Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability

Meredith, Pamela; Strong, Jenny; Feeney, Judith A.

doi:10.1016/j.pain.2006.02.025

Cited by 195 publications

(166 citation statements)

References 36 publications

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“…Similarly, in a sample that included both pain patients and community volunteers, anxious attachment was associated with higher levels of pain intensity and pain-related suffering (MacDonald & Kingsbury, 2006). Among chronic pain patients being treated at a multidisciplinary pain clinic, those who scored high on attachment avoidance and low on pain self-efficacy had particularly high levels of pain intensity (Meredith et al, 2006a). However, other studies have failed to find significant associations between attachment and pain intensity: Williamson et al (2002) measured attachment in children having persistent disease-related pain and their caregivers.…”

Section: Literature Reviewmentioning

confidence: 99%

Attachment and pain: Recent findings and future directions

Porter

Davis

Keefe

2007

Pain

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Long standing interest in individual differences linked to the experience of, and adjustment to, pain has recently expanded to include the "attachment styles" (Bowlby, 1982) of both pain patients and their caregivers. Following a brief review of the nature and origin of attachment styles, we review recent research addressing issues regarding attachment and pain and offer suggested directions for future research. Bowlby (1982) proposed that the attachment system is formed during infancy and early childhood based upon the nature of the child's interactions with primary caregivers, particularly interactions surrounding affect regulation and management of distress. Theoretically, attachment behaviors (such as seeking closeness and comfort from a caregiver) are triggered by threats of three kinds: threats to the subjective availability of the caregiver, internal distress (e.g., from hunger, illness, or pain), or external threats to safety or wellbeing. Based on the pattern of caregiver responses during these early interactions, the child develops specific internal mental models or schemas regarding themselves and others that form the basis of enduring strategies for need satisfaction and affect regulation. These mental models (or "attachment styles") tend to remain stable "from cradle to grave" (Bowlby, 1982), and affect cognitions, emotions and behaviors in virtually all domains of life (see Mikulincer & Shaver, 2003 for a review of the development and impact of attachment styles). The Concept of AttachmentAttachment researchers have identified four attachment styles that vary along two dimensions: attachment anxiety (worry over the availability, responsiveness, and positive regard of others) and attachment avoidance (discomfort with closeness and interdependence). Those with a "secure" attachment style are low on both dimensions, whereas "preoccupied" persons are high in anxiety but low in avoidance, "dismissing" persons are high in avoidance and low in anxiety, and "fearful" persons are high in both.Of particular importance to the issue of the experience and management of pain, attachment style has been linked to appraisal of and reactions to threats of all kinds (Mikulincer & Shaver, 2003, in press). Secure persons tend to engage in the most realistic appraisal of threats, possess greater optimism and self-efficacy regarding threat-related management and outcomes, and experience the most positive outcomes. Both dimensions of attachment insecurity, however, are associated with less optimal emotions and behaviors.

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Section: Literature Reviewmentioning

confidence: 99%

Attachment and pain: Recent findings and future directions

Porter

Davis

Keefe

2007

Pain

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“…Pain severity might correlate to anxiety and fears [8,12], poor pain coping [28], anger in men [21], and pain duration [28].…”

Section: Fear Anger and Durationmentioning

confidence: 99%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27-45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain ''right now'' on a 0-100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75-100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P \ 0.001), and reported pain anxiety more often (P \ 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36-69 vs. md 72, IQR 51-85), (P \ 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8-4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40-45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7-10.0 and 2.7; 95% CI 1.1-6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1-3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95-4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.

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“…These results correspond to the central purpose of this study and are consistent with our initial predictions, suggesting that individual differences in the perception and expression of pain reflect a person's attachment needs, ability to regulate negative emotions 17 and different abilities to cope with pain. 24 Together, these results seem to depict attachment insecurity as a potential risk factor which can lead to poor coping with pain and maladjustment; and attachment security as a more adaptive trait and an important inner resource in the face of stress-inducing events, allowing the individual to positively appraise stressful events and turn to others for support and comfort. Although unexpected, the lack of a significant association between attachment style and post-delivery pain may result from differences in the experience of this important period (the first mother-baby contact), as it is possible that the pain experienced may be influenced by positive emotions that usually characterize the early postpartum period.…”

Section: Discussionmentioning

confidence: 91%

“…21,22 Other studies, however, have reported no association between attachment and pain intensity. 13,[23][24][25] Given these conflicting findings, and given that, to the best of our knowledge, no studies have investigated how attachment is associated with labour pain, this study aimed at assessing the relevance of attachment styles to the prediction of pain during labour and post-delivery.…”

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confidence: 99%

Women’s Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational Study

et al. 2014

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Introduction:Labour is considered to be one of the most painful and significant experiences in a woman's life. The aim of this study was to examine whether women's attachment style is a predictor of the pain experienced throughout labour and post-delivery. Material and Methods: Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale -Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery. Results:Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery. Discussion: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman's attachment style may be a risk factor for greater pain during labour. Conclusion:Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures.

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Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability

Cited by 195 publications

References 36 publications

Attachment and pain: Recent findings and future directions

Attachment and pain: Recent findings and future directions

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Women’s Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational Study

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