Mangione, PhD, is codirector of the Center for Child and Family Studies, WestEd, in Sausalito, California. Peter is one of the principal developers of the Program for Infant/ Toddler Care, a comprehensive approach to professional development of infant and toddler care teachers. pmangio@wested.org Photographs: p. 17, © iStock; pp. 18, 20, 21, 22, © WestEd Copyright © 2017 by the National Association for the Education of Young Children. See Permissions and Reprints online at www.naeyc.org/yc/permissions. 24 Young Children   May 2017 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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