As an attachment-based therapist, I often see the profound impact that early childhood experiences have on an individual's emotional and psychological development. One such experience that has gained considerable attention is the use of the "cry it out" (CIO) method for sleep training infants. While many still use this approach and consider it an effective means to getting a child to sleep independently, it raises significant concerns from an attachment perspective.
Attachment Theory: The Foundation
Attachment theory, developed by John Bowlby and later expanded by Mary Ainsworth, is all about the importance of attachment between a child and their primary caregiver. This attachment is foundational to the child’s emotional regulation, sense of security, sense of self and their overall development—not just psychological or emotional, but physical as well (as noted from babies who are deemed as “Failure to Thrive”).When caregivers consistently respond to a child’s needs—whether for food, comfort, or emotional reassurance—the child learns to trust that their environment is safe and that their needs will be met. This creates the perfect environment to set a child up for success and being well-adapted.
A secure attachment fosters a child’s ability to explore the world with confidence. How? They know they can return to their primary caregiver whenever needed for guidance, support, love, comfort. Conversely, inconsistent or neglectful responses (or abusive) can lead to insecure attachment styles, which can manifest in various ways, including anxiety, difficulty in relationships, and challenges in emotional regulation. You can learn more about attachment styles here.
What is the “Cry It Out” Method?
The "cry it out" method, popularized by Dr. Richard Ferber in the 1980s, involves allowing a baby to cry for a predetermined period before the caregiver responds to those cries. The idea is that by not immediately responding to the crying, the baby will learn to “self-soothe” and learn to sleep on their own.
So does it work? The CIO method will certainly get a baby to sleep through the night, eventually. However, not without consequence. A baby’s primary method of communicating and signaling a need to a caregiver is to cry- so the fundamental concern here is that by ignoring this cry, we are showing our infants that we are not going to meet their needs.
How is the CIO method harmful for our stress and emotional regulation?
Research has shown that when infants are left to cry without comfort, their cortisol levels (a stress hormone) increase significantly. Studies have shown that while babies who were subjected to the CIO method eventually stopped crying, their cortisol levels remained elevated. This indicates that, even though the outward signs of distress subsided, the internal stress response persisted.
Have you ever heard of a baby “shutting down”? It is not uncommon for a baby who is at their peak level of tolerance for distress to suddenly stop crying and appear to be sleeping. While this may look like the child has finally relaxed, it is in fact the child’s brain shutting them down in order to preserve energy (the maximum amount of calories they can) by going into a twilight-like state. As noted above, the stress levels remain peaked during this period.
Prolonged exposure to high cortisol levels in infancy has lasting effects on a child's brain, especially in areas related to emotional regulation. When a baby’s cries are consistently ignored, they may struggle to learn how to manage their emotions effectively, leading to increased anxiety and difficulty soothing themselves in the future. Additionally, we now know that elevated cortisol levels throughout life can lead to an increase in stress-related illnesses as adults, such as heart disease or autoimmune diseases.
How does CIO impact our attachment style?
How do we build a secure attachment style? By having a secure attachment to a primary caregiver that is made of consistent, responsive behavior. When a baby cries and a caregiver responds, they are being shown their needs will be met and in turn this helps to foster a secure attachment style- one where an individual is comfortable communicating their needs, getting those needs met, and hearing/meeting the needs of others.
When a baby’s cries are repeatedly ignored, they may develop an insecure attachment style. Ainsworth's Strange Situation studies demonstrated that children with insecure attachment styles often exhibit heightened anxiety, clinginess, or avoidance behaviors.
This means that these methods used to “make children more independent”, often lead to them acting less independently. If we push our children to independence before they are ready, they are very much likely to push back and be unable to meet those levels of independence due to feelings of heightened stress and anxiety associated with being more independent. These patterns can persist into adulthood, affecting relationships and emotional well-being.
How can this impact relationships long-term?
The impact of insecure attachment starts in childhood and follows us through adulthood. Adults who experienced neglect or inconsistent caregiving in infancy or childhood may struggle with intimacy, trust, and emotional vulnerability in relationships. Not to mention have relationships that are riddled with regular conflict, fear of abandonment, or feeling uncomfortable being close to others. If you’re interested in learning more about your attachment style, you can read more and take our attachment style quiz here.
So what’s the core belief that ingrains with being left to cry with no comfort? Perhaps “I am unimportant” or “I am unworthy”. In general, this can leave an individual with feelings of low self-esteem, passive behavior or “fawning”, or an overall need for validation from others. In other words, in an effort to make our children more independent, we are creating adults that are almost incapable of being independent on an emotional level.
So how do we get our kids to sleep then?
As an attachment-based therapist, and one who has seen the long-term negative impact of unresponsive parenting in my practice, I do not recommend the CIO method under any circumstances. There are just too many risks! In general, I do not believe that sleep training is necessary as often as one might think. Children tend to engage in independent sleep when they are ready, and every child is different. Some kids may need to cosleep for many years, while others may want to sleep independently at a very young age.
Alternatively, here are some approaches you can consider for you can consider doing a responsive version of sleep training which may look something like:
Gradually Pulling Away: Stay in the room with your child until they fall asleep, offering comforting touch, soothing words, gentle rocking. Over time, you can slowly provide less and less comfort while helping the child fall asleep/stay asleep. This meets the child where they are at and does not involve allowing the child to cry.
Co-Sleeping or Room Sharing: Many families, understanding the fundamentals of attachment have chosen to bed or room share. This looks different for every family, but ultimately focuses on two things: everyone getting the best sleep possible and the attachment needs of the child.
Give Options: Many young children still need their parents to help them fall asleep in their own room, but, want to cosleep at some point during the night. This is normal. Consider having an “open-door policy” that allows your child to enter your room if they need to, or, having a sleeping area in your room that they can go to if you do not want to bedshare.
At Root Counseling, we specialize in attachment issues and C-PTSD. If you're interested in learning more and talking with one of our licensed therapists, you can do so here.
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