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Journal of Behavioral Medicine

, Volume 38, Issue 3, pp 518–526 | Cite as

Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program

  • John KowalEmail author
  • Lachlan A. McWilliams
  • Katherine Péloquin
  • Keith G. Wilson
  • Peter R. Henderson
  • Dean A. Fergusson
Article

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.

Keywords

Chronic pain Adult attachment Interdisciplinary Treatment outcomes Pain management Psychosocial 

Notes

Acknowledgments

This research was supported by the Canadian Institutes of Health Research (MOP: 93645) and the Centre for Rehabilitation Research and Development of The Ottawa Hospital Rehabilitation Centre.

Conflict of interest

John Kowal, Lachlan A. McWilliams, Katherine Péloquin, Keith G. Wilson, Peter R. Henderson, and Dean A. Fergusson all declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants included in the study.

References

  1. Andersen, T. E. (2012). 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. Social Science and Medicine, 74, 1461–1468.CrossRefPubMedGoogle Scholar
  2. Andrews, N. A., Meredith, P. J., & Strong, J. (2011). Adult attachment and reports of pain in experimentally-induced pain. European Journal of Pain, 15, 523–530.CrossRefPubMedGoogle Scholar
  3. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.CrossRefPubMedGoogle Scholar
  4. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.Google Scholar
  5. Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. London: Penguin Books.Google Scholar
  6. Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult romantic attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York: Guilford Press.Google Scholar
  7. Cano, A., Gillis, M., Heinz, W., Geisser, M., & Foran, H. (2004). Marital functioning, chronic pain, and psychological distress. Pain, 107, 99–106.CrossRefPubMedCentralPubMedGoogle Scholar
  8. Choinière, M., Dion, D., Peng, P., Banner, R., Barton, P. M., Boulanger, A., et al. (2010). The Canadian STOP-PAIN project—Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities? Canadian Journal of Anesthesia, 57, 539–548.CrossRefPubMedGoogle Scholar
  9. Ciechanowski, P., Russo, J., Katon, W., Von Korff, M., Ludman, E., Lin, E., et al. (2004). Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic Medicine, 66, 720–728.CrossRefPubMedGoogle Scholar
  10. Ciechanowski, P., Sullivan, M., Jensen, M., Romano, J., & Summers, H. (2003). The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain, 104, 627–637.CrossRefPubMedGoogle Scholar
  11. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  12. Collins, N. L., & Allard, L. M. (2001). Cognitive representations of attachment: The content and function of working models. In G. J. O. Fletcher & M. S. Clark (Eds.), Blackwell handbook of social psychology (Vol. 2, pp. 60–85)., Interpersonal processes Oxford: Blackwell.Google Scholar
  13. Davies, K. A., Macfarlane, G. J., McBeth, J., Morriss, R., & Dickens, C. (2009). Insecure attachment style is associated with chronic widespread pain. Pain, 143, 200–205.CrossRefPubMedCentralPubMedGoogle Scholar
  14. Davila, J., Karney, B. R., & Bradbury, T. N. (1999). Attachment change processes in the early years of marriage. Journal of Personality and Social Psychology, 76, 783–802.CrossRefPubMedGoogle Scholar
  15. Forsythe, A. P., Romano, J. M., Jensen, M. P., & Thorn, B. E. (2012). Attachment style is associated with perceived spouse responses and pain-related outcomes. Rehabilitation Psychology, 57, 290–300.CrossRefPubMedCentralPubMedGoogle Scholar
  16. Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.CrossRefPubMedGoogle Scholar
  17. Griffin, D., & Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430–445.CrossRefGoogle Scholar
  18. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.CrossRefPubMedGoogle Scholar
  19. International Association for the Study of Pain. (1995). Pain database questionnaire. Seattle: Author.Google Scholar
  20. Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D. (1999). Comparative reliability and validity of chronic pain intensity measures. Pain, 83, 157–162.CrossRefPubMedGoogle Scholar
  21. Kowal, J., Wilson, K. G., Geck, C. M., Henderson, P. R., & D’Eon, J. L. (2011). Changes in perceived pain severity following interdisciplinary treatment for chronic pain. Pain Research & Management, 16, 451–456.Google Scholar
  22. Kowal, J., Wilson, K. G., McWilliams, L. A., Péloquin, K., & Duong, D. (2012). Self-perceived burden in chronic pain: Relevance, prevalence, and predictors. Pain, 153, 1735–1741.CrossRefPubMedCentralPubMedGoogle Scholar
  23. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.CrossRefPubMedGoogle Scholar
  25. Maunder, R. G., & Hunter, J. L. (2009). Assessing patterns of adult attachment in medical practice. General Hospital Psychiatry, 31, 123–130.CrossRefPubMedGoogle Scholar
  26. McWilliams, L. A., & Asmundson, G. J. G. (2007). The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain, 127, 27–34.CrossRefPubMedGoogle Scholar
  27. McWilliams, L. A., & Bailey, S. J. (2010). Associations between adult attachment ratings and health conditions: Evidence from the National Comorbidity Survey Replication. Health Psychology, 29, 446–453.CrossRefPubMedGoogle Scholar
  28. McWilliams, L. A., & Holmberg, D. (2010). Adult attachment and pain catastrophizing for self and significant other. Pain, 149, 278–283.CrossRefPubMedGoogle Scholar
  29. Meredith, P. J. (2013). A review of the evidence regarding associations between attachment theory and experimentally induced pain. Current Pain and Headache Reports, 17, 326.CrossRefPubMedGoogle Scholar
  30. Meredith, P. J., Ownsworth, T., & Strong, J. (2008). A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clinical Psychology Review, 28, 407–429.CrossRefPubMedGoogle Scholar
  31. Meredith, P. J., Strong, J., & Feeney, J. A. (2005). Evidence of a relationship between adult attachment variables and appraisals of chronic pain. Pain Research & Management, 10, 191–200.Google Scholar
  32. Meredith, P. J., Strong, J., & Feeney, J. A. (2006a). The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain, 120, 44–52.CrossRefPubMedGoogle Scholar
  33. Meredith, P. J., Strong, J., & Feeney, J. A. (2006b). Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain, 123, 146–154.CrossRefPubMedGoogle Scholar
  34. Meredith, P. J., Strong, J., & Feeney, J. A. (2007). Adult attachment variables predict depression before and after treatment for chronic pain. European Journal of Pain, 11, 164–170.CrossRefPubMedGoogle Scholar
  35. Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology, 73, 1092–1106.CrossRefPubMedGoogle Scholar
  36. Mikail, S. F., Henderson, P. R., & Tasca, G. A. (1994). An interpersonally based model of chronic pain: An application of attachment theory. Clinical Psychology Review, 14, 1–16.CrossRefGoogle Scholar
  37. Nicholas, M. K. (2007). The Pain Self-Efficacy Questionnaire: Taking pain into account. European Journal of Pain, 11, 153–163.CrossRefPubMedGoogle Scholar
  38. Pietromonaco, P. R., Uchino, B., & Dunkel Schetter, C. (2013). Close relationship processes and health: Implications of attachment theory for health and disease. Health Psychology, 32, 499–513.CrossRefPubMedCentralPubMedGoogle Scholar
  39. Porter, L., Davis, D., & Keefe, F. (2007). Attachment and pain: Recent findings and future directions. Pain, 128, 195–198.CrossRefPubMedCentralPubMedGoogle Scholar
  40. Roisman, G. I., Holland, A., Fortuna, K., Fraley, R. C., Clausell, E., & Clarke, A. (2007). The Adult Attachment Interview and self-reports of attachment style: An empirical rapprochement. Journal of Personality and Social Psychology, 92, 678–697.CrossRefPubMedGoogle Scholar
  41. Schmitt, D. P., Alcalay, L., Allensworth, M., Allik, J., Ault, L., Austers, I., et al. (2004). Patterns and universals of adult romantic attachment across 62 cultural regions: Are models of self and of other pancultural constructs? Journal of Cross Cultural Psychology, 35, 367–402.CrossRefGoogle Scholar
  42. Shaver, P. R., & Hazan, C. (1993). Adult romantic attachment: Theory and evidence. In D. Perlman & W. Jones (Eds.), Advances in personal relationships—Volume 4 (pp. 29–70). London: Jessica Kingsley.Google Scholar
  43. Sibley, C. G., Fischer, R., & Liu, J. H. (2005). Reliability and validity of the revised experiences in close relationships (ECR-R) self-report measure of adult romantic attachment. Personality and Social Psychology Bulletin, 31, 1524–1536.CrossRefPubMedGoogle Scholar
  44. Sullivan, M. J. L. (2012). The communal coping model of pain catastrophising: Clinical and research implications. Canadian Psychology, 53, 32–41.CrossRefGoogle Scholar
  45. Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRefGoogle Scholar
  46. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston: Pearson.Google Scholar
  47. Wilson, K. G., Kowal, J., Henderson, P. H., McWilliams, L. A., & Péloquin, K. (2013). Brief report: Chronic pain and the interpersonal theory of suicide. Rehabilitation Psychology, 58, 111–115.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • John Kowal
    • 1
    • 2
    • 3
    Email author
  • Lachlan A. McWilliams
    • 4
  • Katherine Péloquin
    • 5
  • Keith G. Wilson
    • 1
    • 2
    • 3
  • Peter R. Henderson
    • 1
    • 2
  • Dean A. Fergusson
    • 3
  1. 1.PsychologyThe Ottawa Hospital Rehabilitation CentreOttawaCanada
  2. 2.School of PsychologyUniversity of OttawaOttawaCanada
  3. 3.The Ottawa Hospital Research InstituteOttawaCanada
  4. 4.Department of PsychologyUniversity of SaskatchewanSaskatoonCanada
  5. 5.Département de PsychologieUniversité de MontréalMontréalCanada

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