Interventions for Attachment Anxiety

Elisa A. Escalante/ LCSW/ 10-13-2025

“Your loneliness will teach you why you settled.” -EaE

Lately, I have been discussing attachment anxiety with a good amount of my patients. This topic requires in depth processing and unpacking various root causes. Many people with attachment anxiety are victims of childhood wounds and unhealthy social teachings. Their neglect and abandonment wounds hurt so badly, they might resort to chasing, clinging, or settling for toxic partners. Or, they might sabotage relationships with healthy partners due to their anxiety leading them into patterns of interrogating and/ or making false accusations toward their partners. When exploring attachment anxiety, I like to first use a screener: “Exploring anxious attachment style” worksheet.

I ask my patient to rate themselves on 1-10 scales for the following attachment anxiety traits: clinginess in relationships, hyper sensitivity to criticism, jealousy in relationships, a need for approval from others, difficulty with being alone, low self esteem, intense fears of rejection, feelings that they are unworthy of being loved, difficulty with trusting people, and a significant fear of being abandoned. As they rate themselves on these scales, a lot of important dialogue comes up. From the conversations I will give my patients journal prompts, reflective questions, and/ or radical acceptance concepts to work on through the following weeks.

1- I tend to get clingy in relationships. Clinginess indicates that the patient has unmet needs. Quite often those unmet needs include emotional attunement, attention, and/ or quality time from parental figures. Clinginess also indicates the patient was likely abandoned and developed a survival program that says: “Must chase and cling to others to preserve my relationships and avoid being abandoned again.” Unfortunately, the clinginess often perpetuates the opposite of what an attachment anxious person wants. Clinginess scares people and chases them away. I often encourage my ‘clingy’ clients to find ways to meet their needs either with other people, or solo. One person cannot meet another persons needs fully, all the time, 24/7 anyways. And it would be unhealthy to expect anyone to. This is an opportunity for the patient to expand their coping outlets and allocate connection to a ‘support system’ versus a singular person that they are ‘obsessed’ with. This can also help them lower their chance of developing a codependency with someone that will perpetuate disappointment.

2- I am highly sensitive to criticism whether it is real or perceived. Patients that are highly sensitive to criticism likely had verbal abuse trauma in their childhoods. Verbal abuse leads people to have increased sensitivity toward words, tones, phrases and even non verbals; body language and shifts in emotional energy. Verbal abuse causes people to walk on eggshells around their abusers. They must pay extra attention to how their body language, facial expressions and words that may trigger their abusers. It will also be harder for them to emotionally regulate themselves when other people do not mind their words/ tones. Therefore everyday conversation could cause them to involuntarily shift into ‘fight, fly or freeze’ mode. Trigger awareness, emotional soothing/ self regulation, cognitive work; trauma dialogue shifting, and evaluating thought stuck points / survival programs are all crucial interventions. These patients may require longer time outs while they engage in these interventions to get back to their own personal equilibrium and not lash out at the people that trigger them. I’ll also encourage them to ask for reassurance when needed, with non accusatory, curious questions. They need to ensure that the people around them are not triggering them on purpose. If they are around verbally abusive people, then we shift into conversational, mental, emotional and internal boundary interventions. People cannot heal/ regulate in abusive environments.

3- I tend to get jealous in relationships. There are two crucial reflective questions I ask people when they are struggling with jealousy in their relationships. 1- What do you fear right now? 2- What are your unmet needs? Perhaps they fear getting cheated on, or being abandoned, or neglected. Perhaps the unmet needs include quality time, words of affirmation or physical touch. This can be communicated to a significant other without making false assumptions or accusations. For example, instead of: ‘You’re talking to that other girl/ guy, you are probably going to cheat on me’, this can be phrased as, “we haven’t been talking as much as we used to, I miss that. I miss you.’ Because the third party person they are jealous of, is simply a reminder of an unmet need. The jealousy is the projection of their heavy emotions. If they fear their partner may abandon them for someone else, they can always ask: “Do you want to leave, are we still good?” Also, can they meet their own needs? Is there any foolproof way anyone can even avoid being abandoned? No. And, trying to control people perpetuates our own suffering, this is one of the laws of radical acceptance. Even in relationships, people still have their own personal autonomy and reserve the right to leave whenever they want.

4- I need approval from others. When people need constant approval, this is a sign of a lack of praise, emotional attunement in childhood, which leads to the compulsion to over compensate by ‘earning’ or ‘chasing’ approval. This could be striving to get approval from intimate partners, friends, authority figures, acquaintances and sometimes even internet strangers. They need approval due to the low self worth that stems from having caregivers that never gave them approval or reassurance. People with attachment anxiety may chase approval to their own detriment. When they chase approval from an avoidant person for example, it will be an endless cycle of dopamine highs followed by rejection wounds. Because avoidants tend to breadcrumb people, including those that they love. Chasing after achievements for the sake of approval could also increase risks of burnout. Because their identity is centered around whether or not others believe they are ‘doing enough’. Building a stronger sense of identity requires more solitude. More tuning out the noise of other peoples opinions, more filtering social media and toxic people. This will require stronger internal boundaries and behavioral modifications.

5- I have a difficult time being alone. People that grew up with neglect/ parental abandonment will be triggered when they feel alone, ignored or even bored. People that have a hard time being alone, will need to practice being alone. Not in an isolative and miserable way, but ideally, in a way that they can learn to enjoy solitude with their own hobbies. We can enjoy our own company when we learn how to entertain ourselves. There are many types of coping outlets that can help people in this practice. Escapism coping such as TV, video games, reading, social media. Behaviorally activating hobbies such as sewing, crochet, knit, gardening, baking, playing an instrument, making puzzles or models. Movement coping; any workout of your choice, ideally something you enjoy to eliminate the low motivation barrier. Relaxation/ mindfulness coping: deep breathing, journaling, guided imagery, body scanning, long baths/ showers, nature etc. People that can enjoy their solitude make for healthier partners in relationships, because they display less patterns of neediness and codependency.

6- I have low self esteem. How do we build self esteem when it has been shattered due to growing up with abusive people? The outer critic eventually becomes our inner critic and we will talk negatively toward ourselves, the way our abusers once did. If self esteem works like a ‘muscle’, then when we have not been in the practice of giving ourselves positive affirmations, it means the self esteem/ affirmation muscle is ‘weak’. We must exercise this with practice. Long, drawn out, tedious, and awkward practice. I ask my patients with low self esteem to give themselves praise and compliments, they struggle at first. I give them prompts every session until it becomes almost second nature. If they really cannot think of a compliment to give themselves, I will ask them to evaluate what their friends/ lovers have told them in the past. I will also tell them what I believe they are good at. And with kids/ teens, when their parent is in their intake session, I will prompt their parents to give them affirmations. Self esteem is also built when we prove ourselves to ourselves. Set mini goals, see them through; we can become people that we are proud of.

7- I have an intense fear of being rejected. This is probably my deepest childhood wound. I did not realize this until I had more in depth cognitive processing therapy / CPTSD treatment. I was able to heal from abandonment wounds and neglect wounds more effectively than rejection wounds. Rejection is very nuanced. Depending on how our childhoods go, there is a multitude of ways one can ‘feel’ rejected. Rejection can be felt when someone does not want to talk to you as much as you would like to talk to them. When/ if someone does not reciprocate your quality time, your gift giving, your energy. If someone downright breaks up with you, or sleeps with you and then ghosts you after. Rejection is constant and it reopens wounds daily. The only way to avoid it is to avoid connection all together. Since isolation is also not healthy, we instead need to work on how we view/ think about our feelings of rejection. We have to learn to not personalize it, how to not let it destroy our self worth. We have to remember that one person’s opinion of us is not the end all be all. We must learn that life moves on, even when some people do not like us. Consider that you are chasing someone’s approval in order to avoid feeling rejected yet again. This is a projection of your own childhood wound onto an unwilling participant. Rejection wounds require deep cognitive work and behavioral modifications.

8- I have feelings that I am unworthy of being loved. Low self worth and the sense that one does not deserve love is tied directly to how they were treated as children. Neglect/ verbal abuse and abandonment may teach children that they are a ‘burden’. That they should be ashamed of being born. They are more likely to grow into adults that carry heavy burdens of guilt on their shoulders. They are also more likely to be emotionally hijacked when people guilt trip them. Even in their intimate relationships with solid proof that they are loved, they may not believe it. Or they may believe that it won’t last. They may ask for constant reassurance because they are unable to reassure themselves of their own worthiness. This could look like requiring consistent calls, texts or dates with their partner, otherwise their anxiety may take over and cause them to reach out desperately for reassurance. I am a huge advocate of ‘energy matching’ and radical acceptance work when people find themselves in these patterns. Why? Because chasing people that do not help you feel good about yourself, will perpetuate… more low self worth! Meanwhile walking away from those that hurt you and inviting in healthy people that help you feel good about yourself, perpetuates healthy relationships/ self worth.

9- I have a hard time trusting others. Trust is extremely hard to earn, and very easy to shatter. I do not believe that trust should be given quickly or easily, but I also do not believe we should assume everyone is awful and close ourselves off to everyone. Humans are social beings by nature/ nurture. We get endorphins and oxytocin when we have fun with our friends/ family and/ or have intimate connections with lovers. Our trust is ours to either give or withhold. I also believe that people would be better off if they compartmentalize their trust into categories. For example, maybe you learn you can trust one of your friends to be on time/ punctual, but you cannot trust them to keep a secret. You may be able to trust your S/O to pay the bills, but maybe you cannot trust them to be a good listener when it comes to your feelings. Maybe you can trust your parent to make quality time for you, but you cannot trust them to not judge or lecture you. And, what do we do with this information as we gather it? We allocate people to their trust positions. Example: Mom is for good in depth secret talks, Dad is great for adventures, this friend is good for planning and sticking to hang outs, that friend is good for a laugh, this family member will always give me constructive feedback…. etc.

10- I have a significant fear of being abandoned. Once again, the law of radical acceptance teaches us: We do not have control over others. The crucial reflective questions: Can we prevent people from leaving us, abandoning us, or dying? NO. Will we likely be abandoned throughout our lives? Either voluntarily or by death. Yes, this will happen. This is a very uncomfortable topic that society wants to avoid. But, it is a necessary conversation with those that suffer with attachment anxiety. When people try to ‘never get abandoned’, they suffer more. They are literally trying to prevent something that will inevitably happen anyways. This is a waste of energy. This also gives people false delusions of control that will eventually be shattered. For example, you decide to become the best wife per society standards: cook/ clean/ submissive/ faithful/ emotionally supportive… and then you still get abandoned. Or, a man trying to be a great provider: pays all the bills, shelters his family, helps their spouse feel protected.. and then gets abandoned any ways. We can absolutely do things as individuals to foster healthier relationships, but we CANNOT prevent getting abandoned. Unless we unlawfully try to lock someone up against their will. (I do not recommend) The fear of abandonment requires radical acceptance work. It requires us to surrender to what is out of our control. I also encourage all patients to think about that ‘worse case scenario’. “Okay, so what if they do leave you??” Let’s make a plan Z. The anxious brain may be alerting them to have a ‘back up plan’ in case they cannot rely on someone. And that is not a bad thing.