Adult attachment variables predict depression before and after treatment for chronic pain

Division of Occupational Therapy, The University of Queensland, St. Lucia, Qld 4072, Australia.
European Journal of Pain (Impact Factor: 2.93). 03/2007; 11(2):164-70. DOI: 10.1016/j.ejpain.2006.01.004
Source: PubMed

ABSTRACT The complex relationship between chronic pain and depression has long been of clinical and empirical interest. Although attachment theory has been described as a "theory of affect regulation", and has been lauded as a developmental framework for chronic pain, surprisingly little research specifically considers the links between adult attachment variables and pain-related depression. A sample of 99 participants with chronic pain of non-cancer origin was evaluated before and after pain rehabilitation. Results demonstrated that two attachment dimensions (comfort with closeness and relationship anxiety) were related to pre- and post-treatment depression. Of particular interest was the finding that comfort with closeness was the unique predictor of lower levels of post-treatment depression, usurping pain intensity and pre-treatment depression. These results are discussed in terms of clinical implications, and suggest that adult attachment theory may prove a valuable perspective in pain treatment programs.

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Available from: Jenny, Professor - Strong, Sep 15, 2015
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    • "Future research could be enhanced by examining patients' engagement in treatment, their therapeutic alliances with health care providers, and their participation as members of a group. Consistent with some past research (Andersen, 2012; Meredith et al., 2007), the attachment variables were unrelated to pain intensity and disability. Because the treatment program was designed for patients with generally high levels of pain and disability, the absence of associations between these measures and attachment characteristics could reflect a restriction of range. "
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    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.
    Journal of Behavioral Medicine 02/2015; 38(3). DOI:10.1007/s10865-015-9623-8 · 3.10 Impact Factor
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    • "This fact implied demands on the therapist to try to create a secure base in therapy from where the patient could feel safe to try new strategies, just like the small child exploring the world with its mother as a secure base (Bowlby, 1988). An adult insecure attachment pattern both represents a risk factor for developing chronic pain and a vulnerability factor for poor outcome (Meredith, Strong, & Feeney, 2007). In this study the therapy was experienced as a secure base that could strengthen and empower the patients. "
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    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.
    International Journal of Qualitative Studies on Health and Well-Being 08/2014; 9:24420. DOI:10.3402/qhw.v9.24420 · 0.93 Impact Factor
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    • "However, the hypothesis regarding the association between the attachment dimensions and anxiety and depression was confirmed. Similar to Ciechanowski et al. (2003) and Meredith et al. (2007), we found that both attachment dimensions were significantly related to anxiety and depression. In addition, the hypothesis regarding the association between attachment avoidance and the use of opioids was confirmed. "
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    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.
    Social Science [?] Medicine 02/2012; 74(9):1461-8. DOI:10.1016/j.socscimed.2012.01.009 · 2.89 Impact Factor
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