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Meredith PJ, Strong J. Attachment and chronic illness. Curr Opin Psychol 2019; 25:132-138. [DOI: 10.1016/j.copsyc.2018.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
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Yavuz M, Aluç N, Tasa H, Hamamcıoğlu İ, Bolat N. The relationships between attachment quality, metacognition, and somatization in adolescents: The mediator role of metacognition. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:33-39. [DOI: 10.1111/jcap.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Mesut Yavuz
- Department of PsychologyFrench Lape Hospital, Child and Adolescent Psychiatry, İstanbul Aydin Universityİstanbul Turkey
| | - Nurşah Aluç
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - Hande Tasa
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - İrem Hamamcıoğlu
- Department of Child and Adolescent PsychiatryYalova State HospitalYalova Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent PsychiatryÇanakkale Onsekiz Mart University School of MedicineÇanakkale Turkey
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Adult attachment and health symptoms: The mediating role of emotion regulation difficulties. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0097-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractPrevious research suggests that insecurely attached individuals may, in some cases, have a higher risk of developing negative health symptoms than securely attached ones. We conducted two studies (Study 1, n = 191; Study 2, n = 216) aimed at broadening this finding. We analysed the relationships between two distinct dimensions of insecure attachment (anxious and avoidant) and several classes of negative physical and mental health symptoms. Additionally, we placed emotion regulation difficulties in the role of potential mediator of these relationships. Our results indicated that both anxious and avoidant attachment were positively related to health symptoms on the level of bivariate correlations. However, when both of them were controlled within one mediation model, it was only attachment anxiety, and not attachment avoidance, that proved to be a significant, positive predictor of most health symptom classes: vegetative, agoraphobic, social phobia symptoms and global symptom severity index (which reflects a broad range of negative health symptoms). These relationships were indeed mediated by emotion regulation difficulties. Our results support the notion that (1) different dimensions of insecure attachment can have differential consequences for physical and mental health, and (2) emotion regulation can be one of the mechanisms that explain the links between attachment and health.
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Peilot B, Andréll P, Gottfries J, Sundler AJ, Mannheimer C. Vulnerability and Resilience in Patients with Chronic Pain in Occupational Healthcare: A Pilot Study with a Patient-Centered Approach. PAIN RESEARCH AND TREATMENT 2018; 2018:9451313. [PMID: 30687552 PMCID: PMC6304616 DOI: 10.1155/2018/9451313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/16/2018] [Accepted: 11/07/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach. METHODS This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account. RESULTS A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (p=0.01), pain interference (p=0.001), life control (p=0.01), affective distress (p=0.02), and dysfunction (p=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI. CONCLUSION A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.
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Affiliation(s)
- Birgitta Peilot
- Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Gottfries
- Department of Chemistry and Molecular Biology, Gothenburg University, Sweden
| | - Annelie J. Sundler
- Faculty of Caring Science, Work Life and Social Wellfare, University of Borås, Sweden
| | - Clas Mannheimer
- Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Payne H, Brooks S. Different Strokes for Different Folks: The BodyMind Approach as a Learning Tool for Patients With Medically Unexplained Symptoms to Self-Manage. Front Psychol 2018; 9:2222. [PMID: 30483203 PMCID: PMC6243086 DOI: 10.3389/fpsyg.2018.02222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/26/2018] [Indexed: 12/28/2022] Open
Abstract
Medically unexplained symptoms (MUS) are common and costly in both primary and secondary health care. It is gradually being acknowledged that there needs to be a variety of interventions for patients with MUS to meet the needs of different groups of patients with such chronic long-term symptoms. The proposed intervention described herewith is called The BodyMind Approach (TBMA) and promotes learning for self-management through establishing a dynamic and continuous process of emotional self-regulation. The problem is the mismatch between the patient's mind-set and profile and current interventions. This theoretical article, based on practice-based evidence, takes forward the idea that different approaches (other than cognitive behavioural therapy) are required for people with MUS. The mind-set and characteristics of patients with MUS are reflected upon to shape the rationale and design of this novel approach. Improving services for this population in primary care is crucial to prevent the iterative spiraling downward of frequent general practitioner (GP) visits, hospital appointments, and accident and emergency attendance (A&E), all of which are common for these patients. The approach derives from embodied psychotherapy (authentic movement in dance movement psychotherapy) and adult models of learning for self-management. It has been developed from research and practice-based evidence. In this article the problem of MUS in primary care is introduced and the importance of the reluctance of patients to accept a psychological/mental health referral in the first instance is drawn out. A description of the theoretical underpinnings and philosophy of the proposed alternative to current interventions is then presented related to the design, delivery, facilitation, and educational content of the program. The unique intervention is also described to give the reader a flavor.
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Affiliation(s)
- Helen Payne
- School of Education, University of Hertfordshire, Hatfield, United Kingdom
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Hass-Cohen N, Bokoch R, Clyde Findlay J, Banford Witting A. A four-drawing art therapy trauma and resiliency protocol study. ARTS IN PSYCHOTHERAPY 2018. [DOI: 10.1016/j.aip.2018.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dehghani-Arani F, Besharat MA, Fitton VA, Aghamohammadi A. Efficacy of an Attachment-Based Intervention Model on Health Indices in Children with Chronic Disease and Their Mothers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:900-910. [PMID: 29736633 PMCID: PMC6208895 DOI: 10.1007/s10488-018-0873-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies have shown significant relationship between health conditions and attachment. This study aimed to examine an attachment-based intervention model named mother-child-disease triangle (MCDT) on health indices in children with chronic disease and their mothers. This randomized trial study included 22 volunteer children aged 12-18 years undergoing medical treatment for a chronic disease and their mothers. After evaluation by 28-form General Health Questionnaire (GHQ-28), inventory of parent and peer attachment (IPPA), 28-form Child Health Questionnaire (CHQ-28) and Illness Perception Questionnaire (IPQ), the mother-child dyads were paired on the basis of IPPA scores. These pairs were then randomly assigned to an experimental or control group. The experimental group received ten 90-min sessions of MCDT over a 7-week period. Meanwhile, the control group received ten simple conversational sessions as a dummy intervention. In accordance with this study's pre-test/post-test design, both groups were evaluated once again after completing their respective treatment. Multivariate analysis of covariance (MANCOVA) showed members of the experimental group to have significantly stronger attachment and better physiological and psychosocial health than those in the control group. These findings suggest that attachment-based interventions can be used to improve the effectiveness of treatment among children with chronic disease and their mothers.
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Affiliation(s)
- Fateme Dehghani-Arani
- Department of Psychology, University of Tehran, Dr Kardan Street, Nasr Bridge, Jalal Al-Ahmad Street, Chamran Highway, Tehran, 1445983861 Iran
| | - Mohammad Ali Besharat
- Department of Psychology, University of Tehran, Dr Kardan Street, Nasr Bridge, Jalal Al-Ahmad Street, Chamran Highway, Tehran, 1445983861 Iran
| | - Victoria A. Fitton
- School of Social Work, Michigan State University, 242 Baker Hall, 655 Auditorium Road, East Lansing, MI 48824 USA
| | - Asghar Aghamohammadi
- Pediatric Medical Center Hospital, Tehran University of Medical Science, Dr Gharib Street, Tehran, Iran
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Migraine, qualité de l’attachement et mentalisation : étude de la dynamique psychique à partir du cas de Sylvie. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2017.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pfeifer AC, Penedo JMG, Ehrenthal JC, Neubauer E, Amelung D, Schroeter C, Schiltenwolf M. Impact of attachment behavior on the treatment process of chronic pain patients. J Pain Res 2018; 11:2653-2662. [PMID: 30464583 PMCID: PMC6219424 DOI: 10.2147/jpr.s165487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Insecure attachment patterns are related to the onset and development of chronic pain. However, it is less documented on how short- and long-term effects of pain therapy might differ with the attachment style in interaction with specific pain conditions. We therefore examined how two different groups of chronic pain patients differ in their treatment trajectories and in regard to attachment. Method N=85/76/67 (T1/T2/T3) patients with medically unexplained musculoskeletal pain (UMP group) were compared to n=89/76/56 patients with joint pain from osteoarthritis (OA group), using multilevel modeling. UMP patients received a multimodal pain program, and OA patients received surgery. Pain intensity before (T1) and after (T2) treatment and at a 6 months follow-up (T3) was assessed by using a visual analog scale of pain. Results Pain patients report a significant reduction in pain intensity upon the completion of the treatment compared to T1. Over the next 6 months, the pain intensity has further declined for patients with low attachment anxiety. In contrast, patients with highly anxious attachment report an increase in pain intensity. This main effect of anxious attachment on pain is significant when predicting changes both in acute treatment and during follow-up while controlling for group effect. In addition, there is also an interactive effect of group by avoidant attachment. In the UMP group, high scores in avoidant attachment were associated with the lower reduction in pain severity, while in the OA group, high scores in attachment avoidance were associated with a steeper reduction in pain severity. Conclusion The results indicate that insecurely attached patients with pain symptoms only benefit from a multimodal pain therapy in limited ways in regard to posttreatment trajectories. Maintaining positive results over a period of 6 months is a challenge, compared with securely attached patients. Significance The results of this study suggest the importance of direct and indirect mechanisms of attachment and its relevance for the management of pain experiences. Therefore, to include the individual attachment patterns in the treatment may be a promising way to enhance the treatment prospects.
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Affiliation(s)
- Ann-Christin Pfeifer
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany, .,Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany,
| | | | - Johannes C Ehrenthal
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany,
| | - Eva Neubauer
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany,
| | | | - Corinna Schroeter
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany,
| | - Marcus Schiltenwolf
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany,
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Falgares G, Lo Gioco A, Verrocchio MC, Marchetti D. Anxiety and depression among adult amputees: the role of attachment insecurity, coping strategies and social support. PSYCHOL HEALTH MED 2018; 24:281-293. [DOI: 10.1080/13548506.2018.1529324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Giorgio Falgares
- Department of Psychological, Pedagogical, and Educational Sciences, University of Palermo, Palermo, Italy
| | - Adriana Lo Gioco
- Department of Psychological, Pedagogical, and Educational Sciences, University of Palermo, Palermo, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health, and Territorial Sciences, University of Chieti-Pescara, Palermo, Italy
| | - Daniela Marchetti
- Department of Psychological, Health, and Territorial Sciences, University of Chieti-Pescara, Palermo, Italy
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Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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62
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Krahé C, von Mohr M, Gentsch A, Guy L, Vari C, Nolte T, Fotopoulou A. Sensitivity to CT-optimal, Affective Touch Depends on Adult Attachment Style. Sci Rep 2018; 8:14544. [PMID: 30266979 PMCID: PMC6162325 DOI: 10.1038/s41598-018-32865-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022] Open
Abstract
Affective touch supports affiliative bonds and social cognition. In particular, gentle, stroking touch, which has recently been associated with the C Tactile (CT) system, is typically perceived as pleasant and prosocial. However, it remains unknown whether pre-existing models of social relating influence the perception of CT-optimal touch. In this study (N = 44 adults), we examined how individual differences in attachment styles relate to the perception of CT-optimal touch, as well as to a different modality of interoception, namely heartbeat perception. Using the gold-standard assessment of attachment (Adult Attachment Interview), we found that insecure attachment was associated with reduced pleasantness discrimination between CT-optimal vs. non-CT optimal touch. Acknowledging the different traditions in measuring attachment, we also used a well-validated self-report questionnaire that pertains to explicit representations of current close relationships. Using this measure, we found that higher scores in attachment anxiety (but not attachment avoidance) were associated with reduced pleasantness discrimination between CT-optimal vs. non-CT optimal touch. Attachment patterns (in both measures) were not related to cardiac perception accuracy. These results corroborate and extend previous literature on CT-optimal touch and its relation with affiliative bonds and social cognition. Given that attachment was not related to perceived cardiac accuracy, these findings point to the specificity of the relationship between CT-optimal touch and attachment.
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Affiliation(s)
- Charlotte Krahé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mariana von Mohr
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Antje Gentsch
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lisette Guy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chiara Vari
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Nolte
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Smith MD, Meredith PJ, Chua SY. The experience of persistent pain and quality of life among women following treatment for breast cancer: An attachment perspective. Psychooncology 2018; 27:2442-2449. [PMID: 30067313 DOI: 10.1002/pon.4848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/29/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aims of this study were to investigate associations between attachment and the presence of persistent pain in women following treatment for breast cancer and to investigate the relationship between attachment, pain, and quality of life (QOL) in women with persistent pain. METHODS Women (N = 335) previously diagnosed with primary non-metastatic breast cancer completed an online survey with measures of attachment, pain, QOL, demographics, and medical history. Variables were compared between women with (N = 128) and without (N = 207) persistent pain. For those reporting pain, regression analyses were conducted to investigate relationships between attachment, pain, and QOL. RESULTS Higher attachment anxiety, but not attachment avoidance, was related to the presence of persistent pain. Among women with persistent pain, associations between attachment anxiety and avoidance and greater pain intensity were lost when pain catastrophizing was considered in analysis. Significant associations between attachment and diminished QOL and perceived effectiveness of pain management were identified in multivariate analysis. CONCLUSIONS These findings extend the available literature regarding associations between pain and attachment insecurity. In women with pain after breast cancer treatment, attachment anxiety and avoidance were associated with negative pain and QOL outcomes. Further attention regarding the use of attachment-informed approaches in supporting women following breast cancer treatment is indicated.
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Affiliation(s)
- Michelle D Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Pamela J Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Siong Yin Chua
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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The impact of attachment insecurity on pain and pain behaviors in experimental pain. J Psychosom Res 2018; 111:127-132. [PMID: 29935745 DOI: 10.1016/j.jpsychores.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Pain perception and pain behaviors are distinct phenomena with different functions. Pain behaviors are protective in their functions, which include eliciting empathy or caring behaviors from others. Moreover, pain behaviors are intertwined with interpersonal relationships with significant others, which is why attachment orientations have been suggested as interpersonal schemas moderating the association between pain and pain behaviors. The aim of the current study was to assess the impact of insecure attachment dimensions on pain behaviors in laboratory-induced pain. METHODS This experimental study included a sample of 60 patients with low back pain recruited from a large spine center in a hospital in Region of Southern Denmark. Patients were recorded on video during a cold pressor procedure and asked to rate their level of pain. Prior to the procedure, attachment orientations were assessed by the Revised Adult Attachment Scale. Two assessors independently coded the recorded video material for protective and communicative pain behaviors. RESULTS A positive correlation of moderate size was found between pain intensity and pain communication. As hypothesized, attachment anxiety moderated the association between pain and pain behaviors. A high level of attachment anxiety was associated with at weaker association between pain and pain behaviors. None of the attachment dimensions correlated with pain intensity or pain behaviors. CONCLUSION The results indicate that patients with high levels of attachment anxiety may downplay pain and communication thereof. This finding is of potential clinical importance, since pain communication, among others, serves the function of eliciting caring behavior from healthcare personnel.
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Abstract
Attachment theory was developed by John Bowlby in the 1950s. He defined attachment as a specific neurobiological system that resulted in the infant connecting to the primary caretaker in such a way to create an inner working model of relationships that continues throughout life and affects the future mental health and physical health of the infant. Given the significance of this inner working model, there has been a tremendous amount of research done in animals as well as humans to better understand the neurobiology. In this article the neurobiology of early development will be outlined with respect to the formation of attachment. This article will review what we have begun to understand as the neurobiology of attachment and will describe how the relationship with the primary caretaker affects the infant in a way leading to neurobiological changes that later in life affect emotional responses, reward, and perception difficulties that we recognize as psychiatric illness and medical morbidity.
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Affiliation(s)
- Joanna Chambers
- Associate Professor of Clinical Psychiatry, Indiana University School of Medicine; Chair of Scientific Programs, American Academy of Psychoanalysis and Dynamic Psychiatry
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66
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[Psychosocial risk factors for chronic back pain in the general population and in competitive sports : From theory to clinical screening-a review from the MiSpEx network]. Schmerz 2018; 32:259-273. [PMID: 29946960 DOI: 10.1007/s00482-018-0307-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. METHODS The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months. RESULTS We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). CONCLUSION Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
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Sahan HE, Yildirim EA, Soylu A, Tabakci AS, Cakmak S, Erkoc SN. Comparison of functional dyspepsia with organic dyspepsia in terms of attachment patterns. Compr Psychiatry 2018; 83:12-18. [PMID: 29501961 DOI: 10.1016/j.comppsych.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/28/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022] Open
Abstract
AIM Functional dyspepsia, originates from gastroduodenal region, is described as resistant and recurring dyspeptic symptoms with unknown etiology. Although there is some evidence in support of a relationship between functional dyspepsia and psychopathology, attachment patterns of functional dyspepsia patients have not been studied yet. In our study, we aimed to compare attachment patterns of functional dyspepsia patients with organic dyspepsia patients and healthy volunteers. METHOD 43 patients diagnosed with functional dyspepsia, 38 patients with organic dyspepsia and 42 healthy volunteers matched in terms of age, sex and education were included in the study. All participants were evaluated using a socio-demographic and clinical data questionnaire, the State and Trait Anxiety Inventory, the Experiences in Close Relationships Questionnaire and the Adult Attachment Scale. RESULTS There was no difference in sociodemographic features among the three groups. Functional dyspepsia group exhibited significantly higher Trait Anxiety scores compared to organic dyspepsia and control groups. Control group showed significantly higher secure attachment styles compared to functional dyspepsia and organic dyspepsia groups, there was no difference between groups in non-secure attachment styles according to triple attachment model. Dimensionally, functional dyspepsia group showed more avoidant attachment patterns than organic dyspepsia groups and organic dyspepsia group showed more avoidant attachment patterns than control group. CONCLUSION According to our findings, Functional dyspepsia patients are more anxious than organic dyspepsia patients and healthy volunteers. Non-secure attachment patterns were seen generally in all dyspeptic patients while avoidant attachment patterns are more prominent in functional dyspepsia patients.
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Affiliation(s)
- Halide E Sahan
- Van Training And Research Hospital Department Of Psychiatry, 65300 Edremit, Van, Turkey
| | - Ejder A Yildirim
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic Bakirkoy, 34147 Istanbul, Turkey.
| | - Aliye Soylu
- Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Gastroenterology, Tevfik Sağlam Cad. No: 11, Zuhuratbaba Mah., 34147 Istanbul, Turkey
| | - Abdulkadir S Tabakci
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic Bakirkoy, 34147 Istanbul, Turkey
| | - Serdal Cakmak
- Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Gastroenterology, Tevfik Sağlam Cad. No: 11, Zuhuratbaba Mah., 34147 Istanbul, Turkey
| | - Sahap N Erkoc
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Bakirkoy, 34147, Istanbul, Turkey
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Monin JK, Xu A, Mitchell HR, Buurman F, Riffin C. Recalling support provision decreases distress and anger in response to partner suffering. Aging Ment Health 2018; 22:587-594. [PMID: 28165759 PMCID: PMC5786490 DOI: 10.1080/13607863.2017.1286452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Thinking about a loved one's suffering can be emotionally stressful and have negative effects on a person's psychological and physical health over time. This study examined the hypotheses that when thinking about a partner's suffering (1) recalling past support provision to the suffering partner can decrease distress and anger and increase compassion, and (2) attachment orientation moderates these effects. METHOD Seventy-seven older adult spouses of individuals with chronic pain were video-recorded while they disclosed: (1) an instance of partner suffering and (2) an instance of partner suffering plus their support provision. Compassion for the partner and their own distress and anger were self-reported immediately after each account. Accounts were coded for statements of support. Attachment was assessed with the Experiences with Close Relationships measure. RESULTS As hypothesized, distress and anger were lower in the 'suffering with support' condition versus the 'suffering only' condition. There was no evidence that attachment orientation significantly moderated the effect of support recollection on emotional responses; however, more avoidant individuals reported less compassion and anger and used more words reflecting anger across conditions. More anxiously attached individuals reported greater compassion across conditions. CONCLUSION When thinking about a partner's suffering, there are attachment-related differences in emotional reactions. Yet, regardless of these differences, it may be adaptive for spouses to think about their role in providing support to their partner to decrease their own negative emotions.
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Affiliation(s)
- Joan K. Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Annie Xu
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Hannah-Rose Mitchell
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Catherine Riffin
- Geriatrics Department, Yale School of Medicine, New Haven, CT, USA
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Habibi M, Hosseini F, Darharaj M, Moghadamzadeh A, Radfar F, Ghaffari Y. Attachment Style, Perceived Loneliness, and Psychological Well-Being in Smoking and Non-Smoking University Students. THE JOURNAL OF PSYCHOLOGY 2018; 152:226-236. [DOI: 10.1080/00223980.2018.1446894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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70
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Bolat N, Eliacik K, Yavuz M, Kanik A, Mertek H, Guven B, Dogrusoz B, Bakiler AR. Adolescent mental health, attachment characteristics, and unexplained chest pain: a case–control study. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1454374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Nurullah Bolat
- Department of Child and Adolescent Psychiatry, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Kayi Eliacik
- Division of Adolescent Medicine, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mesut Yavuz
- Department of Psychology, İstanbul Aydin University, İstanbul, Turkey
- Child and Adolescent Psychiatry, French Lape Hospital, İstanbul, Turkey
| | - Ali Kanik
- Department of Paediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hilal Mertek
- Department of Paediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Baris Guven
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Buket Dogrusoz
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Rahmi Bakiler
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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Tarantino S, Papetti L, De Ranieri C, Boldrini F, Rocco AM, D’Ambrosio M, Valeriano V, Battan B, Paniccia MF, Vigevano F, Gentile S, Valeriani M. Maternal Alexithymia and Attachment Style: Which Relationship with Their Children's Headache Features and Psychological Profile? Front Neurol 2018; 8:751. [PMID: 29403425 PMCID: PMC5786507 DOI: 10.3389/fneur.2017.00751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/28/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION A growing body of literature has shown an association between somatic symptoms and insecure "attachment style." In a recent study, we found a relationship between migraine severity, ambivalent attachment style, and psychological symptoms in children/adolescents. There is evidence that caregivers' attachment styles and their way of management/expression of emotions can influence children's psychological profile and pain expression. To date, data dealing with headache are scarce. Our aim was to study the role of maternal alexithymia and attachment style on their children's migraine severity, attachment style, and psychological profile. MATERIALS AND METHODS We enrolled 84 consecutive patients suffering from migraine without aura (female: 45, male: 39; mean age 11.8 ± 2.4 years). According to headache frequency, children/adolescents were divided into two groups: (1) high frequency (patients reporting from weekly to daily attacks), and (2) low frequency (patients having ≤3 episodes per month). We divided headache attacks intensity into two groups (mild and severe pain). SAFA "Anxiety," "Depression," and "Somatization" scales were used to explore children's psychological profile. To evaluate attachment style, the semi-projective test SAT for patients and ASQ Questionnaire for mothers were employed. Maternal alexithymia traits were assessed by TAS-20. RESULTS We found a significant higher score in maternal alexithymia levels in children classified as "ambivalent," compared to those classified as "avoiding" (Total scale: p = 0.011). A positive correlation has been identified between mother's TAS-20 Total score and the children's SAFA-A Total score (p = 0.026). In particular, positive correlations were found between maternal alexithymia and children's "Separation anxiety" (p = 0.009) and "School anxiety" (p = 0.015) subscales. Maternal "Externally-oriented thinking" subscale correlated with children's school anxiety (p = 0.050). Moreover, we found a correlation between TAS-20 Total score and SAFA-D "Feeling of guilt" subscale (p = 0.014). Our data showed no relationship between TAS-20 and ASQ questionnaires and children's migraine intensity and frequency. CONCLUSION Maternal alexithymia and attachment style have no impact on children's migraine severity. However, our results suggest that, although maternal alexithymic traits have no causative roles on children's migraine severity, they show a relationship with patients' attachment style and psychological symptoms, which in turn may impact on migraine severity.
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Affiliation(s)
- Samuela Tarantino
- Division of Neurology, Headache Center, Bambino Gesù Ospedale Pediatrico (IRCCS), Rome, Italy
| | - Laura Papetti
- Division of Neurology, Headache Center, Bambino Gesù Ospedale Pediatrico (IRCCS), Rome, Italy
| | - Cristiana De Ranieri
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Francesca Boldrini
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Angela Maria Rocco
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Monica D’Ambrosio
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Valeria Valeriano
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Barbara Battan
- Division of Neurology, Headache Center, Bambino Gesù Ospedale Pediatrico (IRCCS), Rome, Italy
| | | | - Federico Vigevano
- Division of Neurology, Headache Center, Bambino Gesù Ospedale Pediatrico (IRCCS), Rome, Italy
| | - Simonetta Gentile
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Headache Center, Bambino Gesù Ospedale Pediatrico (IRCCS), Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Adshead G, Guthrie E. The role of attachment in medically unexplained symptoms and long-term illness. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.114.013045] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryIn this article, we explore the role of attachment in the development of medically unexplained symptoms (MUS) and response to physical illness. We review the evidence that attachment insecurity is common in people with different forms of MUS and certain long-term physical conditions. We discuss a possible developmental model for understanding how MUS develop. We conclude with discussion of potential therapies and implications for services.
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73
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Shahar G, Lerman SF, Topaz M, Brill S, Shalev H, Rudich Z. Depressive personality vulnerability in chronic physical pain: Centrality of sociotropy. J Pers 2017; 86:907-918. [PMID: 29222926 DOI: 10.1111/jopy.12365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/09/2017] [Accepted: 12/02/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Chronic physical pain is one of modern medicine's principal challenges. Recently, there has been a keen research interest in the role of depressive personality vulnerability (DPV) in the course of chronic pain. This is the first attempt to examine the role of three leading DPV dimensions-sociotropy, autonomy, and self-criticism-in chronic pain. METHOD Chronic pain patients (N = 428) were assessed four times as to their pain, disability, anxious depression, and pain-based catastrophizing. At Time 1, sociotropy, autonomy, and self-criticism were also assessed. The effects of sociotropy, autonomy, and self-criticism on pain, disability, anxious depression, and pain-based catastrophizing were examined using structural equation modeling analyses. RESULTS All DPV dimensions uniquely predicted Time 1, but not Time 2, anxious depression. Sociotropy predicted Time 1 pain and catastrophizing over and above anxious depression, as well as an increase in catastrophizing over time. Autonomy predicted a decrease in catastrophizing and disability, and Time 1 anxious depression predicted an increase in self-criticism. CONCLUSIONS Sociotropy appears to be a unique dimension of DPV in chronic pain.
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Nacak Y, Morawa E, Tuffner D, Erim Y. Insecure attachment style and cumulative traumatic life events in patients with somatoform pain disorder: A cross-sectional study. J Psychosom Res 2017; 103:77-82. [PMID: 29167050 DOI: 10.1016/j.jpsychores.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Current models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls. METHODS We compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors. RESULTS Insecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32-94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84-6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06-3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance. CONCLUSIONS The high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD.
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Affiliation(s)
- Yeliz Nacak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniela Tuffner
- Multidisciplinary Pain Center, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model. Pain 2017; 157:2628-2639. [PMID: 27380502 DOI: 10.1097/j.pain.0000000000000637] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
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76
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Peñacoba C, Perez-Calvo S, Blanco S, Sanroman L. Attachment styles, pain intensity and emotional variables in women with fibromyalgia. Scand J Caring Sci 2017; 32:535-544. [PMID: 28885733 DOI: 10.1111/scs.12477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/05/2017] [Indexed: 02/06/2023]
Abstract
This study aims to explore the relations between attachment styles and pain intensity and certain emotional variables (anxiety, depression and alexithymia) in a sample of fibromyalgia patients, in comparison with healthy women. Data were collected from 146 women with fibromyalgia and 122 healthy women. The variables studied were attachment style, pain intensity, anxiety, depression and alexithymia dimensions. Patients with fibromyalgia showed lower percentages of secure attachment style (69.9% vs. 86%) whilst showing higher avoidant attachment (19.8% vs. 7.4%), as well as increased numbers of anxious-ambivalent attachment (10.3% vs. 6.6%) than healthy women (X2 = 9.915, p = .007). Also, fibromyalgia patients showed significantly higher scores in two of the insecure attachment factors (p < .000; p = .020) and lower scores on the secure attachment factor (p = .008) in comparison with healthy women. Higher scores of alexithymia were found in women showing anxious-ambivalent and avoidant attachment styles in comparison with those showing a secure attachment style, regardless of the group they belonged to. In fibromyalgia patients, higher anxiety (p = .005) was found among the women with anxious-ambivalent attachment styles (Mean = 15.15; SD = 1.15) in comparison with those with secure attachment style (Mean = 11.18; SD = .45). No relation was found between attachment style and pain intensity. Avoidant attachment seems to carry out a contradictory role and warrants further research. The results found seem to highlight the need for the Attachment-Diathesis Model of Chronic Pain to include attachment styles as a predictor of the emotional experience of pain in fibromyalgia patients.
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Affiliation(s)
- Cecilia Peñacoba
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Soledad Perez-Calvo
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Sheila Blanco
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Lucía Sanroman
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Rey Juan Carlos University, Madrid, Spain
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Rosenbloom BN, Rabbitts JA, Palermo TM. A developmental perspective on the impact of chronic pain in late adolescence and early adulthood: implications for assessment and intervention. Pain 2017; 158:1629-1632. [PMID: 28267063 PMCID: PMC5561523 DOI: 10.1097/j.pain.0000000000000888] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brittany N. Rosenbloom
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Jennifer A. Rabbitts
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Naylor B, Boag S, Gustin SM. New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scand J Pain 2017; 17:58-67. [PMID: 28850375 DOI: 10.1016/j.sjpain.2017.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Personality traits may influence development and adjustment to ongoing pain. Over the past 120 years, there has been considerable research into the relationship between pain and personality. This paper presents new evidence for common personality traits found amongst chronic pain sufferers. In particular, it evaluates evidence for Cloninger's biopsychosocial model of personality in distinguishing typical personality features of chronic pain sufferers. It evaluates this evidence in the context of the past 120 years of research including psychodynamic formulations, MMPI studies, personality disorder investigations, and the influence of neuroticism on chronic pain. METHODS A literature search was conducted using PubMed, Medline, PsycINFO, SCOPUS and Cochrane library. Search terms included chronic pain, pain, personality, neuroticism, harm avoidance, self-directedness, attachment, Temperament and Character Inventory (TCI-R), MMPI, MMPI-2, NEO-PI, EPI, Millon Clinical Multiaxial Inventory, Millon Behavioral Health Inventory, Millon Behavioral Medicine Diagnostic, the Personality Assessment Inventory, the Locus of Control Construct and different combinations of these terms. CONCLUSIONS Recent descriptive studies using Cloninger's Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic, sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of 'a pain personality'. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support 'a pain personality' and may be confounded by somatic items in the instrument. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples. CLINICAL IMPLICATIONS Because harm avoidance reflects a tendency to developed conditioned fear responses, we suggest that higher harm avoidance may create more vulnerability to developing a fear-avoidance response to chronic pain. Furthermore, lower self-directedness may contribute to keeping a sufferer within this vicious cycle of fear, avoidance and suffering. Moreover, we suggest that harm avoidance and self-directedness are broader and more complex constructs than current clinical targets of CBT such as fear-avoidance and self-efficacy. Thus, assessing such personality traits may help to address the complexity of chronic pain presentations. For example, it may help to identify and treat sufferers more resistant to treatment, more prone to comorbidity and more vulnerable to entering the vicious cycle of chronic pain, suffering and disability.
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Affiliation(s)
- Brooke Naylor
- Neuroscience Research Australia, Australia; School of Psychology, Macquarie University, Australia
| | - Simon Boag
- School of Psychology, Macquarie University, Australia
| | - Sylvia Maria Gustin
- Neuroscience Research Australia, Australia; School of Psychology, University of New South Wales, Australia.
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Andersen CM, Pedersen AF, Carlsen AH, Olesen F, Vedsted P. Data quality and factor analysis of the Danish version of the Relationship Scale Questionnaire. PLoS One 2017; 12:e0176810. [PMID: 28472074 PMCID: PMC5417595 DOI: 10.1371/journal.pone.0176810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/18/2017] [Indexed: 01/18/2023] Open
Abstract
Background The Relationship Scale Questionnaire (RSQ) is a widely-used measure of adult attachment, but whether the results obtained by the RSQ fit the attachment construct has only been examined to a limited extent. Objective The objectives of this study were to investigate the psychometric properties of the Danish translation of the RSQ and to test whether the results are consistent with the hypothesized model of attachment. Methods The study included two samples: 602 general practitioners and 611 cancer patients. The two samples were analyzed separately. Data quality was assessed by mean, median and missing values for each item, floor and ceiling effects, average inter-item correlations and Cronbach’s α for each subscale. Test-retest was assessed by intra-class correlations among 76 general practitioners. A confirmatory factor analysis was conducted to establish evidence of the four proposed subscales. Due to an inadequate fit of the model, data was randomly split into two equally sized subsamples and an exploratory factor analysis was conducted for all 30 items in the first subsample comprised of 286 cancer patients and 285 general practitioners. The EFA yielded a three-factor structure which was validated through a confirmatory factor analyses in a second subsample comprised of 278 cancer patients and 289 general practitioners. Results The data quality of the RSQ was generally good, except low internal consistency and low to moderate test-retest reliability. The four subscales of the RSQ were not confirmed by the confirmatory factor analysis. An exploratory factor analysis suggested a three-factor solution for both general practitioners and patients, which accounted for 61.1% of the variance among general practitioners and 62.5% among patients. The new three-factor solution was verified in a confirmatory factor analyses. Conclusion The proposed four-factor model of the RSQ could not be confirmed in this study. Similar challenges have been found by other studies validating the RSQ. An alternative three-factor structure was found for the RSQ.
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Affiliation(s)
- Christina Maar Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Anette Fischer Pedersen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anders Helles Carlsen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Frede Olesen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Romeo A, Tesio V, Castelnuovo G, Castelli L. Attachment Style and Chronic Pain: Toward an Interpersonal Model of Pain. Front Psychol 2017; 8:284. [PMID: 28286493 PMCID: PMC5323382 DOI: 10.3389/fpsyg.2017.00284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic pain (CP) is a burdensome symptom. Different psychological models have been proposed to explain the role of psychological and social factors in developing and maintaining CP. Attachment, for example, is a psychological construct of possible relevance in CP. The first studies on the role of attachment in CP did not investigate the partner’s psychological factors, thus neglecting the influence of the latter. The main aim of this mini-review was to examine the more recent literature investigating the relationship between CP and attachment style. In particular, whether or not more recent studies assessed the psychological variables of a patient’s partner. The articles were selected from the Medline/PubMed database using the search terms “attachment” AND “pain”; “CP” AND “attachment style,” which led to nine papers being identified. The results showed that, even though the key point was still the hypothesis that an insecure attachment style is associated with CP, in recent years researchers have focused on the possible psychological aspects mediating between attachment style and CP. In particular, worrying, coping strategies, catastrophizing and perceived spouse responses to pain behavior were taken into account. Only one study considered the role of the reciprocal influence of attachment style of both patient and partner, underlining the role of real significant others’ responses to pain behaviors. In conclusion, the results of the present mini-review highlight how in recent years researchers have moved toward investigating those psychological aspects that could mediate the relationship between attachment and CP, while only partially evaluating the interpersonal perspective.
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Affiliation(s)
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, IRCCS Istituto Auxologico ItalianoVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
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Slatcher RB, Selcuk E. A Social Psychological Perspective on the Links between Close Relationships and Health. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2017; 26:16-21. [PMID: 28367003 DOI: 10.1177/0963721416667444] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The association between the quality of people's close relationships and their physical health is well-established. But from a psychological perspective, how do close relationships impact physical health? This article summarizes recent work seeking to identify the relationship processes, psychological mediators and moderators of the links between close relationships and health, with an emphasis on studies of married and cohabitating couples. We begin with a brief review of a recent meta-analysis of the links between marital quality and health. We then describe our strength and strain model of marriage and health, homing in on one process-partner responsiveness-and one moderator-adult attachment style-to illustrate ways in which basic relationship science can inform our understanding of how relationships impact physical health. We conclude with a brief discussion of promising directions in the study of close relationships and health.
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Johannsen M, O’Toole M, O’Connor M, Jensen A, Zachariae R. Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - explorative analyses from a randomized controlled trial. Acta Oncol 2017; 56:321-328. [PMID: 28094662 DOI: 10.1080/0284186x.2016.1268713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mindfulness-based intervention has been found efficacious in reducing persistent pain in women treated for breast cancer. Little, however, is known about possible moderators of the effect. We explored clinical and psychological moderators of the effect on pain intensity previously found in a randomized controlled trial of mindfulness-based cognitive therapy (MBCT) with women treated for breast cancer with persistent pain. MATERIAL AND METHODS A total of 129 women treated for breast cancer reporting persistent pain were randomized to MBCT or a wait-list control. The primary outcome of pain intensity (11-point numeric rating scale) was measured at baseline, post-intervention, three, and six months follow-up. Proposed clinical moderators included age, axillary lymph node dissection (ALND), radiotherapy, and endocrine treatment. Psychological moderators included psychological distress [the Hospital Anxiety and Depression Scale (HADS)], the adult attachment dimensions anxiety and avoidance [the Experiences in Close Relationships Short Form (the ECR-SF)], and alexithymia [the Toronto Alexithymia Scale (TAS-20)]. Multi-level models were used to test moderation effects over time, i.e. time × group × moderator. RESULTS Only attachment avoidance (p = 0.03, d = 0.36) emerged as a statistically significant moderator. Higher levels of attachment avoidance predicted a larger effect of MBCT in reducing pain intensity compared with lower levels attachment avoidance. None of the remaining psychological or clinical moderators reached statistical significance. However, based on the effect size, radiotherapy (p = 0.075, d = 0.49) was indicated as a possible clinical moderator of the effect, with radiotherapy being associated with a smaller effect of MBCT on pain intensity over time compared with no radiotherapy. CONCLUSION Attachment avoidance, and potentially radiotherapy, may be clinically relevant factors for identifying the patients who may benefit most from MBCT as a pain intervention. Due to the exploratory nature of the analyses, the results should be considered preliminary.
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Affiliation(s)
- M. Johannsen
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - M.S. O’Toole
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - M. O’Connor
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - A.B. Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R. Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Aarhus, Denmark
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Tarantino S, De Ranieri C, Dionisi C, Gagliardi V, Paniccia MF, Capuano A, Frusciante R, Balestri M, Vigevano F, Gentile S, Valeriani M. Role of the Attachment Style in Determining the Association Between Headache Features and Psychological Symptoms in Migraine Children and Adolescents. An Analytical Observational Case-Control Study. Headache 2017; 57:266-275. [PMID: 28058729 DOI: 10.1111/head.13007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/19/2016] [Accepted: 10/06/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aimed to study the role of attachment style on headache severity and psychological symptoms in migraineurs children/adolescents. Moreover, we investigated the association between attachment style, migraine severity, and psychological symptoms. BACKGROUND Attachment theory suggests that early interpersonal relationships may be important determinants of psychopathology and pain management. In particular, individuals with insecure attachment styles have been shown to experience more pain than people with secure attachment style. Few studies focused on headache and data on attachment style in pediatric headache are scarce. METHODS We studied 90 migraineurs (mean age 12.2 ± 2.6 years; female: 54, male: 36). Patients were divided in two groups according to headache attack frequency: (1) high frequency (HF) patients, having from weekly to daily episodes and (2) low frequency (LF) patients, showing ≤3 episodes per month. According to headache attack intensity, patients were classified in two groups: (1) mild pain (MP), allowing the patient to continue his/her daily activities and (2) severe pain (SP), leading to interruption of patient activities or forcing the child to go to bed. The psychological screening was assessed by SAFA Anxiety, Depression, and Somatization questionnaires. Attachment style was measured by the semi-projective test Separation Anxiety Test. Patients were divided into "secure," "avoidant," "ambivalent," and "disorganized/confused" attachment patterns. RESULTS We found a significant relationship between the attachment style and migraine features. The ambivalent attachment was the most common style among patients reporting high attack frequency (51%) and severe pain intensity (50%). Anxiety (SAFA-A Tot: F = 23.3, P < .001), depression (SAFA-D Tot: F = 11.8, P < .001), and somatization (SAFA-S Tot: F = 10.1, P < .001) were higher in patients with ambivalent attachment style. Moreover, our results showed an association between high attack frequency and high anxiety levels, in children with ambivalent attachment style (F = 6.7, P < .002). CONCLUSIONS Ambivalent attachment style may be a common vulnerability factor that impacts on pain severity, anxiety, depression, and somatization symptoms in young migraineurs. In particular, the present study provides the first evidence of the role of insecure attachment on the relationship between pain severity and psychological symptoms in migraine children.
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Affiliation(s)
- Samuela Tarantino
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Cristiana De Ranieri
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Cecilia Dionisi
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Valentina Gagliardi
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Alessandro Capuano
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Roberto Frusciante
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Martina Balestri
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Federico Vigevano
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Simonetta Gentile
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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84
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Donnelly TJ, Jaaniste T. Attachment and Chronic Pain in Children and Adolescents. CHILDREN-BASEL 2016; 3:children3040021. [PMID: 27792141 PMCID: PMC5184796 DOI: 10.3390/children3040021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022]
Abstract
Although attachment theory is not new, its theoretical implications for the pediatric chronic pain context have not been thoroughly considered, and the empirical implications and potential clinical applications are worth exploring. The attachment framework broadly focuses on interactions between a child’s developing self-regulatory systems and their caregiver’s responses. These interactions are believed to create a template for how individuals will relate to others in the future, and may help account for normative and pathological patterns of emotions and behavior throughout life. This review outlines relevant aspects of the attachment framework to the pediatric chronic pain context. The theoretical and empirical literature is reviewed regarding the potential role of attachment-based constructs such as vulnerability and maintaining factors of pediatric chronic pain. The nature and targets of attachment-based pediatric interventions are considered, with particular focus on relevance for the pediatric chronic pain context. The potential role of attachment style in the transition from acute to chronic pain is considered, with further research directions outlined.
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Affiliation(s)
- Theresa J Donnelly
- Department of Pain & Palliative Care, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
| | - Tiina Jaaniste
- Department of Pain & Palliative Care, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW 2052, Australia.
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85
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Sirois FM, Millings A, Hirsch JK. Insecure attachment orientation and well-being in emerging adults: The roles of perceived social support and fatigue. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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86
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Pfeifer AC, Ehrenthal JC, Neubauer E, Gerigk C, Schiltenwolf M. [Impact of attachment behavior on chronic and somatoform pain]. Schmerz 2016; 30:444-456. [PMID: 27681778 DOI: 10.1007/s00482-016-0156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.
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Affiliation(s)
- A-C Pfeifer
- Tagesklinik für Schmerztherapie, Konservative Orthopädie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| | - J C Ehrenthal
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E Neubauer
- Tagesklinik für Schmerztherapie, Konservative Orthopädie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - C Gerigk
- Tagesklinik für Schmerztherapie, Konservative Orthopädie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - M Schiltenwolf
- Tagesklinik für Schmerztherapie, Konservative Orthopädie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
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87
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The moderation effect of mindfulness on the relationship between adult attachment and wellbeing. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.080] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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88
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Egle UT, Egloff N, von Känel R. Stressinduzierte Hyperalgesie (SIH) als Folge von emotionaler Deprivation und psychischer Traumatisierung in der Kindheit. Schmerz 2016; 30:526-536. [DOI: 10.1007/s00482-016-0107-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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89
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Personal and Contextual Factors Affecting the Functional Ability of Children and Adolescents with Chronic Pain: A Systematic Review. J Dev Behav Pediatr 2016; 37:327-42. [PMID: 27096569 DOI: 10.1097/dbp.0000000000000300] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic pain can significantly impair functioning of children and adolescents; however, evidence suggests that current psychological approaches have limited effect on functioning post treatment. The objective of this review is to present the current evidence for the personal and contextual factors that affect functioning and disability of children and adolescents with chronic pain, to support the evolution of new treatments. METHOD Key word searches were conducted in PsycINFO, MEDLINE via Ovid, CINAHL, and PubMed from 1995 to October 2014. Studies were included if they (1) were written in English, (2) included children or adolescents with chronic pain (>3 mo), (3) had at least 1 personal attribute or 1 contextual factor, (4) had 1 measure of functional ability, and (5) had reported correlations between personal or contextual factors and functional measure. RESULTS Thirty-three studies were identified which met all inclusion criteria. Several personal factors (depression, anxiety, pain intensity, and catastrophizing) and contextual/environmental factors (parenting characteristics) were consistently associated with higher levels of disability, whereas evidence for other factors was less consistent. Complex interactions between personal and contextual factors were reported. Child physical/cognitive capacities, teacher/peer behaviors, and broader cultural and environmental social systems, received little attention. CONCLUSION Several parent and child factors were consistently linked with functional disability, whereas better family functioning was associated with functional ability. Applying an ecological framework, assisted identification of areas for further research, and provides direction for treatments that may be more effective in optimizing long-term functional outcomes, extending current psychological approaches.
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90
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Lagerløv P, Rosvold EO, Holager T, Helseth S. How adolescents experience and cope with pain in daily life: a qualitative study on ways to cope and the use of over-the-counter analgesics. BMJ Open 2016; 6:e010184. [PMID: 26932141 PMCID: PMC4785298 DOI: 10.1136/bmjopen-2015-010184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe how different adolescents experience and manage pain in their daily life, with a focus on their use of over-the-counter analgesics. More specifically, the aim was to explore different patterns among the adolescents in pain descriptions, in the management of pain, in relationships with others, and in their daily life. DESIGN Qualitative semistructured interviews on experiences with pain, pain management and involvement of family and friends during pain. Pain and stress management strategies and attachment theory will be in focus for interpretations. PARTICIPANTS AND SETTING 25 participants aged 15-16-years from six different junior high schools, both genders, with and without immigrant background were interviewed at their local schools in Norway. RESULTS We identified 4 groups of adolescents with similarities in attitudes and management strategies to pain: 'pain is manageable', 'pain is communicable', 'pain is inevitable' and 'pain is all over'. The participants within each group differed in how they engaged their parents in pain; how they perceived, communicated and managed pain; and how they involved emotions and used over-the-counter analgesics. CONCLUSIONS The adolescents' different involvement with the family during pain related to their pain perception and management. Knowledge of the different ways of approaching pain is important when supporting adolescents and may be a subject for further research on the use of over-the-counter analgesics in the family.
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Affiliation(s)
- Per Lagerløv
- The Medical Faculty, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elin Olaug Rosvold
- The Medical Faculty, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tanja Holager
- Regional Medicines Information and Pharmacovigilance Centre, The University Hospital Oslo, Oslo, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences, Department of Nursing, Oslo, Norway
- Akershus University College of Applied Sciences, Oslo, Norway
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91
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Pfeifer AC, Amelung D, Gerigk C, Schroeter C, Ehrenthal J, Neubauer E, Schiltenwolf M. Study protocol - efficacy of an attachment-based working alliance in the multimodal pain treatment. BMC Psychol 2016; 4:10. [PMID: 26883622 PMCID: PMC4756452 DOI: 10.1186/s40359-016-0114-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 02/08/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The concept of attachment is relevant for the onset and development of chronic pain. Insecure attachment styles negatively affect therapeutic outcome. Insecurely attached patients seem to be less able to sustain positive effects of a multimodal treatment program. However, it has never been tested before if an attachment-oriented approach can improve treatment results of insecurely attached patients in a multimodal outpatient setting. To test this assumption, we compare the short- and long-term outcomes for pain patients who will receive multidisciplinary, attachment-oriented treatment with the outcomes for patients in a control group, who will receive the multidisciplinary state-of-the-art treatment. METHODS Two patient groups (baseline, attachment intervention) are assessed before treatment, after treatment, and at a 6 month follow-up. The study is conducted in a block design: After data collection of the first block (controls) and before as well as during data collection for the second block (treatment group), the health care personnel of the outpatient pain clinic receives training on attachment theory and its use in the therapeutic context. Pain intensity as measured with visual analogue scales and physical functioning will serve as the primary outcome measures. DISCUSSION The design of our study allows for a continuous exchange of experienced team members, which may help bring about concrete attachment related guidelines for the enhancement of therapeutic outcome. This would be the first attempt at an attachment-oriented improvement of multimodal pain programs. CONCLUSION An attachment-based approach may be a promising way to enhance long-term treatment outcomes for insecurely attached pain patients. TRIAL REGISTRATION DRKS00008715 (registered on the 3(rd) of June 2015).
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Affiliation(s)
- Ann-Christin Pfeifer
- />Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118 Heidelberg, Germany
| | - Dorothee Amelung
- />University of Heidelberg, Grabengasse 1, 69117 Heidelberg, Germany
| | - Carina Gerigk
- />Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118 Heidelberg, Germany
| | - Corinna Schroeter
- />Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118 Heidelberg, Germany
| | - Johannes Ehrenthal
- />Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstr 2, 69115 Heidelberg, Germany
| | - Eva Neubauer
- />Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118 Heidelberg, Germany
| | - Marcus Schiltenwolf
- />Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118 Heidelberg, Germany
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Andersen TE, Lahav Y, Defrin R, Mikulincer M, Solomon Z. Attachment security and pain--The disrupting effect of captivity and PTSS. J Psychosom Res 2015; 79:471-6. [PMID: 26652590 DOI: 10.1016/j.jpsychores.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/01/2015] [Accepted: 10/24/2015] [Indexed: 11/28/2022]
Abstract
The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We found that ex-POWs showed higher levels of clinical pain and attachment insecurities compared to controls. Moreover, attachment avoidance and soothing effect of attachment (SEA) were both associated with lower levels of clinical pain. Most importantly, PTSS moderated the associations between attachment and pain, as well as the mediation role of attachment between captivity and pain. The results imply that although attachment can be an important resource for coping with pain, it can be severely disrupted by PTSS among trauma survivors.
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Affiliation(s)
| | - Yael Lahav
- Bob Shapell School of Social Work, Tel Aviv University, Israel, Postdoc, University of Southern Denmark, Denmark
| | - Ruth Defrin
- School of Health Professions, Tel Aviv University, Israel
| | - Mario Mikulincer
- New School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Israel, Postdoc, University of Southern Denmark, Denmark
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94
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Quinn K, Spiby H, Slade P. A longitudinal study exploring the role of adult attachment in relation to perceptions of pain in labour, childbirth memory and acute traumatic stress responses. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1030733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Sirous Mobini
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, UK
- Regional Neurological Rehabilitation Unit, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK
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Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosom Med 2015; 77:333-41. [PMID: 25849129 DOI: 10.1097/psy.0000000000000158] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The current study sets out to examine the longitudinal relationship between pain, pain-related disability, and symptoms of depression and anxiety. The latter symptoms are highly prevalent in chronic pain and seriously impede functioning and quality of life. Nevertheless, the direction of the relationship involving these variables among individuals with chronic pain is still unclear. METHODS Four-hundred twenty-eight individuals with chronic pain (238 women, mean age 54.84 years, mean pain duration 85.21 months) treated at two pain clinics completed questionnaires regarding their pain (Short-Form McGill Pain Questionnaire), depression (Center for Epidemiological Studies-Depression Scale), state anxiety (State-Trait Anxiety Inventory), and pain-related disability (Pain Disability Index) at four time points, with an average of 5 months between measurements. Cross-lagged, structural equation modeling analyses were performed, enabling the examination of longitudinal associations between the variables. RESULTS Significant symptoms of both depression and anxiety were reported by more than half of the sample on all waves. A latent depression/anxiety variable longitudinally predicted pain (β = .27, p < .001) and pain-related disability (β = .38, p < .001). However, neither pain (β = .10, p = .126) nor pain-related disability (β = -.01, p = .790) predicted depression/anxiety. CONCLUSIONS Among adult patients with chronic pain treated at specialty pain clinics, high levels of depression and anxiety may worsen pain and pain-related disability.
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97
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Schroeter C, Ehrenthal JC, Giulini M, Neubauer E, Gantz S, Amelung D, Balke D, Schiltenwolf M. Attachment, symptom severity, and depression in medically unexplained musculoskeletal pain and osteoarthritis: a cross-sectional study. PLoS One 2015; 10:e0119052. [PMID: 25807172 PMCID: PMC4373893 DOI: 10.1371/journal.pone.0119052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Attachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study. METHODS 85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression. RESULTS Patients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns. CONCLUSIONS Our results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.
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Affiliation(s)
- Corinna Schroeter
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Johannes C. Ehrenthal
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstr. 2, 69115 Heidelberg, Germany
| | - Martina Giulini
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Eva Neubauer
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Simone Gantz
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Dorothee Amelung
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Doreen Balke
- SRH Gesundheitszentrum Bad Wimpfen, Bei der alten Saline 2, 74206 Bad Wimpfen, Germany
| | - Marcus Schiltenwolf
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
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Kowal J, McWilliams LA, Péloquin K, Wilson KG, Henderson PR, Fergusson DA. Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program. J Behav Med 2015; 38:518-26. [PMID: 25716120 DOI: 10.1007/s10865-015-9623-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 02/12/2015] [Indexed: 01/15/2023]
Abstract
The aim of this study was to examine the hypothesis that attachment insecurity is associated with poorer responses to interdisciplinary treatment for chronic pain. Patients (n = 235) admitted to a 4-week interdisciplinary rehabilitation program were recruited. At pre-treatment, participants completed a battery of questionnaires assessing adult attachment styles and dimensions, as well as pain intensity, disability, self-efficacy, pain catastrophizing, and depressive symptoms. The latter measures were completed again at post-treatment. Nearly two-thirds of participants (65.5 %) reported having an insecure attachment style. Attachment insecurity was unrelated to pre- and post-treatment reports of pain intensity and pain-related disability, but was significantly associated with most other clinical variables at both time points. Regression analyses controlling for pre-treatment functioning indicated that attachment insecurity was associated with less improvement in pain catastrophizing, pain self-efficacy, and depressive symptoms. Further research is warranted to investigate the processes by which attachment characteristics influence patients' responses to chronic pain rehabilitation.
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Affiliation(s)
- John Kowal
- Psychology, The Ottawa Hospital Rehabilitation Centre, 505 Smyth Road, Ottawa, ON, K1H 8M2, Canada,
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Laird KT, Preacher KJ, Walker LS. Attachment and adjustment in adolescents and young adults with a history of pediatric functional abdominal pain. Clin J Pain 2015; 31:152-8. [PMID: 24751542 PMCID: PMC4201885 DOI: 10.1097/ajp.0000000000000090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study tested predictions of the Attachment-Diathesis Model (ADM) of Chronic Pain in a cross-sectional sample of adolescents and young adults with a history of childhood functional abdominal pain (FAP). ADM posits that attachment anxiety is a diathesis for poor adjustment (physical health, mental health, and functioning) in the context of chronic pain and that pain self-efficacy, pain threat appraisal, and passive coping mediate this effect. METHODS Participants (N=261) were recruited from a database of consecutive new patients evaluated for abdominal pain at a pediatric gastroenterology clinic. Participants' mean age at the follow-up assessment was 21 years. Structural equation modeling was used to test the fit of our conceptual model to the data. RESULTS Model fit was good (comparative fit index=0.971, the Tucker-Lewis index=0.940, root mean square error of approximation=0.067). Attachment anxiety significantly predicted poorer health in both the mental and physical domains. Model fit was consistent with our hypothesis that pain self-efficacy mediates the effect of attachment anxiety on passive coping and that passive coping, in turn, mediates the effect of pain self-efficacy and pain threat appraisal on mental and physical health. DISCUSSION Among individuals with a childhood history of FAP, those with anxious attachment may be at higher risk for poor physical and mental health. Pain beliefs and coping may mediate the relation between anxious attachment and health outcomes and may serve as effective targets for intervention in chronic pain.
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Decety J, Fotopoulou A. Why empathy has a beneficial impact on others in medicine: unifying theories. Front Behav Neurosci 2015; 8:457. [PMID: 25642175 PMCID: PMC4294163 DOI: 10.3389/fnbeh.2014.00457] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/20/2014] [Indexed: 12/30/2022] Open
Abstract
The past decades have seen an explosion of studies on empathy in various academic domains including affective neuroscience, psychology, medicine, and economics. However, the volumes of research have almost exclusively focused on its evolutionary origins, development, and neurobiological bases, as well as how the experience of empathy is modulated by social context and interpersonal relationships. In the present paper, we examine a much less attended side of empathy: why it has a positive impact on others? After specifying what the construct of empathy encompasses, we briefly review the various effects of empathy on health outcomes in the domain of medicine. We then propose two non-mutually exclusive mechanistic explanations that contribute to explain the positive effects of physician empathy on patients. (1) The social baseline theory (SBT), building on social support research, proposes that the presence of other people helps individuals to conserve metabolically costly somatic and neural resources through the social regulation of emotion. (2) The free energy principle (FEP) postulates that the brain optimizes a (free energy) bound on surprise or its complement value to respond to environmental changes adaptively. These conceptualizations can be combined to provide a unifying integrative account of the benefits of physicians’ empathetic attitude on their patients and how it plays a role in healing beyond the mere effect of the therapeutic alliance.
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Affiliation(s)
- Jean Decety
- Department of Psychology, University of Chicago Chicago, IL, USA ; Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine Chicago, IL, USA
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London London, UK
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