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
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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- "To date, only two studies have prospectively assessed the impact of attachment on functioning following treatment for chronic pain. Meredith et al. (2007), in a sample of 99 patients treated in a multidisciplinary treatment program, found that pre-treatment attachment avoidance predicted less improvement in depressive symptoms after controlling for pre-treatment depression scores. Andersen (2012) investigated associations between attachment insecurity and a broader range of pain-related outcomes in 72 multidisciplinary pain clinic patients. "
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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- "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. "
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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- "The negative association between avoidant attachment and subjective well-being has in fact been found among patients suffering from chronic pain. Chronic pain patients with high avoidant attachment were reported to have a greater level of depression in multiple studies (Ciechanowski, Sullivan, Jensen, Romano, & Summers, 2003; Meredith, Strong, & Feeney, 2007). "
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.