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Stamp GE, Wadley AL, Iacovides S. Could Relationship-Based Learnt Beliefs and Expectations Contribute to Physiological Vulnerability of Chronic Pain? Making a Case to Consider Attachment in Pain Research. THE JOURNAL OF PAIN 2024:104619. [PMID: 38945383 DOI: 10.1016/j.jpain.2024.104619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/10/2024] [Accepted: 06/22/2024] [Indexed: 07/02/2024]
Abstract
Pain is an interpersonal and inherently social experience. Pain perception and administration of medical treatment all occur in a particular environmental and social context. Early environmental influences and early learning experiences and interactions condition the body's response to different threats (like pain), ultimately shaping the underlying neurophysiology. These early interactions and experiences also determine what situations are perceived as threatening, as well as our belief in our own ability to self-manage, and our belief in others to offer support, during perceived threats. These beliefs intrinsically drive the combination of behaviors that emerge in response to perceived threats, including pain. Such behaviors can be categorized into attachment styles. In this interdisciplinary review, we synthesize and summarize evidence from the neurobiological, psychobiological, psychosocial, and psychobehavioral fields, to describe how these beliefs are embedded in the brain's prediction models to generate a series of expectations/perceptions around the level of safety/threat in different contexts. As such, these beliefs may predict how one experiences and responds to pain, with potentially significant implications for the development and management of chronic pain. Little attention has been directed to the effect of adult attachment style on pain in research studies and in the clinical setting. Using interdisciplinary evidence, we argue why we think this interaction merits further consideration and research. PERSPECTIVE: This review explores the influence of attachment styles on pain perception, suggesting a link between social connections and chronic pain development. It aligns with recent calls to emphasize the social context in pain research and advocates for increased focus on adult attachment styles in research and clinical practice.
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Affiliation(s)
- Gabriella Elisabeth Stamp
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Antonia Louise Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nasika IN, Wiart C, Bonvarlet AS, Guillaume J, Yavchitz A, Tereno S. Attachment patterns, self-compassion, and coping strategies in patients with chronic pain. Pain Rep 2023; 8:e1087. [PMID: 38225960 PMCID: PMC10789448 DOI: 10.1097/pr9.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/12/2023] [Accepted: 05/11/2023] [Indexed: 01/17/2024] Open
Abstract
Introduction In the recent year's literature, attachment insecurity is described as a vulnerability factor among patients with chronic pain, associated with poor pain coping, anxiety, depression, catastrophizing, greater pain intensity, and disability. Self-compassion, on the other hand, is described as a protective factor, associated with lower levels of negative affect, catastrophizing, depression, and anxiety in patients with chronic pain. Methods In this study, we aim to explore the association between attachment, self-compassion quality, and coping strategies, in patients with chronic pain. Thus, 134 eligible patients with chronic pain were recruited at the certified Evaluation and Treatment Pain Center of the A. de Rothschild Foundation in Paris. We used a sociodemographic questionnaire, the Relationship Scale Questionnaire (RSQ-RC), the Self-Compassion Scale, and the Brief COPE. Results Results supported our principal hypothesis; securely attached participants reported a significantly higher global self-compassion score compared with insecurely attached ones. Secure attachment and higher self-compassion levels were positively correlated with functional coping strategies and negatively correlated with dysfunctional ones. Discussion Attachment patterns may be the basis of someone's ability to be compassionate to himself and to cope adequately with a difficult situation, such as a chronic pain condition. An attachment-informed approach to pain management could offer a better understanding of the complexity of this clinical condition and potentially provide appropriate support for both patients and health professionals, aiming to improve the effectiveness of interventions.
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Affiliation(s)
| | | | | | - Jessica Guillaume
- Clinical Research Department, Hospital Adolphe de Rothschild Foundation, Paris, France
| | - Amélie Yavchitz
- Clinical Research Department, Hospital Adolphe de Rothschild Foundation, Paris, France
| | - Susana Tereno
- Department of Psychology, Research Centre on Psychological Functioning and Dysfunctioning (CRFDP, EA 7475), University of Rouen, Rouen, Normandy, France
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Does insecure attachment affect treatment outcome in young persons with post-concussion symptoms? A secondary analysis of the GAIN trial. J Psychosom Res 2023; 164:111100. [PMID: 36502555 DOI: 10.1016/j.jpsychores.2022.111100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
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Gender Differences in Attachment Anxiety and Avoidance and Their Association with Psychotherapy Use—Examining Students from a German University. Behav Sci (Basel) 2022; 12:bs12070204. [PMID: 35877274 PMCID: PMC9312160 DOI: 10.3390/bs12070204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Attachment anxiety and avoidance might explain gender differences in psychotherapy use, which is generally lower in men. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal. A total of 4894 students completed an online survey answering questions regarding psychotherapy use and completing the PHQ-D identifying psychological syndromes. In addition, the ECR-RD12 was used to measure attachment anxiety and avoidance. Significant gender differences for attachment anxiety and avoidance emerged, showing higher attachment anxiety in female students and higher attachment avoidance in male students. Male students used psychotherapy significantly less than female students. Male students’ attachment anxiety and avoidance predicted psychotherapy use, while for female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety is positively associated with psychotherapy use, and lower attachment anxiety in men may explain lower psychotherapy use in male students.
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Charbonneau-Lefebvre V, Vaillancourt-Morel MP, Rosen NO, Steben M, Bergeron S. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2022; 19:479-495. [PMID: 35090839 DOI: 10.1016/j.jsxm.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)-the most prevalent form of vulvodynia-no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy-a recommended treatment for PVD. AIM The present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners' sexuality. METHODS One hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up. OUTCOMES (1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index. RESULTS Both attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition. CLINICAL IMPLICATIONS Although these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress. STRENGTHS & LIMITATIONS Using a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties. CONCLUSION Findings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity. V Charbonneau-Lefebvre, M-P Vaillancourt-Morel, NO Rosen, et al. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2022;19:479-495.
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Affiliation(s)
| | | | - Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Marc Steben
- Department of Social and Preventive Medicine, Groupe de médecine familiale La Cité du Parc Lafontaine, Université de Montréal, Montreal, Canada
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, Montreal, Canada
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Napier TR, Howell KH, Schaefer LM, Schwartz LE. Differentiating the effects of anxious and avoidant attachment on depression and resilience following trauma. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:625-633. [PMID: 32569516 DOI: 10.1080/07448481.2020.1762605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/15/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
Objective Few studies have explored the impact of insecure attachment on college student mental health. The present study examined how anxious and avoidant attachment to a mother, father, and best friend were related to depression and resilience in emerging adults exposed to trauma. Participants: Participants included 372 trauma-exposed emerging adults, aged 18-24 (Mage=19.64, SD = 1.62), from a university in the Midsouth, United States. Method: Participants completed an assessment battery of self-report measures to determine how maternal, paternal, and best friend insecure attachment each uniquely contribute to the variance in depression and resilience. Results: Hierarchical linear regression analyses revealed that anxious and avoidant attachment to a best friend were associated with lower resilience, but only anxious attachment to a best friend was associated with more depressive symptoms. Discussion: Findings highlight the importance of cultivating healthy relationships in a university setting to foster secure peer attachments for emerging adults exposed to adversity.
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Affiliation(s)
- Taylor R Napier
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kathryn H Howell
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Lauren M Schaefer
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Laura E Schwartz
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
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Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study. Pain Res Manag 2021; 2021:5527261. [PMID: 34804266 PMCID: PMC8601840 DOI: 10.1155/2021/5527261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/13/2021] [Indexed: 01/11/2023]
Abstract
Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.
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Tuborgh A, Svendsen SW, Elklit A, Hunter J, Jensen JS, Schröder A, Nielsen JF, Thastum MM, Næss-Schmidt ET, Rask CU. Attachment and symptom reporting in adolescents and young adults after a concussion. J Psychosom Res 2021; 150:110603. [PMID: 34509710 DOI: 10.1016/j.jpsychores.2021.110603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. METHODS This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. RESULTS In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)). CONCLUSION Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.
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Affiliation(s)
- A Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - S W Svendsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Department of Public Health, Section of Environmental Health, University of Copenhagen, Denmark
| | - A Elklit
- Department of Psychology, National Centre of Psycho-traumatology, University of Southern Denmark, Denmark
| | - J Hunter
- Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | - J S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - M M Thastum
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - E T Næss-Schmidt
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Altmann U, Nodop S, Dinger U, Ehrenthal JC, Schauenburg H, Dymel W, Willutzki U, Strauss BM. Differential effects of adult attachment in cognitive-behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self-rating and an observer rating. Clin Psychol Psychother 2020; 28:373-383. [PMID: 32888374 DOI: 10.1002/cpp.2513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/04/2023]
Abstract
Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.
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Affiliation(s)
- Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, Jena, Germany
| | - Steffi Nodop
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, Jena, Germany
| | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg, Germany
| | | | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg, Germany
| | | | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, University of Witten-Herdecke, Witten-Herdecke, Germany
| | - Bernhard M Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, Jena, Germany
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The Relationship between Insecure Attachment to Depression: Mediating Role of Sleep and Cognitive Reappraisal. Neural Plast 2020; 2020:1931737. [PMID: 32351552 PMCID: PMC7178506 DOI: 10.1155/2020/1931737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
Previously, we have shown that neuromodulators are important factors in stress-induced emotional disorders, such as depression, for example, serotonin is the major substance for depression. Many psychological studies have proved that depression is due to insecure attachment. In addition, sleep is a major symptom of depression. Furthermore, serotonin is the substrate for both sleep and depression. To explore the role of sleep in the relationships between insecure attachment and depression, we investigated 755 college students with Close Relationship Inventory, Emotion Regulation Questionnaire, Self-rated Depression Scale, and Pittsburgh Sleep Quality Index. The results showed that (1) insecure attachment positively predicted poor sleep quality; (2) sleep quality partially affected depression, possibly due the same stress neuromodulators such as norepinephrine and cortisol; and (3) cognitive reappraisal moderated the mediating path leading from attachment anxiety to poor sleep quality. These findings highlight the moderating role of cognitive reappraisal in the effects of attachment anxiety on sleep quality and finally on depression. In conclusion, sleep quality links attachment anxiety and emotional disorders.
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Altmann U, Gawlytta R, Hoyer J, Leichsenring F, Leibing E, Beutel M, Willutzki U, Herpertz S, Strauss B. Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis. J Anxiety Disord 2020; 71:102200. [PMID: 32126336 DOI: 10.1016/j.janxdis.2020.102200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/08/2020] [Accepted: 02/15/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The use of trajectories and analysis of change patterns is a promising way toward better differentiation of subgroups in psychotherapy studies. Research on change patterns in social anxiety disorder (SAD) are still rare, although SAD is one of the most common mental disorders. In a secondary analysis of data from the SOPHO-NET-trial (ISRCTN53517394) this study aimed to investigate change patterns and their predictors in a sample of SAD patients. METHODS Patients with SAD (N = 357) were randomly assigned to cognitive-behavioral or psychodynamic therapy. The Liebowitz Social Anxiety Scale (LSAS) was assessed at 1st session (pre), 8th session, 15th session and at the end of treatment (post). We used latent state variables and latent class analysis for the classification of change patterns and logistic regression for the identification of different predictors. RESULTS Analyses revealed three typical patterns: (i.) responders with a high initial impairment (N = 57), (ii.) responders with a moderate initial impairment (N = 225), and (iii.) patients with a high initial impairment and no remission (N = 75). Among other significant predicators, patient´s attachment anxiety and therapeutic alliance at session eight contributed to the prediction of change patterns. DISCUSSION Psychotherapy of SAD should consider patient's attachment and focus on the establishment of a solid therapeutic alliance in an early therapy stage.
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Affiliation(s)
- Uwe Altmann
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Romina Gawlytta
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Jürgen Hoyer
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Hohe Straße 53, 01187 Dresden Germany.
| | - Falk Leichsenring
- Universitätsklinikum Giessen, Clinic of Psychosomatic and Psychotherapy, Friedrichstr. 33, 35392 Gießen Germany.
| | - Eric Leibing
- Universitätsmedizin Göttingen Clinic of Psychosomatic Medicine and Psychotherapy Von-Siebold-Str. 5, 37075 Göttingen Germany.
| | - Manfred Beutel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Untere Zahlbacher Strasse 8, 55131 Mainz Germany.
| | - Ulrike Willutzki
- Universität Witten/Herdecke, Department of Psychology and Psychotherapy, Alfred-Herrhausen-Straße 44, 58455 Witten Germany.
| | - Stephan Herpertz
- LWL-Universitätsklinikum der Ruhr-Universität Bochum Clinic of Psychosomatic Medicine and Psychotherapy Alexandrinenstr. 1-3, 44791 Bochum Germany.
| | - Bernhard Strauss
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
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Attachment and Mentalizing Abilities in Patients with Inflammatory Bowel Disease. Gastroenterol Res Pract 2019; 2019:7847123. [PMID: 31885546 PMCID: PMC6915150 DOI: 10.1155/2019/7847123] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background Inflammatory bowel diseases (IBD) are associated with stress, poor quality of life, and attachment insecurity. Mentalization is the human ability to perceive and reason about feelings and psychological dispositions of one's self and others. The chronic disorders are believed to affect patients' mentalizing abilities and to determine a shift towards attachment insecurity in patients affected. In this study, the attachment dimensions and mentalization were assessed in IBD patients and healthy controls. Further knowledge about the interplay among IBD, mentalization, and attachment might shed more light into the psychopathological mechanisms leading to insecurity and vulnerability to stress in IBD. Methods A group of 96 IBD patients and 102 healthy controls completed the attachment style questionnaire (ASQ), the reflective functioning questionnaire (RFQ), and the Eyes test, a performance-based measure of mentalization. Results Compared to controls, IBD patients have shown more pronounced attachment anxiety and lower scores in the Eyes test. Disease activity was negatively correlated with the Eyes test scores. Conclusion These findings have suggested a plausible impact of IBD on mentalization abilities and have provided new insights into the interplay between IBD, deficits in mentalization, and attachment insecurity. IBD patients are highly vulnerable to disease-related stress that may promote impairments in mentalization. Low mentalization might play a central role in the development of attachment insecurity and emotional disturbances in IBD. The present study's results might open new scenarios for psychodynamic approaches to the treatment of the emotional disturbances in IBD based on attachment and mentalization theory.
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Merluzzi TV, Pustejovsky JE, Philip EJ, Sohl SJ, Berendsen M, Salsman JM. Interventions to enhance self-efficacy in cancer patients: A meta-analysis of randomized controlled trials. Psychooncology 2019; 28:1781-1790. [PMID: 31206917 PMCID: PMC6731146 DOI: 10.1002/pon.5148] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Self-efficacy expectations are associated with improvements in problematic outcomes widely considered clinically significant (ie, emotional distress, fatigue, and pain), related to positive health behaviors, and as a type of personal agency, inherently valuable. Self-efficacy expectancies, estimates of confidence to execute behaviors, are important in that changes in self-efficacy expectations are positively related to future behaviors that promote health and well-being. The current meta-analysis investigated the impact of psychological interventions on self-efficacy expectations for a variety of health behaviors among cancer patients. METHODS Ovid Medline, PsycINFO, CINAHL, EMBASE, Cochrane Library, and Web of Science were searched with specific search terms for identifying randomized controlled trials (RCTs) that focused on psychologically based interventions. Included studies had (a) an adult cancer sample, (b) a self-efficacy expectation measure of specific behaviors, and (c) an RCT design. Standard screening and reliability procedures were used for selecting and coding studies. Coding included theoretically informed moderator variables. RESULTS Across 79 RCTs, 223 effect sizes, and 8678 participants, the weighted average effect of self-efficacy expectations was estimated as g = 0.274 (P < .001). Consistent with the self-efficacy theory, the average effect for in-person intervention delivery (g = 0.329) was significantly greater than for all other formats (g = 0.154, P = .023; eg, audiovisual, print, telephone, and Web/internet). CONCLUSIONS The results establish the impact of psychological interventions on self-efficacy expectations as comparable in effect size with commonly reported outcomes (distress, fatigue, pain). Additionally, the result that in-person interventions achieved the largest effect is supported by the social learning theory and could inform research related to the development and evaluation of interventions.
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Affiliation(s)
| | | | - E. J. Philip
- Department of Psychology, University of Notre Dame
| | - S. J. Sohl
- Department of Social Science and Health Policy, Wake Forest School of Medicine
| | - M. Berendsen
- Northwestern University Feinberg School of Medicine
| | - J. M. Salsman
- Department of Social Science and Health Policy, Wake Forest School of Medicine
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Pfeifer AC, Meredith P, Schröder-Pfeifer P, Gomez Penedo JM, Ehrenthal JC, Schroeter C, Neubauer E, Schiltenwolf M. Effectiveness of an Attachment-Informed Working Alliance in Interdisciplinary Pain Therapy. J Clin Med 2019; 8:jcm8030364. [PMID: 30875841 PMCID: PMC6463073 DOI: 10.3390/jcm8030364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.
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Affiliation(s)
- Ann-Christin Pfeifer
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany.
| | - Pamela Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland 4072, Australia.
- School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, Queensland 4701, Australia.
| | - Paul Schröder-Pfeifer
- Institute of Psychosocial Prevention at the Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany.
| | | | - Johannes C Ehrenthal
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany.
| | - Corinna Schroeter
- 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.
| | - Marcus Schiltenwolf
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
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Andersen TE, Sterling M, Maujean A, Meredith P. Attachment insecurity as a vulnerability factor in the development of chronic whiplash associated disorder - A prospective cohort study. J Psychosom Res 2019; 118:56-62. [PMID: 30782355 DOI: 10.1016/j.jpsychores.2019.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. METHODS Questionnaire data were collected consecutively from a 1-year cohort of whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). RESULTS Both attachment dimensions were significantly associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. CONCLUSION Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after whiplash injury.
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Affiliation(s)
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Australia
| | - Annick Maujean
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Australia
| | - Pamela Meredith
- School of Health and Rehabilitation, University of Queensland, Australia
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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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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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18
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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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The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial. J Psychosom Res 2018; 108:39-46. [PMID: 29602324 DOI: 10.1016/j.jpsychores.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study. METHODS In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months. RESULTS Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048). CONCLUSION Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group. TRIAL REGISTRATION www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.
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Ultimate (evolutionary) explanations for the attraction and benefits of chronic illness support groups: Attachment, belonging, and collective identity. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9841-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Short-Term Effects of the Empathic Talk: The Role of Perceived Empathy, Interpersonal Dispositions, and Vagal Tone on Experiencing Depth. SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E61. [PMID: 29145917 DOI: 10.1017/sjp.2017.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present study examines the immediate impact of empathic attitudes on the receiver, by comparing an empathic conversation (EC) with a neutral one (NC) on experiencing depth (EXP), perceived empathy and vagal tone. We also evaluate if empathy effects depend on personality dispositions relevant to interpersonal functioning. An experimental, counterbalanced, within-subject design was implemented wherein participants (n = 27, age M = 22.6, SD = 4.0, 52% females) talked about a personal, meaningful topic for 20 minutes under both the EC and NC conditions. At the group level, main results indicated that the EC was more effective than the NC in promoting increases in EXP over time (F(1, 25) = 21.04, p < .001, η p 2 = .457) and perceived empathy in women (F(1, 25) = 9.42, p = .005, η p 2 = .264). At the individual level, the NC particularly precluded EXP gains in people expressing a better interpersonal functioning (βs < -.46, ps < .05 for attachment security and empathy and β = .38, p < .05 for aggression), and who also inhibited their vagal tone throughout this very condition (β = .40, p = .024). We conclude that the empathic context has an immediate positive impact on healthy psychological variables, whereas a more impersonal setting would drive people away from this positive effect. Those results are discussed in the light of the role of interpersonal proximity (being empathic to another's experience and the lack of this attitude) in psychotherapy and healthy functioning.
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Saariaho AS, Saariaho TH, Mattila AK, Ohtonen P, Joukamaa MI, Karukivi M. Alexithymia and depression in the recovery of chronic pain patients: a follow-up study. Nord J Psychiatry 2017; 71:262-269. [PMID: 28413937 DOI: 10.1080/08039488.2016.1275782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare. AIMS The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied. METHODS The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided. RESULTS At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome. CONCLUSIONS Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.
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Affiliation(s)
| | - Tom H Saariaho
- b Pain Clinic , Oulu University Hospital , Oulu , Finland
| | - Aino K Mattila
- c Department of Psychiatry , Tampere University Hospital , Tampere , Finland
| | - Pasi Ohtonen
- d Department of Anesthesiology and Surgery , Oulu University Hospital , Oulu , Finland
| | - Matti I Joukamaa
- e School of Health Sciences, Tampere University , Tampere , Finland
| | - Max Karukivi
- f Department of Psychiatry , University of Turku and Turku University Hospital, Turku Unit of Adolescent Psychiatry, Satakunta Hospital District , Pori , Finland
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Kidd T, Poole L, Ronaldson A, Leigh E, Jahangiri M, Steptoe A. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. Br J Health Psychol 2016; 21:796-811. [PMID: 26999442 PMCID: PMC5082502 DOI: 10.1111/bjhp.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. RESULTS Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. CONCLUSION These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, UK
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, UK
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Agostini A, Spuri Fornarini G, Ercolani M, Campieri M. Attachment and perceived stress in patients with ulcerative colitis, a case-control study. J Psychiatr Ment Health Nurs 2016; 23:561-567. [PMID: 27624586 DOI: 10.1111/jpm.12331] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Ulcerative colitis (UC) is a chronic inflammatory disorder associated with high perceived psychological stress. The attachment theory provides a psychodynamic perspective to investigate the relationship between close interpersonal relationships and stress in UC. Researchers have hypothesized that the chronic illness might affect personality trait as the attachment style of patients. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: UC patients exhibit a more pronounced attachment insecurity that, in turn, resulted as a determinant of psychological stress. This study suggests that UC could determine a shift towards insecurity in the attachment style that, in turn, promotes psychological stress and increases the risk of psychopathologies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The more accurate knowledge of attachment insecurity in patients with chronic disorders such as UC may help the nurses to face with often dysfunctional patients' styles of manifesting distress, patterns of help seeking and expectations of health professionals. The knowledge of psychopathological mechanisms in patients with UC could improve the prevention and treatment of psychological disorders in affected patients. ABSTRACT Introduction Ulcerative colitis (UC) is a chronic disorder characterized by recurrent intestinal symptoms. The attachment theory provides a psychodynamic perspective to investigate the relationship between interpersonal relationships and stress in UC. Aim The aim of this study was to compare the attachment dimensions between UC patients and controls and to evaluate the impact of these dimensions on perceived stress in patients. Method In all, 101 patients with UC completed the attachment style questionnaire and the perceived stress questionnaire (PSQ). Clinical and psychometric parameters were added as predictor variables in a regression with the PSQ score as dependent variable. One hundred and five healthy subjects took part in the study as controls. Results Compared to controls, UC patients exhibited greater scores in relationships as secondary, need for approval and preoccupation with relationships. In UC, disease activity, confidence and preoccupation with relationships resulted predictors of perceived stress. Discussion Compared to healthy controls, UC patients exhibited more pronounced attachment insecurity that, in turn, was a significant predictor of the perceived stress. Implications for practice The knowledge of attachment insecurity may help the nurses and all health care providers to face with dysfunctional patients' styles of manifesting distress, help seeking and expectations of health professionals.
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Affiliation(s)
- Alessandro Agostini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Mauro Ercolani
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Massimo Campieri
- IBD Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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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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26
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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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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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Jang B, Rim HD, Woo J. Reliability and Validity of the Korean Version of the Modified Adult Attachment Scale for the Use of Medically Ill Patients. Psychiatry Investig 2015; 12:483-90. [PMID: 26508959 PMCID: PMC4620305 DOI: 10.4306/pi.2015.12.4.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/05/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Modified Experiences in Close Relationships (ECR-M36) scale was developed for medically ill, older individuals in 2008 (Toronto, Canada, department of psychosocial oncology and palliative care, Princess Margaret Hospital). The scale has displayed satisfactory reliability and validity. This study aimed to test the reliability and validity of the Korean version of Modified Experiences in Close Relationships (K-ECR-M36) questionnaire in female patients with breast cancer. METHODS A total of 199 post-operative breast cancer patients completed the K-ECR-M36 as well as other psychological measures including the Revised Adult Attachment Scale (RAAS), World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). The reliability and validity of the K-ECR-M36 were evaluated. Explorative factor analysis was conducted to identify the factor structure of the K-ECR-M36. RESULTS The K-ECR-M36 showed good internal consistency (Cronbach's α=0.87) and reasonable test-retest reliability (r=0.752, p<0.001). The total as well as avoidance and anxiety subscales demonstrated construct validity with the RAAS, the HADS, and the WHOQOL-BREF. Factor analysis revealed four-factor structure which was originally proposed by Brennan, Clark, and Shaver (1998). CONCLUSION These findings support that the K-ECR-M36 has satisfactory reliability, validity and factor structure among patients with breast cancer.
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Affiliation(s)
- Byunggu Jang
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Li T, Fung HH. How avoidant attachment influences subjective well-being: an investigation about the age and gender differences. Aging Ment Health 2015; 18:4-10. [PMID: 23452097 DOI: 10.1080/13607863.2013.775639] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intimate relationship is a significant factor that influences older adults' subjective well-being. Avoidant attachment reflects a basic working model regarding interpersonal relationships. The current study aims to test how age and gender moderate the effect of avoidant attachment to spouse on subjective well-being. Fifty-six married couples aged from 20 to 79 years in Hong Kong were recruited for the study. Their avoidant attachment to spouse and subjective well-being were measured by questionnaires. In general, avoidant attachment to spouse was found to undermine subjective well-being. More importantly, age significantly moderated the negative association between avoidant attachment and subjective well-being, but the direction of the moderating effect was opposite for husbands and wives. Compared with their younger counterparts, the detrimental effect of avoidant attachment on subjective well-being was weaker for older wives but stronger for older husbands. The results suggest that marital relationship may play different roles in different life stages for the two genders. In later adulthood, males may become more dependent on the marital relationship to maintain subjective well-being, whereas females can be relatively independent.
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Affiliation(s)
- Tianyuan Li
- a Department of Psychological Studies , The Hong Kong Institute of Education , Hong Kong
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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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Fischer-Kern M, Nolte T, Kadi B, Naderer A. Bindungsrepräsentation bei stationär behandelten chronisch-depressiven Patientinnen. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1079-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Individuals with chronic pain exhibit a wide range of coping mechanisms, some of which are maladaptive (eg, activity avoidance or overactivity). The authors of this study aimed to investigate whether individuals may be predisposed to develop a particular maladaptive coping mechanism based on their attachment style (dismissing, preoccupied, fearful or secure), which represents a core feature of their personality. BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework. METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression). RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing. CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.
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Agostini A, Moretti M, Calabrese C, Rizzello F, Gionchetti P, Ercolani M, Campieri M. Attachment and quality of life in patients with inflammatory bowel disease. Int J Colorectal Dis 2014; 29:1291-6. [PMID: 25034592 DOI: 10.1007/s00384-014-1962-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Inflammatory bowel diseases (IBD) are chronic disorders affecting psychological well-being, quality of life (QOL), social interactions, and close interpersonal relationships of patients affected. The attachment theory provides a theoretical framework to evaluate the quality of close interpersonal relationships in the context of chronic disorders. The aims of this study were to compare the attachment dimensions between IBD patients and healthy controls and to evaluate the impact of these dimensions on QOL in IBD patients. METHODS One hundred three consecutive IBD outpatients (70 with Crohn's disease and 33 with ulcerative colitis) were recruited in the IBD Unit of the University of Bologna. They were clinically evaluated and filled out the questionnaire Short Form health survey-36 (SF-36), assessing QOL, and the attachment style questionnaire (ASQ), assessing attachment dimensions. One hundred three matched healthy subjects filled out the same questionnaires and represented the control group. RESULTS IBD patients exhibited worst scores in the QOL measures (both physical and mental health) and in the attachment dimensions Relationships as secondary and Preoccupation with relationships. In IBD, the significant predictors of physical health were disease activity and disease type, while the significant predictors of mental health were disease activity and type, surgery, and the attachment dimensions Confidence and Preoccupation with relationships. CONCLUSIONS Compared to controls, in IBD patients, the close interpersonal relationships are characterized by attachment insecurity that, in turn, is a significant predictor of QOL. These findings suggest plausible insights for psychological interventions in IBD patients with deterioration in QOL.
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Peilot B, Andréll P, Samuelsson A, Mannheimer C, Frodi A, Sundler AJ. Time to gain trust and change--experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity. Int J Qual Stud Health Well-being 2014; 9:24420. [PMID: 25138653 PMCID: PMC4138494 DOI: 10.3402/qhw.v9.24420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients’ well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients’ special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.
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Affiliation(s)
- Birgitta Peilot
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden;
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Clas Mannheimer
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann Frodi
- Developmental Psychology, University of Wisconsin, Iowa, Michigan, Rochester, NY, USA
| | - Annelie J Sundler
- School of Health and education, University of Skövde, Skövde, Sweden; Post Doctoral Research Fellow at School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden
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Abstract
BACKGROUND This study examined attachment style as a moderator of the relationship between childhood abuse and inflammatory bowel disease (IBD)-related outcomes. METHODS Study participants were 205 patients with IBD from Mount Sinai Hospital in Toronto. Participants completed self-report questionnaires regarding personal relationships, abuse history, and IBD-related information. Multiple regression models were fit using 3 outcome variables: disease-related quality of life (QOL), disease activity for ulcerative colitis, and disease activity for Crohn's disease. RESULTS Patients reporting less severe abuse and low levels of avoidant attachment had the highest levels of QOL, whereas patients reporting high levels of avoidant attachment had the lowest levels of QOL, regardless of abuse severity. Patients reporting greater anxious attachment had lower QOL scores. Patients reporting less severe abuse and low levels of avoidant attachment had the lowest levels of disease activity, whereas patients reporting high levels of avoidant attachment had the highest levels of ulcerative colitis-related disease activity, regardless of abuse severity. However, for anxious attachment, there was no significant main effect or significant interaction of abuse by anxious attachment on ulcerative colitis-related disease activity. Childhood abuse and attachment style were not found to be associated with Crohn's disease-related disease activity. CONCLUSIONS Adult attachment style may moderate the relationship between childhood abuse and IBD-related outcomes, by impacting one's QOL and disease activity. Distinct types of insecure attachment styles may impact these relationships differently. Psychological interventions focusing on attachment styles of patients with IBD have the potential to improve IBD-related QOL and disease activity.
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Costa-Martins JM, Pereira M, Martins H, Moura-Ramos M, Coelho R, Tavares J. Attachment styles, pain, and the consumption of analgesics during labor: a prospective observational study. THE JOURNAL OF PAIN 2014; 15:304-11. [PMID: 24393700 DOI: 10.1016/j.jpain.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED Individuals with less secure attachment styles have been shown to experience more pain than people with more secure attachment styles; however, attachment styles have not yet been examined in the context of labor pain and analgesic consumption. The purpose of this prospective observational study was to assess the influence of the mother's attachment style on the perception of labor pain, as assessed by a visual analog scale and analgesic consumption. Eighty-one pregnant women with a mean age of 32 years (standard deviation = 5.1) were assessed during the third trimester of pregnancy and during labor. The physical predictors of labor pain were recorded, and the adult attachment style was assessed with the Adult Attachment Scale-Revised. For labor analgesia, a low dose of patient-controlled epidural analgesia protocol (ropivacaine .6 mg/mL plus sufentanil .5 μg/mL) was used. Women with a secure attachment style reported significantly less labor pain (P < .001) and a significantly lower analgesic consumption during labor (P < .001) than insecurely attached women. These findings suggest that women's attachment style was associated with labor pain and analgesic consumption and support the relevance of the attachment theory as a promising conceptual framework for understanding labor pain. PERSPECTIVE This study showed that women with an insecure attachment style were more likely to report higher pain before patient-controlled epidural analgesia and higher analgesic consumption and to request supplemental analgesia during labor. The assessment of adult attachment has the potential to identify women at high risk of poorly coping with pain during childbirth.
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Affiliation(s)
- José Manuel Costa-Martins
- Department of Anaesthesiology, Maternity Hospital Alfredo da Costa, University of Porto, Porto, Portugal.
| | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Henriqueta Martins
- Instituto Superior de Psicologia Aplicada, University Institute, Lisbon, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Rui Coelho
- Department of Clinical Neurosciences and Mental Health, Hospital de São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Tavares
- Department of Anaesthesiology, Hospital de São João, University of Porto, Porto, Portugal
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Monin JK, Zhou L, Kershaw T. Attachment and Psychological Health in Older Couples Coping with Pain. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2014; 27:115-127. [PMID: 27346993 DOI: 10.1024/1662-9647/a000110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Attachment theory is useful for understanding how couples cope with stress across the lifespan. This study used the the Actor Partner Interdependence Model to examine the extent to which attachment related to one's own (actor effect) and one's partner's (partner effect) depressive symptoms and marital satisfaction among older, married couples with a musculoskeletal condition. Pain and support were also examined as mediators. A group of 77 couples completed self-report measures as part of a larger study in which support was manipulated. Results revealed that, when one or both partners were insecurely attached, both partners reported greater depressive symptoms and lower satisfaction; however, pain and support were not significant mediators. Findings have implications for targeted, dyadic interventions to improve psychological health of couples coping with pain.
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Affiliation(s)
- Joan K Monin
- Chronic Disease Epidemiology, Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Lu Zhou
- Chronic Disease Epidemiology, Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Trace Kershaw
- Chronic Disease Epidemiology, Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Zarbo C, Compare A, Baldassari E, Bonardi A, Romagnoni C. In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association. Clin Pract Epidemiol Ment Health 2013; 9:255-62. [PMID: 24403952 PMCID: PMC3884151 DOI: 10.2174/1745017901309010255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 12/28/2022]
Abstract
A narrative review of the major evidence concerning the relationship between anxiety, social support and cardiac disease was conducted. Literature demonstrates that a strict relationship between anxiety, social support and cardiac disease outcomes subsists. However, the function of social support within anxiety and heart disease association remains unclear and needs to further researches to be established. Moreover evidence suggests that it's the quality of close relationships to play an important role in affecting psychological and physiological health status. The main components that the literature suggests for a better quality of social support and close relationship, and the main assessment measure are presented. Evidence about cardiac rehabilitation programs and the need to assess and intervene on psychological and psychosocial factors is discussed.
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Affiliation(s)
- Cristina Zarbo
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Elena Baldassari
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Alberto Bonardi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Claudia Romagnoni
- Cardiovascular Division, "L. Sacco" University General Hospital, University of Milan, Milano, Italy
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Monin JK, Schulz R, Kershaw TS. Caregiving spouses' attachment orientations and the physical and psychological health of individuals with Alzheimer's disease. Aging Ment Health 2013; 17:508-16. [PMID: 23215899 PMCID: PMC3596494 DOI: 10.1080/13607863.2012.747080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Attachment theory is a useful framework for understanding how caregiving dyads regulate emotions and maintain feelings of security in reaction to a loved one's chronic illness. In this study we examined the extent to which the attachment orientations (anxiety and avoidance) of persons with Alzheimer's disease (AD) and their spousal caregivers were associated with each partner's report of the physical and psychological health symptoms of the person with AD. METHOD Fifty-eight individuals with AD and their spousal caregivers each completed a 12-item self-report measure of trait attachment orientation and rated the physical and psychological health symptoms of the person with AD over the past two weeks. Data from the persons with AD were used after determining that they were able to provide reliable responses. RESULTS As predicted, individuals with AD who were high in anxious attachment self-reported more physical and psychological symptoms, particularly when their caregivers were high in anxious attachment. Also, caregivers perceived more physical symptoms in individuals with AD who were high in avoidant attachment. CONCLUSION This study highlights the importance of considering the attachment security of both caregivers and persons with AD when considering how each partner views the psychological and physical health symptoms of the person with AD. Our results have implications for providing care-recipients and caregivers with improved, tailored care.
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Affiliation(s)
- Joan K. Monin
- Social and Behavioral Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, CT, 06520
| | - Richard Schulz
- Department of Psychiatry and the University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA 15260
| | - Trace S. Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, CT, 06520
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Gauthier LR, Rodin G, Zimmermann C, Warr D, Librach SL, Moore M, Shepherd FA, Gagliese L. The Communal Coping Model and Cancer Pain: The Roles of Catastrophizing and Attachment Style. THE JOURNAL OF PAIN 2012. [DOI: 10.1016/j.jpain.2012.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Viggers LC, Caltabiano ML. Factors affecting the psychological functioning of Australian adults with chronic pain. Nurs Health Sci 2012; 14:508-13. [DOI: 10.1111/j.1442-2018.2012.00726.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/13/2012] [Accepted: 06/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Lorna C. Viggers
- Department of Psychology; James Cook University; Cairns; Queensland; Australia
| | - Marie L. Caltabiano
- Department of Psychology; James Cook University; Cairns; Queensland; Australia
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Does attachment insecurity affect the outcomes of a multidisciplinary pain management program? The association between attachment insecurity, pain, disability, distress, and the use of opioids. Soc Sci Med 2012; 74:1461-8. [PMID: 22398142 DOI: 10.1016/j.socscimed.2012.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 11/29/2011] [Accepted: 01/03/2012] [Indexed: 11/22/2022]
Abstract
Cognitive and behavioural treatments have been shown to be effective for the management of chronic pain. However, not all patients succeed at such a treatment. Attachment insecurity has recently been proposed as an individual vulnerability factor that may have a negative impact on pain, disability, psychological distress, and compliance with treatment, resulting in a poorer outcome. Furthermore, attachment avoidance has been associated with opioid abuse. We hypothesised that attachment anxiety would be associated with higher levels of pain intensity and disability, and that both attachment dimensions would be associated with anxiety and depression. Moreover, we hypothesised that attachment avoidance would be positively associated with the use of opioids. Finally, we predicted that patients with an insecure attachment orientation would profit less from a routine pain management program. Data were collected from 72 patients referred consecutively from December 2008 to August 2009 to a 13-week pain management program at a Danish multidisciplinary pain centre. Both attachment dimensions were positively associated with anxiety and depression. Moreover, the insecurely attached patients used significantly more opioids compared to the securely attached. None of the attachment dimensions was associated with pain and disability, and the pain management program was equally effective for both the secure and insecure groups. However, the level of anxiety and depression for insecurely attached patients did not decline below a clinical level post-treatment. The present study suggests that attachment insecurity plays an important role in the context of chronic pain management. With regards to the management of pain related anxiety, depression, and the use of opioids, the current results suggests that practitioners should keep attachment insecurity in mind.
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Attachment styles in patients with lung cancer and their spouses: associations with patient and spouse adjustment. Support Care Cancer 2012; 20:2459-66. [PMID: 22246596 DOI: 10.1007/s00520-011-1367-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE This study examined attachment styles in patients with lung cancer and their spouses and associations between attachment styles and patient and spouse adjustment. METHODS One hundred twenty-seven patients with early stage lung cancer completed measures of attachment style, marital quality, self-efficacy, pain, depression, anxiety, and quality of life. Their spouses completed measures of attachment style, marital quality, self-efficacy, caregiver strain, and mood. RESULTS Analyses indicated that, among patients, those high in either attachment anxiety or avoidance had significantly higher levels of anxiety and poorer social well-being. Attachment avoidance was also significantly associated with higher levels of depression and poorer marital quality and functional well-being. Spouse avoidant attachment was significantly associated with patient reports of increased pain and poorer functional well-being, and spouse anxious attachment was associated with poorer patient marital quality. Among spouses, those high in attachment avoidance reported significantly higher levels of caregiver strain, anger, depressed mood, and poorer marital quality; those high in attachment anxiety reported higher anxious mood. Dyads in which both partners were insecurely attached had significantly poorer adjustment compared to dyads in which both partners reported secure attachment. CONCLUSIONS These preliminary findings raise the possibility that attachment styles of cancer patients and their spouses as individuals and as a dyad may be important factors affecting adjustment in multiple domains.
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Strauss BM, Mestel R, Kirchmann HA. Changes of attachment status among women with personality disorders undergoing inpatient treatment. COUNSELLING & PSYCHOTHERAPY RESEARCH 2011. [DOI: 10.1080/14733145.2010.548563] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kirchmann H, Steyer R, Mayer A, Joraschky P, Schreiber-Willnow K, Strauss B. Effects of adult inpatient group psychotherapy on attachment characteristics: an observational study comparing routine care to an untreated comparison group. Psychother Res 2011; 22:95-114. [PMID: 22092435 DOI: 10.1080/10503307.2011.626807] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
This study investigated the changes in attachment characteristics of patients undergoing inpatient group psychotherapy in routine care. We collected data from 265 consecutively recruited patients and 260 non-clinical control persons using self-report measures of attachment, depression, and socio-demographic characteristics. The effects of treatment on patients were analyzed using propensity score techniques (propensity strata and logit-transformed propensity scores) in combination with a generalized analysis of covariance. A moderate increase of attachment security was found which could be attributed to a decrease both in attachment anxiety and avoidance. Pre-post improvements in attachment with regard to romantic partnerships were stable after a 1-year follow-up. Furthermore, we found significant treatment-covariate interactions indicating that subjects with particularly high treatment propensities (propensities were highly correlated with depression and attachment anxiety) improved the most in terms of attachment security. Our results are encouraging for psychotherapeutic practice in that they provide evidence that long-term attachment improvements can be reached via psychotherapy. Our results will also provide a sound basis for future studies in the field of clinical attachment research, e.g., studies examining whether improved attachment security is correlated to symptom improvements in different psychological disorders.
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Affiliation(s)
- Helmut Kirchmann
- Jena University Hospital, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany.
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MARTÍNEZ MPILAR, MIRÓ ELENA, SÁNCHEZ ANAI, MUNDO ANTONIO, MARTÍNEZ ELENA. Understanding the relationship between attachment style, pain appraisal and illness behavior in women. Scand J Psychol 2011; 53:54-63. [DOI: 10.1111/j.1467-9450.2011.00925.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ravitz P, Maunder R, Hunter J, Sthankiya B, Lancee W. Adult attachment measures: a 25-year review. J Psychosom Res 2010; 69:419-32. [PMID: 20846544 DOI: 10.1016/j.jpsychores.2009.08.006] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/01/2009] [Accepted: 08/12/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Over the past 25 years, attachment research has extended beyond infant-parent bonds to examine dyadic relationships in children, adolescents, and adults. Attachment has been shown to influence a wide array of biopsychosocial phenomena, including social functioning, coping, stress response, psychological well-being, health behavior, and morbidity, and has thus emerged as an important focus of psychosomatic research. This article reviews the measurement of adult attachment, highlighting instruments of relevance to-or with potential use in-psychosomatic research. METHODS Following a literature search of articles that were related to the scales and measurement methods of attachment in adult populations, 29 instruments were examined with respect to their utility for psychosomatic researchers. RESULTS Validity, reliability, and feasibility were tabulated on 29 instruments. Eleven of the instruments with strong psychometric properties, wide use, or use in psychosomatic research are described. These include the following: Adult Attachment Interview (George, Kaplan, and Main); Adult Attachment Projective (George and West); Adult Attachment Questionnaire (Simpson, Rholes, and Phillips); Adult Attachment Scale (and Revised Adult Attachment Scale) (Collins and Read); Attachment Style Questionnaire (Feeney); Current Relationship Interview (Crowell and Owens); Experiences in Close Relationships (Brennan, Clark, and Shaver) and Revised Experiences in Close Relationships (Fraley, Waller, and Brennan); Parental Bonding Instrument (Parker, Tupling, and Brown); Reciprocal Attachment Questionnaire (West and Sheldon-Keller); Relationship Questionnaire (Bartholomew and Horowitz); and Relationship Scales Questionnaire (Grifiin and Bartholomew). CONCLUSION In addition to reliability and validity, investigators need to consider relationship focus, attachment constructs, dimensions or categories of interest, and the time required for training, administration, and scoring. Further considerations regarding attachment measurement in the context of psychosomatic research are discussed.
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Affiliation(s)
- Paula Ravitz
- Department of Psychiatry, University of Toronto, Toronto, Canada; Mount Sinai Hospital and Joseph and Wolf Lebovic Health Complex, Toronto, Canada.
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Oliveira P, Costa ME. Interrelationships of adult attachment orientations, health status and worrying among fibromyalgia patients. J Health Psychol 2010; 14:1184-95. [PMID: 19858338 DOI: 10.1177/1359105309342471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study examined associations between adult attachment dimensions, perceived health status and worrying (coping strategy with chronic pain), and explored whether worrying mediated observed relationships between attachment dimensions and health outcomes within a sample of 128 Portuguese female fibromyalgia patients. Physical health status was inversely correlated with dependence and worrying; mental health status was positively correlated with trust, and inversely related to attachment-related ambivalence, dependence and worrying. Finally, worrying mediated relationships between dependence and both physical and mental health status; moreover, worrying partially mediated the relationship between ambivalence and mental health status. Implications of the findings are discussed.
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Affiliation(s)
- Paula Oliveira
- Faculty of Psychology and Educational Sciences, University of Porto, Instituto de Consulta Psicológica, Formação e Desenvolvimento, Porto, Portugal.
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