The role of attachment in medically unexplained symptoms and long-term illness

Medically unexplained symptoms (MUS) are common and costly in both primary and secondary health care. It is gradually being acknowledged that there needs to be a variety of interventions for patients with MUS to meet the needs of different groups of patients with such chronic long-term symptoms. The proposed intervention described herewith is called The BodyMind Approach (TBMA) and promotes learning for self-management through establishing a dynamic and continuous process of emotional self-regulation. The problem is the mismatch between the patient’s mind-set and profile and current interventions. This theoretical article, based on practice-based evidence, takes forward the idea that different approaches (other than cognitive behavioural therapy) are required for people with MUS. The mind-set and characteristics of patients with MUS are reflected upon to shape the rationale and design of this novel approach. Improving services for this population in primary care is crucial to prevent the iterative spiraling downward of frequent general practitioner (GP) visits, hospital appointments, and accident and emergency attendance (A&E), all of which are common for these patients. The approach derives from embodied psychotherapy (authentic movement in dance movement psychotherapy) and adult models of learning for self-management. It has been developed from research and practice-based evidence. In this article the problem of MUS in primary care is introduced and the importance of the reluctance of patients to accept a psychological/mental health referral in the first instance is drawn out. A description of the theoretical underpinnings and philosophy of the proposed alternative to current interventions is then presented related to the design, delivery, facilitation, and educational content of the program. The unique intervention is also described to give the reader a flavor.

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“…Some insecure attachment styles have been correlated with MUS, for example avoidant/dismissive ( Adshead and Guthrie, 2015 ).…”

Section: Patient Profilementioning

confidence: 99%

“…Aspects of self and identity which could be threatened in MUS may be those which are embodied and not easily verbalized. Insecure attachment style is often displayed by such a patient population ( Taylor et al, 2012 ; Adshead and Guthrie, 2015 ).…”

Section: The Bodymind Approachmentioning

confidence: 99%

Different Strokes for Different Folks: The BodyMind Approach as a Learning Tool for Patients With Medically Unexplained Symptoms to Self-Manage

Payne

Brooks

2018

Front. Psychol.

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“…As aforementioned, to be a care provider is to be available to the patient when he/she needs it the most, which is paralleled with what the attachment theory states about the caregiving system. Researchers (Adshead & Guthrie, 2015;Wilhelm & Tietze, 2016) show that attachment patterns influence the relationships with healthcare professionals (i.e., doctors) and if they are missing or deficient they lead to weaker adherence and illness management. Other studies (Micelli, 2009;Tan, Zimmermann & Rodin, 2005) posit that an empathic stance towards the patients may result in therapeutic success, meaning empathic responsiveness to attachment needs and threats.…”

Section: The Doctor-patient Relationship and The Caregiving System: Bmentioning

confidence: 99%

O sistema de cuidado e a relação médico-paciente: respondendo às necessidades do outro

Neves

Grillo

Sollero-de-Campos

2019

Av. Psicol. Latinoam.

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El sistema de cuidado en salud y la relación médico-paciente: responder a las necesidades del otro O sistema de cuidado e a relação médico-paciente: respondendo às necessidades do outro AbstractThe attachment theory states that human beings have in parallel an attachment system, an exploratory system and a caregiving system. The caregiving system is the counterpart of both the attachment and the exploratory systems. The caregiving system consists of providing safe haven to which the individual can go back when feeling threatened, and a secure base from which he/she can explore the environment. The caregiving system can also be experienced in the doctor-patient relationship. To be a care provider means to be available when one is most needed. Attachment patterns influence the doctor's relationships, affecting the adherence and the illness management. Taking care of his/her patients in times of need is equivalent to activate the doctor's own caregiving system to protect and secure the patient's health and wellbeing. An open and available doctor means a more open, present, secure and confident patient.

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“…This article builds on attachment theory (Bowlby, 1969; Holmes, 1993, 1994; Main, 2000; Holmes and Slade, 2018) and draws the links made between it and medically unexplained symptoms (MUS) by Adshead and Guthrie (2015). Its contribution to knowledge lies in that it describes how a novel group model, using a biopsychosocial perspective, called The BodyMind Approach ® (TBMA) (Payne, 2009a, b, 2015) supports people with MUS who also have insecure attachment.…”

Section: Introductionmentioning

confidence: 99%

“…This article discusses how The BodyMind Approach ® (TBMA) addresses insecure attachment styles in medically unexplained symptoms (MUS). Insecure attachment styles are associated with adverse childhood experiences (ACEs) and MUS (Adshead and Guthrie, 2015) and affect sufferers’ capacity to self-manage. The article goes on to make a new hypothesis to account for TBMA’s effectiveness (Payne and Brooks, 2017), that is, it addresses insecure attachment styles, which may be present in some MUS sufferers, leading to their capacity to self-manage.…”

mentioning

confidence: 99%

Medically Unexplained Symptoms and Attachment Theory: The BodyMind Approach®

Payne

Brooks

2019

Front. Psychol.

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This article discusses how The BodyMind Approach® (TBMA) addresses insecure attachment styles in medically unexplained symptoms (MUS). Insecure attachment styles are associated with adverse childhood experiences (ACEs) and MUS (Adshead and Guthrie, 2015) and affect sufferers’ capacity to self-manage. The article goes on to make a new hypothesis to account for TBMA’s effectiveness (Payne and Brooks, 2017), that is, it addresses insecure attachment styles, which may be present in some MUS sufferers, leading to their capacity to self-manage. Three insecure attachment styles (dismissive, pre-occupied and fearful) associated with MUS are discussed. TBMA is described and explanations provided of how TBMA has been specifically designed to support people’s insecure attachment styles. Three key concepts to support insecure attachment styles involved in the content of TBMA are identified and debated: (a) emotional regulation; (b) safety; and (c) bodymindfulness. There is a rationale for the design of TBMA as opposed to psychological interventions for this population. The programme’s structure, facilitation and content, takes account of the three insecure attachment styles above. Examples of how TBMA works with their specific characteristics are presented. TBMA has been tested and found to be effective during delivery in the United Kingdom National Health Service (NHS). Improved self-management has potential to reduce costs for the NHS and in General Practitioner time and resources.

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The role of attachment in medically unexplained symptoms and long-term illness

Cited by 45 publications

References 57 publications

Different Strokes for Different Folks: The BodyMind Approach as a Learning Tool for Patients With Medically Unexplained Symptoms to Self-Manage

Different Strokes for Different Folks: The BodyMind Approach as a Learning Tool for Patients With Medically Unexplained Symptoms to Self-Manage

O sistema de cuidado e a relação médico-paciente: respondendo às necessidades do outro

Medically Unexplained Symptoms and Attachment Theory: The BodyMind Approach®

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