Anxiety, Avoidance, and Virtual Dates: The Role of Attachment Theory In Reducing Risky Behavior Among Men Having Sex with Men

Theoretical Background and research questions/hypothesis:  HIV diagnoses among men who have sex with men (MSM) has been steadily increasing in the United States (CDC, 2010).  One of the crucial prevention challenges pertains to young MSM—a generation that has been shown to engage in more risky sexual encounters, and, having grown up with a myriad of advanced technologies, is less likely to be responsive to conventional interventions (Wolitski, Valdiserri, Denning, & Levine, 2001). Attachment theory (Bowlby, 1969, 1973, 1980) states that people’s early experience with caregivers forms their mental models regarding expectations about interpersonal relationships in later life. These cognitive models not only govern our behaviors towards others but also influence our interpretation of interactional partners’ responses (Cohen, 2004). Attachment theory posits that individuals vary on two continuums: anxiety and avoidance. Anxiously attached individuals often harbor a negative portrayal of self and strongly desire intimacy and acceptance by partners (Collins & Read, 1990; Cooper, Shaver, & Collins, 1998). People with a high level of attachment avoidance tend to distrust others and avoid close relationships (Simpson, Rholes, & Phillips, 1996). Young MSM high on both types of attachments are less likely to benefit from social support in family, school, and work contexts (Gwadz, Clatts, Leonard, & Goldsamt, 2004) .   Our past studies have demonstrated the efficacy of Socially Optimized Learning in Virtual Environments (SOLVE), an approach to risk-reduction that utilizes interactive media. In interventions based on the SOLVE model, young MSM assume the role of a virtual character and make choices while on a virtual date with an attractive partner.  Users also receive advice and persuasive risk-reduction messages from peer-guide characters (Appleby, Godoy, Miller, & Read, 2008; Read et al., 2006).  As SOLVE interventions are designed to simulate real life social interaction, MSM on a virtual date may try to build intimate and trusting virtual relationships (with virtual partners, guides, etc.) as they would in real-life.  Do participants’ attachment styles and their sense of presence, which has been found to be a key moderator of the effectiveness of persuasive virtual environments, predict MSM’s virtual choices in these intimate interactions?

Methods: In the current work, we analyze participant’s evaluations of a SOLVE-based intervention designed to curb risky sexual behavior among 18-30 year old MSM.  

Results: Correlational analyses indicated that MSM with higher attachment anxiety and avoidance were significantly less likely to trust and feel accepted by the guide characters. The guide characters were also found to be considered less believable among anxiously attached MSM (p=.025). Additionally, attachment avoidance was negatively correlated with a sense of presence.

Conclusions: Varying along two continuums of attachment dimensions--anxiety and avoidance, MSM responded differentially to an interactive video that involves fostering close and trusting relationships with guide characters who offer advice on risky sexual behaviors. 

Implications for research and/or practice: In addition to HIV-prevention skills, future development of interactive-media based interventions should incorporate relationship skills to decrease attachment anxiety and avoidance.