The Effectiveness of Attachment-based Parent Training Method in Anxiety Syndrome of Preschool Children

Document Type : Original Article


1 Assistant Professor, Department of Clinical & Health Psychology, Shahid Beheshti University, Tehran, Iran

2 Professor, Department of Clinical & Health Psychology, Shahid Beheshti University, Tehran, Iran

3 Associate Professor, Department of Educational Psychology and Counseling, Tehran University, Tehran, Iran

4 4Professor, Department of Clinical & Health Psychology, Shahid Beheshti University, Tehran, Iran

5 M.A in family counseling, Shahid Beheshti University, Tehran, Iran


Introduction: The purpose of this study was to investigate the effectiveness of attachment-based parent training on anxiety syndrome in 2- to 6-year-old children.
Method: A quasi-experimental design was conducted in this research. 278 mothers completed The Spence Preschool Anxiety Scales (SPAS). 74 mothers that their children’s anxiety scores were one standard deviation above the population’s mean were selected. They completed The Conner’s Behavioral Rating Scale, investigating the absence of any other psychological problems in those children. Finally, 61 mothers were selected and assigned to the experimental and control group and received the training package for eight sessions, 2-hour-long each. Three months after finishing finishing the trainin g sessions for the experimental group and 3 months later, The SPAS were completed by mothers in both groups. Repeated mesures ANOVA was used to analyze the data.
Result: The results showed that Parent Training Package diccreased generalized, social and separation anxiety subscales and total anxiety score in the experimental group more than the control group (p<0.0001). This reduction was sustained during the three months of follow-up, but no significant reduction in problems related to obsessive compulsive disoder and physical injury phobia was found after the intervention.
Conclusion: It can be concluded that attachment-based parent training can decrease anxiety in preschool children. These results suggest that child therapists can use this method in order to prevent and treat children’s anxiety.


1. Cartwright-Hatton S, McNicol K, Doubleday E. Anxiety in a
neglected population: Prevalence of anxiety disorders in preadolescent
children. Clinical psychology review.
2. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA.
Annual Research Review: A meta‐ analysis of the worldwide
prevalence of mental disorders in children and adolescents.
Journal of Child Psychology and Psychiatry. 2015;56(3):345-65.
3. Maughan B, Rowe R, Messer J, Goodman R, Meltzer H. Conduct
disorder and oppositional defiant disorder in a national sample:
developmental epidemiology. Journal of child psychology and
psychiatry. 2004;45(3):609-21.
4. Pine DS, Helfinstein SM, Bar-Haim Y, Nelson E, Fox NA.
Challenges in developing novel treatments for childhood
disorders: lessons from research on anxiety.
Neuropsychopharmacology. 2009;34(1):213.
5. Luby JL. Handbook of preschool mental health: Development,
disorders, and treatment: Guilford Press; 2009.
6. Egger HL, Angold A. Common emotional and behavioral
disorders in preschool children: presentation, nosology, and
epidemiology. Journal of child psychology and psychiatry.
2006;47(3‐ 4):313-37.
7. Priceputu M. Attachment style-from theory to the integrative
intervention in anxious and depressive symptomathology.
Procedia-Social and Behavioral Sciences. 2012;33:934-8.
8. Mash EJ, Barkley RA. Child psychopathology: Guilford
Publications; 2014.
9. Muris P. The pathogenesis of childhood anxiety disorders:
Considerations from a developmental psychopathology
perspective. International Journal of Behavioral Development.
10. Cassidy J, Shaver PR. Handbook of attachment: theory, research
and clinical applications. New York: Guilford; 2008.
11. Ainsworth MDS. Infancy in Uganda: Infant care and the growth
of love. 1967.
12. Bowlby J. Attachment and Loss: Attachment.-1969.-(RUidnr.:
M102591232): Basic books; 1969.
13. Bowlby J. Attachment and loss: Separation: Anxiety and anger
(Vol. 2). new york: Basic Books; 1973.
14. Bowlby J. Attachment and loss: Loss, sadness and depression
(Vol. 3). New York: Basic Books; 1980.
15. Knappe S, Beesdo-Baum K, Fehm L, Lieb R, Wittchen H-U.
Characterizing the association between parenting and adolescent
social phobia. Journal of anxiety disorders. 2012;26(5):608-16.
16. Festa CC, Ginsburg GS. Parental and peer predictors of social
anxiety in youth. Child Psychiatry & Human Development.
17. Ziv Y, Oppenheim D, Sagi-Schwartz A. Social information
processing in middle childhood: Relations to infant-mother
attachment. Attachment & Human Development. 2004;6(3):327-
18. Woodhouse SS. Attachment‐ based interventions for families
with young children. Journal of clinical psychology. 2018.
19. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Juffer F. Less
is more: meta-analyses of sensitivity and attachment
interventions in early childhood. Psychological bulletin.
20. Ainsworth MDS, Blehar MC, Waters E, Wall SN. Patterns of
attachment: A psychological study of the strange situation:
Psychology Press; 2015.
21. Ainsworth MDS. Object relations, dependency, and attachment:
A theoretical review of the infant-mother relationship. Child
development. 1969:969-1025.
22. Egeland B, Weinfield NS, Bosquet M, Cheng VK.
Remembering, repeating, and working through: Lessons from
attachment-based interventions. WAIMH handbook of infant
mental health. 2000;4:35-89.
23. Beijersbergen MD, Juffer F, Bakermans-Kranenburg MJ, van
IJzendoorn MH. Remaining or becoming secure: Parental
sensitive support predicts attachment continuity from infancy to
adolescence in a longitudinal adoption study. Developmental
psychology. 2012;48(5):1277.
24. van den Boom DC. Do first‐ year intervention effects endure?
Follow‐ up during toddlerhood of a sample of Dutch irritable
infants. Child development. 1995;66(6):1798-816.
25. Van Zeijl J, Mesman J, Van IJzendoorn MH, Bakermans-
Kranenburg MJ, Juffer F, Stolk MN, et al. Attachment-based
intervention for enhancing sensitive discipline in mothers of 1-to
3-year-old children at risk for externalizing behavior problems:
a randomized controlled trial. Journal of consulting and clinical
psychology. 2006;74(6):994.
26. Ebrahimnezhad MF, Ghasemzadeh A, Borjali A, Sohrabi F,
Soleimani M. Effect of secure attachment style based on motheradolescent
training on reducing depression in female
adolescents. Procedia-Social and Behavioral Sciences.
27. Goldsmith DF. Challenging Children’s Negative Internal
Working Models: Utilizing Attachment-Based Treatment
Strategies in a Therapeutic Preschool, 2007. In D. Oppenheim,
& D. F. Goldsmith (Eds.), Attachment Theory in Clinical Work
with Children New York: Guilford Press.
28. Cooper G, Hoffman K, Powell B, Marvin RS. The Circle of
Security Intervention: Differential Diagnosis and Differential
Treatment, 2005. In L. J. Berlin, Y. Ziv, L. A. Jackson, M. T.
Greenberg (Eds.), Enhancing Early Attachments Theory,
Research, Intervention, and Policy. New York: Guilford Press.
29. Dozier M, Lindhiem O, Ackerman JP. Attachment and
Biobehavioral Catch-up, 2004. In L. J. Berlin, Y. Ziv, L. Amaya-
Jackson, & M. T. Greenberg (Eds.), Enhancing early
attachments: Theory, research, intervention, and policy New
York: Guilford Press.
30. Koren-Karie N, Oppenheim D, Goldsmith D. Keeping the inner
world of the child in mind: Using the insightfulness assessment
Ghanbari et al.
17 Int J Behav Sci Vol.12, No.1, Spring 2018
with mothers in a therapeutic preschool. Attachment theory in
clinical work with children. 2007:31-57.
31. Moretti MM, Obsuth I. Effectiveness of an attachment-focused
manualized intervention for parents of teens at risk for aggressive
behaviour: The Connect Program. Journal of Adolescence.
32. Frick PJ, Barry CT, Kamphaus RW. Clinical assessment of child
and adolescent personality and behavior. New York: Springer;
33. Conners CK. Conners 3rd edition manual. Toronto, Ontario,
Canada: Multi-Health Systems; 2008.
34. Khushabi K, Pour-Etemad H, Mohammadi M, Mohammadkhani
P. The prevalence of ADHD in primary school students in
Tehran. Medical Journal of The Islamic Republic of Iran
(MJIRI). 2006;20(3):147-50.
35. Shahaeian A, Shahim S, Bashash L, YOUSEFI F.
36. Spence SH, Rapee R, McDonald C, Ingram M. The structure of
anxiety symptoms among preschoolers. Behaviour Research and
Therapy. 2001;39(11):1293-316.
37. Ghanbari S, Khanmohamadi M, Khodapanahi M, Mazaheri A,
Gholamali Lavasani M. Study of psychometric properties of
preschool anxiety scale. Journal of psychology. 2011;15:222-34.
38. Wood JJ, Piacentini JC, Southam-Gerow M, Chu BC, Sigman
M. Family cognitive behavioral therapy for child anxiety
disorders. Journal of the American Academy of Child &
Adolescent Psychiatry. 2006;45(3):314-21.
39. Mayer-Brien S, Turgeon L, Lanovaz MJ. Effects of a parent
training programme for the treatment of young children with
separation anxiety disorder. the Cognitive Behaviour Therapist.
40. LaFreniere PJ, Capuano F. Preventive intervention as means of
clarifying direction of effects in socialization: Anxiouswithdrawn
preschoolers case. Development and
psychopathology. 1997;9(3):551-64.
41. Benoit D, Madigan S, Lecce S, Shea B, Goldberg S. Atypical
maternal behavior toward feeding‐ disordered infants before and
after intervention. Infant Mental Health Journal: Official
Publication of The World Association for Infant Mental Health.
42. Robert‐ Tissot C, Cramer B, Stern DN, Serpa SR, Bachmann JP,
Palacio‐ Espasa F, et al. Outcome evaluation in brief motherinfant
psychotherapies: Report on 75 cases. Infant Mental Health
Journal: Official Publication of The World Association for Infant
Mental Health. 1996;17(2):97-114.
43. Koren‐ Karie N, Oppenheim D, Getzler‐ Yosef R. Mothers who
were severely abused during childhood and their children talk
about emotions: Co‐ construction of narratives in light of
maternal trauma. Infant Mental Health Journal: Official
Publication of The World Association for Infant Mental Health.
44. Sroufe LA. Emotional development: The organization of
emotional life in the early years: Cambridge University Press;
45. Egeland B, Erickson M. Attachment theory and findings:
Implications for prevention and intervention. Prevention in
mental health: Now, tomorrow, ever. 1993:21-50.
46. Manassis K. Child–parent relations: Attachment and anxiety
disorders. Anxiety disorders in children and adolescents.
47. Muris P, Meesters C, van den Berg S. Internalizing and
externalizing problems as correlates of self-reported attachment
style and perceived parental rearing in normal adolescents.
Journal of Child and family Studies. 2003;12(2):171-83.
48. Steinberg L, Lamborn SD, Darling N, Mounts NS, Dornbusch
SM. Over-time changes in adjustment and competence among
adolescents from authoritative, authoritarian, indulgent, and
neglectful families. Child Developmen. 1994;65(3):754–70.
49. Propper C, Willoughby M, Halpern C, Carbone M, Cox M.
Parenting quality, DRD4, and the prediction of externalizing and
internalizing behaviors in early childhood. Developmental
Psychobiology: The Journal of the International Society for
Developmental Psychobiology. 2007;49(6):619-32.
50. Sadock BJ, Sadock VA. Kaplan & Sadock's concise textbook of
clinical psychiatry: Lippincott Williams & Wilkins; 2008.
51. Juffer F, Bakermans-Kranenburg MJ, Van Ijzendoorn MH.
Promoting positive parenting: An attachment-based intervention.
London: Taylor & Francis Group; 2008.
52. Juffer F, Bakermans-Kranenburg MJ, MH. vI. The importance
of parenting in the development of disorganized attachment:
evidence from a preventive intervention study in adoptive
families. Child Psychol Psychiatry. 2005;46:263-74.
53. Steele H, Steele M. Understanding and resolving emotional
conflict. Attachment from infancy to adulthood: The major
longitudinal studies. 2005:137-64.
54. Zeanah CH, Benoit D. Clinical applications of a parent
perception interview in infant mental health. Child and
Adolescent Psychiatric Clinics of North America.
55. Koren-Karie N, Oppenheim D, Dolev S, Sher E, Etzion-Carasso
A. Mothers' insightfulness regarding their infants' internal
experience: Relations with maternal sensitivity and infant
attachment. Developmental Psychology. 2002;38(4):534.
56. Fonagy P. Attachment Theory and Psychoanalysis. New York
(Other Press) 2001.