Effects of Attachment on Condom Use Attitudes and

BehaviorJohn K. Sakaluk, M.A.Omri Gillath, Ph.D.

University of Kansas

Outline

1. Determinants of condom use

2. Attachment theory

3. Present results from 4 experiments

4. What do results mean for condom use promotion

Condom Use Promotion

Critiques of Pure Reasoned Action

“Oversimplified” WHO, 2012

“Mechanistic” Feeney & Raphael, 1992

“Ignoring important interpersonal and affectional nature of sexual relationships” Ciesla et al., 2004

Our Relational Focus: Attachment

Attachment theory—an account of emotional bonding in close relationships

What’s a baby/person in distress to do? Bowlby 1969/1982

Extensions to adult romantic/sexual relationshipsFraley & Davis, 1997; Mikulincer & Shaver, 2007

Internal Working Models of Self and Other

Anxious-Preoccupie

dSecure

Fearful Avoidant

Dismissive Avoidant

Positive Other

Negative Other

Positive SelfNegative Self

Internal Working Models of Self and Other

Anxious-Preoccupie

dSecure

Fearful Avoidant

Dismissive Avoidant

Positive Other

Negative Other

Positive SelfNegative Self

Internal Working Models of Self and Other

Anxious-Preoccupie

dSecure

Fearful Avoidant

Dismissive Avoidant

Positive Other

Negative Other

Positive SelfNegative Self

Attachment and Condom Use Research

Feeney et al (1999, 2000): Avoidants like condoms more/use condoms more Anxious like condoms less/use condoms less

Bogaert & Sadava (2002): Secures don’t like/use condoms Anxious like/use condoms

Kershaw et al. (2007): Avoidants and anxious both don’t like/use condoms

Goals and Predictions of Our Research

Examine the causal effects of attachment on condom use attitudes and behaviorsPriming attachment styles

Gillath et al., 2008; Sakaluk, 2013

General hypotheses: Secure/Anxious share positive working model of other (esp. when sex-related)Security/Anxiety should cause more negative

condom use attitudes/less behavior

Study 1 (n = 335)

Control Prime

Security Prime

Anxiety Prime

Avoidance Prime

Self-Reported (Explicit) Condom Use Attitudes

If I always (never) used condoms every time I had penile-vaginal intercourse, it would be…

Caring Selfish

Smart Stupid

Responsible Reckless

Safe Dangerous

Protective Risky

Respectful Insulting

Right Wrong

(αs = .93, .95); Higher scores = more positive evaluation

Sakaluk & Muehlenhard, 2012

Results

Control Security Anxiety Avoidance

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

Discusison

Priming attachment styles that involve positive working models of other lead to self-report preferences for condom use

No examination of mediating mechanism

Study 2

Health behavior theories suggest perceiving threat to health as necessary precursor to taking actionHochbaum, 1958; Rosenstock, 1960

Perceived sexual health threat as mediator of attachment effects on condom use attitudes

Study 2 (n = 145)

Control Prime

Security Prime

Anxiety Prime

Avoidance Prime

Perceived Sexual Health Threat (α = .65)

1-7 scale (1 = not at all; 7 = extremely)

1. How safe do you feel having sex with your partners?

2. How confident are you that partners would not give you a sexually transmitted infection?

3. How suspicious are you of your partners cheating?

Mediation by Sexual Health Threat

Sec/Anx vs. Avo

Perceived Sexual Health

Threat

Explicit Attitudes

Total Effect (c): β = -.87** Direct Effect (c’): β = -.67*

β = -.60** β = -.19*

95% CI (-.01, -.50)Bootstrapped N = 10,000

DiscussionPositive working models of other lower

perceptions of sexual health threat more negative attitudes towards condom use

Studies 1-2 limited to self-report (explicit) measuresVulnerable to socially desirable respondingExplicit attitudes require motivation/opportunity to

translate to behavior

Study 3

What about implicit attitudes?Automatic, and not always consciously accessible

What kind of behaviors are implicit attitudes good at predicting?Socially sensitive behaviors Greenwald et al., 2009

When motivation/opportunity for deliberate consideration are low Fazio, 1990

Study 3 (n = 89)

Control Prime

Security Prime

Anxiety Prime

Avoidance Prime

Positive Negative

Condom Use Condom Non-Use

SexyDisgusting

Mediation by Sexual Health Threat

Sec/Anx vs. Avo

Perceived Sexual Health

Threat

Implicit Preferences

Total Effect [c]: β = -.18*

95% CI (.-02, .04)

Study 3 DiscussionSame effect on implicit attitudes, but not

mediated by sexual health threat perceptionsPoor measurement of threat perceptions to blame?

(α = .40)

Studies 1-3 limited to study of self-report and finger movements—what about behavior?Unfortunate that security has negative effect given

other benefits of secure attachment styleMikulincer & Shaver, 2007

Study 4

Mikulincer & Shaver’s (2007) review of security priming effects1. Increased mental health/well-being

Mikulincer et al., 2006

2. Decreased intergroup aggression/hostilityMikulincer & Shaver, 2001

3. Increased levels of altruism/pro-social behaviorMikulincer et al., 2003

Benefits of Security

Mikulincer & Shaver’s (2007) review of security priming effects1. Increased mental health/well-being

(e.g., Mikulincer et al., 2006)

2. Decreased intergroup aggression/hostility(e.g., Mikulincer & Shaver, 2001)

3. Increased levels of altruism/pro-social behaviorMikulincer et al., 2003

Study 4 (n = 228)

Control Prime

Security Prime

Anxiety Prime

Avoidance Prime

Results

Control Security Anxiety Avoidance0

0.5

1

1.5

2

2.5

3

3.5

Self-FocusOther-Focus

Security (v. control) x Framing interaction: eβ = 0.59, p = .03

Summary and Limitations

Consistent effect of security across Studies 1-4Effect of anxiety did not carry over to behavior

Ad-hoc measurement of sexual health threat perceptions was a limiting factor for Studies 2-3

Although Studies 1-2 diverse in age, otherwise homogenous samples across Studies 1-4

Conclusions and Future Directions

Relational factors play important role in condom use evaluation/behaviorSecurity effect in particular warrants consideration

for sexual health promotion

Examining causal effects of attachment on broader indicators of sexual health

Security Prime

“I had a boyfriend for six years and we got along from the first moment we met…and I had no fear of abandonment. I don't think he did either….we grew

very close and for awhile it seemed we'd be together forever.”

“My husband and I have that kind of relationship. We are in love, trust each other, depend in each

other for everything and share our feelings.”

Anxiety Prime

“He felt like a sieve through which my affection poured through.”

“When in public I would try to hold their hand or put my arm through theirs, but they would kinda brush me off…even when we were alone in the

house, they pulled away when I would touch them...”

Avoidance Prime

“When I was ready to break up with a boyfriend, every physical gesture he made was painful and

unendurable. I did not want to be close or intimate, I just wanted to escape his physical presence.”

“I met a man in whom I had a casual interest…He quickly became enamored of me, much more so than I of him. He wanted me to meet his family, move in with him, pick out his clothes, name his

pets, etc. It gave me the creeps.”

Control Prime

“A new girl at work started about 1 week ago.She is very standoffish, a know it all and worst of

allshe is the boss’s friend”

“I know a guy from work. I do not talk to him except for a few small conversations in passing. He

seems nice. He talks to many people at work.”