Attachment Theory

“Decades of research support the anxiety-buffering and growth-promoting functions of the sense of attachment security and the positive consequences of making felt security contextually salient (what Mikulincer & Shaver, 2016, called security priming). Whereas secure attachment facilitates effective coping with undesirable physiological and psychological states, attachment insecurities might hamper emotion regulation. Research indicates that anxious attachment reinforces distress up-regulation, negative self-views, and catastrophic beliefs, whereas avoidant attachment leads people to suppress emotions and inhibit direct contact with inner experiences (Mikulincer et al., 2003). Over time, insecure attachment can become a vulnerability factor for emotional and interpersonal problems, with disorganized attachment as a particular risk factor for psychopathology (Stovall-McClough & Dozier, 2016). By contrast, secure attachment functions as a source of resilience that sustains well-being and mental health (Mikulincer & Shaver, 2016). Consequently, attachment security at the outset of psychotherapy and increases in felt security during therapy predict favorable clinical outcomes (Levy et al., 2018)” (Cherniak et al., 2021, p. 5).

“Attachment-secure people hold inner senses of self-worth and self-fortitude that allow them to remain calm, confident, and experientially open when facing uncertainty and ambiguity (Mikulincer & Shaver, 2016). Moreover, they rely on effective emotion regulation strategies allowing them to mitigate distress and remain mindful, aware of, and fully engaged with, novel and exciting experiences even if they evoke temporary confusion (Mikulincer et al., 2003). As a result, attachment security may facilitate a calm surrender to the psychedelic-induced experience. By contrast, as reviewed in a previous section, attachment insecurities hinder effective distress management, which, in turn, precludes experiential openness, mindful awareness, and full engagement with novel and challenging experiences (Mikulincer & Shaver, 2016). Attachment avoidance is related to cognitive and experiential closure, discomfort with novelty and ambiguity, and low tolerance of uncertainty (e.g., Mikulincer, 1997), which, in turn, may prevent "surrendering" to psychedelic-induced experiences. The intake of psychedelics may also lead avoidant individuals to rely on their typical defensive strategies, such as suppressing or escaping uncomfortable sensations, feelings, or thoughts, further exacerbating their resistance to "surrendering" to the drugs' effects. However, these avoidant defenses tend to fail in situations of extreme stress that involve a high cognitive or emotional load, leaving the avoidant person vulnerable to an overwhelming torrent of negative feelings and thoughts (Mikulincer et al., 2004) potentially alongside a ‘psychedelic-like’ altered state of consciousness (Brouwer & CarhartHarris, 2021). This could also be the case for psychedelic-induced experiences: Psychedelics' dysregulatory action on top-down controlling processes might interfere with psychological defenses, such that suppressed material may resurge into awareness and create an aversive experiential state. This view of the action of psychedelics explains why such emphasis is placed on the importance of twinning the drugs with psychological support (Carhart-Harris et al., 2018)” (Cherniak et al., 2021, p. 14).

“Attachment security may also facilitate the exploration/integration of psychedelic-induced experiences. Psychotherapy research has linked attachment security to better therapeutic processes and outcomes (Mikulincer et al., 2013). In a self-exacerbating cycle, secure attachment contributes to the formation of a stable therapeutic alliance and sustains open exploration, deep reflection, and coherent integration of personal memories, feelings, and beliefs, which, in turn, boosts attachment security over the course of treatment. Likewise, attachment security may aid in deriving enduring, transformational meaning from powerful experiences induced by psychedelics. While insecure attachment may hinder this process, as a maladaptive "set" factor, a sound "setting" – a supportive therapeutic environment and competent health professional – may provide the compensatory security necessary to facilitate more favorable psychedelic experiences and their integration into a person's narrative and IWMs of the self and others” (Cherniak et al., 2021, p. 17).