Conference Agenda

Attachment insecurity has been linked to poorer psychotherapy outcomes (Levy et al., 2018), yet the mechanisms through which attachment influences change remain unclear. In particular, it is often assumed that individuals with insecure attachment styles benefit less from therapy due to difficulties forming a strong working alliance (Notsu et al., 2025). This study examined whether baseline attachment anxiety and avoidance predicted trajectories of working alliance and treatment outcomes in 8-week group trainings of Acceptance and Commitment Therapy (ACT) and Mindful Self-Compassion (MSC). Participants were 73 university students (mean age = 26.89 years, SD = 6.24; 87.5% female) randomized to ACT (n = 24) or MSC (n = 49). Attachment anxiety and avoidance were assessed at baseline and post-training (ECR-R). Working alliance (WAV-12) and outcomes, including psychological symptoms (OQ-45), subjective well-being (ACSA), self-compassion (SCS), compassion toward others (CS), compassion towards strangers (SCBCS), and emotion regulation (DERS-36), were measured repeatedly across treatment. Longitudinal mixed-effects models were used to analyze the data. Baseline attachment styles showed distinct associations with treatment processes and outcomes across interventions. Higher attachment anxiety was consistently associated with greater baseline symptom severity and lower baseline self-compassion. Across treatment, attachment anxiety predicted greater increases in self-compassion. Higher attachment avoidance was associated with lower compassion toward strangers at post-treatment. Findings suggest that attachment insecurity, particularly attachment anxiety, functions primarily as a marker of baseline vulnerability rather than a barrier to therapeutic change.

Introduction: Attachment theory emphasizes that adolescents’ emotional and behavioural symptoms are embedded within relational and affective regulation systems rather than existing as isolated difficulties. Although attachment-based interventions have demonstrated consistent benefits, less is known about how attachment-related change unfolds over time. Key questions remain concerning sequencing: which processes shift first, how changes influence one another, and how symptom improvement emerges within this broader system.

Method: This talk presents findings from a longitudinal network analysis examining mechanisms of change in Connect, a ten-week attachment-based group parenting program for caregivers of adolescents with mental health and behavioural concerns (M_age = 14.05). Data were drawn from more than 1,300 families, with caregivers reporting on adolescents’ attachment, emotion regulation, and psychopathology at pre-intervention, post-intervention, and six-month follow-up. Network analysis conceptualizes psychological functioning as interacting components. Thoughts, emotions, and behaviours are modeled as nodes, and their associations as edges. Cross-lagged panel models were used to compare networks across waves, visualize reorganization over time, and identify processes carrying influence across domains.

Results & Discussion: Distinct patterns of network reorganization emerged across intervention phases. From pre- to post-intervention, reflective processes were the most influential nodes, showing strong outward connections with changes in attachment, emotion regulation, and symptoms. During this phase, comfort-seeking behaviours and difficulty calming down were primarily shaped by change elsewhere in the network. From post-intervention to follow-up, suppression and reflective meaning-making showed the strongest outward connectivity, whereas abandonment concerns and emotional overwhelm were most strongly influenced by earlier network shifts. Together, findings suggest that Connect initiates change by strengthening reflective capacity and relational engagement early, with longer-term improvements maintained through regulatory processes linking attachment security with reductions in psychological distress. Clinical implications for formulation, sequencing of therapeutic targets, and timing of intervention focus within attachment-based parent programs are discussed. Results highlight clinically meaningful system-level change.

Background

Sensitive caregiving is crucial for secure attachment and healthy development, yet families facing adversity often lack support. Minding the Baby® (MTB) is a home-visiting intervention integrating mentalization- and attachment theory. This trial examined the effects of MTB on parent-child interaction, maternal well-being, child development, and out-of-home placements in a universal welfare setting in Denmark among pregnant individuals experiencing adversity.

Methods

This pragmatic, cluster quasi-randomized controlled trial was conducted across 11 Danish municipalities. Pregnant individuals aged ≥15 years identified by antenatal care teams as high-risk were enrolled. Municipalities were randomized in two waves to receive MTB training; families enrolled before training acted as controls (care-as-usual, CAU). MTB was delivered from the third trimester until the child was 24 months old via alternate home visits by a health visitor and a family therapist. All participants were assessed at baseline and at 3, 12, and 24 months postpartum. The primary outcome was maternal sensitivity measured by the Coding Interactive Behavior scale applied to video recordings of mother-infant interactions at 24 months postpartum. Secondary outcomes included parental mental health, reflective functioning, parenting experiences, child development, well-being (questionnaires), and out-of-home placement (administrative data).

Results

A total of 256 participants were recruited (183 MTB, 73 CAU). At 24 months postpartum we found no significant effect for the primary outcome (parental sensitivity). However, secondary outcomes revealed positive effects: MTB mothers were more often enrolled in education and reported greater interest and curiosity. Compared to CAU, MTB children demonstrated improved peer relationships, socio-emotional development, global functioning, but also lower child health. Fewer MTB children were placed in out-of-home care.

Conclusions

MTB showed meaningful benefits across maternal and child outcomes, especially child development and reduced out-of-home placements. These findings highlight MTB’s potential to support at-risk families even within a universal welfare system.

Engagement is critical for the effectiveness of home-visiting interventions, yet families facing adversity often experience ambivalence, mistrust, or practical barriers to participation. Minding the Baby® (MTB) is a trauma-informed, interdisciplinary home-visiting intervention delivered from pregnancy until the child’s second birthday. This study explored how parents experienced MTB in a Danish context, with particular attention to factors shaping engagement, retention, and disengagement.

As part of a Danish MTB trial, we conducted 31 semi-structured telephone interviews with mothers and fathers who completed the program, discontinued participation, or declined enrollment. Interviews were analyzed using reflexive thematic analysis to capture both shared and divergent experiences.

Eight themes were identified. Parents commonly described MTB as validating and confidence-building, particularly during the transition to early parenthood, and valued the relational support and flexibility of home visitors. The intervention also played an important role in mobilizing community resources and facilitating access to additional services. However, engagement was shaped by several barriers. Parents described divergent perspectives within couples, with mothers often more engaged than fathers. Fathers frequently faced scheduling constraints related to employment or questioned the personal relevance of the intervention. Some families experienced the program as time-consuming or confusing, particularly when communication or coordination was unclear. Fear of surveillance and child protection involvement was common early in the intervention and, for some, undermined trust. Several parents did not identify with the target group, describing themselves as “too well-functioning,” while others felt that their needs exceeded what MTB could offer in situations of acute adversity.

Overall, MTB was broadly acceptable and experienced as supportive, but engagement depended on trust, clarity, and perceived fit. Findings highlight the importance of transparent communication about program aims, flexible scheduling and structured father engagement, and clear pathways to more intensive support when families’ needs surpass the scope of preventive home visiting.