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Kasper LA, Pfeifer AC, Volkert J, Schiltenwolf M, Taubner S. [Mentalizing the pain-Implementation of a mentalization-based manual for the therapeutic support of pain patients.]. Schmerz 2024; 38:118-124. [PMID: 37071211 DOI: 10.1007/s00482-023-00709-6] [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: 12/21/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 04/19/2023]
Abstract
Chronic pain is usually a complex disorder with possible indications for an impairment at the personality functioning level. Guidelines recommend a multiprofessional interdisciplinary treatment approach. Based on the alternative model of personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Classification of Diseases, eleventh revision (ICD-11), an integrative manual was designed to exactly fit the interdisciplinary multimodal treatment of patients of the day clinic for pain at the orthopedic clinic of the University Hospital Heidelberg. The treatment manual specifically promotes various areas of personality functioning levels, such as emotion regulation, identity, empathy and relationships through individual and group interventions against the background of a mentalization-based therapeutic attitude. A focus group was used to qualitatively evaluate the implementation of the new treatment manual. With good applicability of the manual and satisfaction of the therapy team, a common language for the interdisciplinary team could be created to improve the therapeutic interaction.
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Affiliation(s)
- L A Kasper
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimerstr. 54, 69115, Heidelberg, Deutschland.
- Psychologisches Institut, Universität Heidelberg, Heidelberg, Deutschland.
| | - A-C Pfeifer
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J Volkert
- Abteilung Psychologie, Medical School Berlin, Berlin, Deutschland
| | - M Schiltenwolf
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Taubner
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimerstr. 54, 69115, Heidelberg, Deutschland
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Müller S, Spitzer C, Flemming E, Ehrenthal JC, Mestel R, Strauß B, Lübke L. Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment. J Pers Assess 2024; 106:218-229. [PMID: 37493362 DOI: 10.1080/00223891.2023.2238816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.
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Affiliation(s)
- Sascha Müller
- Department of Psychology, University of Kassel, Kassel, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | - Eva Flemming
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | | | - Robert Mestel
- Department of Psychosomatics, VAMED Rehabilitation Clinic Bad Grönenbach, Bad Grönenbach, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Laura Lübke
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, Rostock, Germany
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3
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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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Liddiard KJ, Raynor AJ, DeJong H, Brown CA. The experience of meaningful rehabilitation as perceived by people with chronic pain: A phenomenological study. Work 2022:WOR220119. [DOI: 10.3233/wor-220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: People with chronic pain may seek rehabilitation to reduce pain and restore productivity and valued roles. Theoretically, a biopsychosocial approach makes rehabilitation more meaningful, however, the limited research on meaningful rehabilitation predominantly describes the perspective of therapists and researchers. The client’s perspective of meaningfulness in rehabilitation is lacking. OBJECTIVE: To investigate the experience of meaningfulness in rehabilitation from the perspective of people with chronic pain. METHOD: Qualitative, semi-structured interviews were conducted with Australian adults who had chronic pain and recent experience of occupational therapy or physiotherapy. Sampling continued until thematic saturation occurred. Transcripts were coded and analyzed using theory-driven and data-driven thematic analysis. RESULTS: Ten participants (four males; six females) were interviewed. Pain histories ranged from nine months to 20+ years, with conditions such as fibromyalgia or trauma. Three themes from a prior concept analysis were upheld, and a further three data-driven themes emerged. Results indicate that people with chronic pain seek a “genuine connection”; from a therapist who is “credible”; and can become a “guiding partner”, and they find rehabilitation meaningful when it holds “personal value”; is “self-defined”; and relevant to their sense of “self-identity”. CONCLUSIONS: The genuine connection and guiding partnership with a credible therapist, that is sought by people with chronic pain, may be at odds with aspects of contemporary rehabilitation. Client-defined meaningfulness is an important construct to engage clients in treatment and improve work and other occupational outcomes for people with chronic pain.
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Affiliation(s)
- Katrina J. Liddiard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Annette J. Raynor
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Helen DeJong
- Perth Scar and Pain Clinic, Mount Pleasant, WA, Australia
| | - Cary A. Brown
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Maras D, Balfour L, Lefebvre M, Tasca GA. Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:634. [PMID: 36052881 PMCID: PMC9893049 DOI: 10.4081/ripppo.2022.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023]
Abstract
Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.
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Affiliation(s)
- Danijela Maras
- School of Psychology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5 Canada.
| | - Louise Balfour
- School of Psychology, Faculty of Medicine, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Monique Lefebvre
- School of Psychology, University of Ottawa; The Ottawa Hospital; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Giorgio A. Tasca
- School of Psychology, Faculty of Medicine, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Nyland JE, Escolas HD, Archuleta D, Aden JK, Escolas SM. Attachment Style and Burn Pain. J Burn Care Res 2022; 43:1386-1393. [PMID: 35395671 DOI: 10.1093/jbcr/irac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pain management is a challenge when treating patients with burn injuries. Understanding the behavioral and interpersonal aspects of the experience of burn pain may aid in its management. Attachment style-which influences how an individual relates to other people-is one aspect that may affect the experience of burn pain. Past research has shown a relationship between an individual's attachment style and certain types of pain and disorders. The study builds upon that past work to investigate specifically how attachment style affects the experience of acute burn pain. Participants were at least 18 years old and admitted to an American Burn Association verified burn center with burns encompassing 30% or less total body surface area. Participants completed demographic questionnaires and a standardized measure of adult attachment style. Data regarding use of analgesics, daily pain scores, and burn-related information were collected through medical chart review. Participants who reported a secure attachment style required less pain medication and reported less pain compared with participants who reported an insecure attachment style. There was no difference in burn-related variables between participants with secure and insecure attachment styles, suggesting that these differences were not due to burn-related factors. Attachment, therefore, may play a role in an individual's perception of acute burn pain, which impacts analgesic requirements needed to manage the pain. These results have potential implications for the use of psychosocial interventions to reduce the experience of pain and the amount of pain medication needed to manage acute burn pain.
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Affiliation(s)
- Jennifer E Nyland
- United States Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA.,Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Hollie D Escolas
- United States Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA
| | - Debra Archuleta
- United States Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA.,The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James K Aden
- United States Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA.,Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Sandra M Escolas
- United States Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, TX, USA
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Paap D, Krops LA, Schiphorst Preuper HR, Geertzen JHB, Dijkstra PU, Pool G. Participants' unspoken thoughts and feelings negatively influence the therapeutic alliance; a qualitative study in a multidisciplinary pain rehabilitation setting. Disabil Rehabil 2021; 44:5090-5100. [PMID: 33970736 DOI: 10.1080/09638288.2021.1924297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting. MATERIALS AND METHODS A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth. RESULTS Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered. CONCLUSIONS Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered.Implications for rehabilitationDifferences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance.When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences.From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required.It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans.During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants.
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Affiliation(s)
- Davy Paap
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henrica R Schiphorst Preuper
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Grieteke Pool
- Faculty of Medical Sciences, Section Health Psychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Ickmans K, Voogt L, Nijs J. Rehabilitation Succeeds Where Technology and Pharmacology Failed: Effective Treatment of Persistent Pain across the Lifespan. J Clin Med 2019; 8:jcm8122042. [PMID: 31766486 PMCID: PMC6947016 DOI: 10.3390/jcm8122042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kelly Ickmans
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (L.V.); (J.N.)
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-(0)24774503
| | - Lennard Voogt
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (L.V.); (J.N.)
- Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (L.V.); (J.N.)
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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