Psychosocial intervention for children affected by war: The role of attachment and emotion regulation

Abstract

Development of emotion regulation (ER) is intertwined with attachment style. Attachment style and ER are related to mental health in general as well as to the severity of post traumatic stress disorder (PSTD) symptoms after traumatic experiences. Attachment style is also known to affect on outcomes of psychotherapy on adults, but research is lacking on children. An important part of cognitive behavioral therapy (CBT) is teaching affective modulation skills designed to improve ER. This study examined the role of attachment style and changes in attachment-related ER patterns in effectiveness of CBT-based psychosocial intervention (Teaching Recovery Techniques; TRT) in a war-context. Participants were 482 Palestinian children (10-13 years) who were randomized to either TRT or waiting-list groups. We assessed attachment dimensions, ER, PTSD symptoms, depressive symptoms, psychological distress, and psychological well-being. Data collection was done at the baseline (T1) and at the 9-month follow-up (T2). Results suggest that attachment style was differently associated with the change in mental health in the TRT and control groups. In the intervention group both secure and insecure-preoccupied attachment styles were associated with improved mental health, and children with avoidant attachment did not benefit from the intervention. In the control group avoidant attachment predicted negatively change in mental health, whereas secure and preoccupied attachment styles did not have effects on mental health. Changes in attachment related ER-patterns partially mediated intervention effects in the intervention group. The potential mechanisms underlying findings, and implications for clinical work and future research are discussed.