Pamela Meredith

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

Abstract Pain self‐efficacy and anxiety have each been shown to contribute substantially to pain intensity and pain‐related disability. Although adult attachment theory has been related separately to chronic pain, anxiety, and self‐efficacy, it has not before been investigated with either pain self‐efficacy or anxiety in the context of chronic pain. This study investigated the interrelations between these aspects of the chronic pain experience and their relative contributions towards pain intensity and disability. A clinical sample of 152 chronic pain patients participated in this study, completing self‐report measures of attachment, self‐efficacy, pain intensity, and disability, prior to attending a multidisciplinary pain clinic. Results revealed that fearful and preoccupied (anxious) attachment categories were associated with low pain self‐efficacy, while high scores on the attachment dimension of comfort with closeness were linked with high pain self‐efficacy, particularly for males. Insecure attachment (whether defined in terms of categories or dimensions) was related to higher levels of anxiety. Pain self‐efficacy proved a stronger predictor of pain intensity than did anxiety and was a stronger predictor of disability than pain intensity or anxiety. In addition, comfort with closeness moderated the associations between pain self‐efficacy and disability, pain self‐efficacy and pain intensity, and anxiety and disability. Together, these findings support the value of adopting an attachment theoretical approach in the context of chronic pain. Treatment considerations and future research directions are considered.

The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain.

Abstract Although insecure attachment has been associated with a range of variables linked with problematic adjustment to chronic pain, the causal direction of these relationships remains unclear. Adult attachment style is, theoretically, developmentally antecedent to cognitions, emotions and behaviours (and might therefore be expected to contribute to maladjustment). It can also be argued, however, that the experience of chronic pain increases attachment insecurity. This project examined this issue by determining associations between adult attachment characteristics, collected prior to an acute (coldpressor) pain experience, and a range of emotional, cognitive, pain tolerance, intensity and threshold variables collected during and after the coldpressor task. A convenience sample of 58 participants with no history of chronic pain was recruited. Results demonstrated that attachment anxiety was associated with lower pain thresholds; more stress, depression, and catastrophizing; diminished perceptions of control over pain; and diminished ability to decrease pain. Conversely, secure attachment was linked with lower levels of depression and catastrophizing, and more control over pain. Of particular interest were findings that attachment style moderated the effects of pain intensity on the tendency to catastrophize, such that insecurely attached individuals were more likely to catastrophize when reporting high pain intensity. This is the first study to link attachment with perceptions of pain in a pain‐free sample. These findings cast anxious attachment as a vulnerability factor for chronic pain following acute episodes of pain, while secure attachment may provide more resilience.

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

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.

Evidence of a relationship between adult attachment variables and appraisals of chronic pain

OBJECTIVE Although threat and challenge appraisals of pain have been linked to both the acute and laboratory-induced pain experience, these appraisals have not yet been explored in relation to chronic pain. In addition, although attachment theory has been separately linked to the chronic pain experience and to responses to perceived threat, it has not been explored in the context of threat and challenge appraisals of chronic pain. The present paper addresses these two main goals. METHODS A sample of 141 participants reporting noncancer pain longer than two months in duration completed a battery of assessments before commencing treatment in one of two multidisciplinary rehabilitation programs. RESULTS Analysis of the pain appraisal inventory produced two factors (threat and challenge), replicating earlier findings. Reliability coefficients for the two extracted scales were 0.87 and 0.86, respectively. Links between the two pain appraisal scales and adult attachment variables proved to be significant. In particular, comfort with closeness was strongly related to challenge appraisal, while anxiety over relationships was strongly associated with threat appraisal. As expected, both appraisals and attachment variables were also related to catastrophizing and emotional distress. CONCLUSIONS Results support use of the pain appraisal inventory as an evaluation tool for those with chronic pain. Findings further suggest a substantial association between adult attachment and pain appraisal, supporting the need for more in-depth analysis and consideration of implications for treatment.

Attachment and Infant Difficultness in Postnatal Depression

This project investigated the relationship between attachment style and postnatal depression. In a sample of mothers with infants, those identifying themselves as depressed reported a more preoccupied attachment style by comparison with their nondepressed counterparts. Maternal attachment style was not related to perceived infant characteristics or to the reported mother-child relationship. Postnatal depression, however, was related to both perceived infant characteristics and the reported mother-child relationship. Although postnatal depression was not significantly related to marital quality, a trend did emerge between attachment style and marital quality. These findings suggest that further research is warranted to clarify the relationship between attachment style and postnatal depression.

Adult attachment and reports of pain in experimentally-induced pain.

Attachment theory has been proposed as a framework for understanding the development of chronic pain, with evidence supporting the overrepresentation of insecure attachment styles in chronic pain populations and links between insecure attachment and factors known to impact ones ability to cope with pain. The present study sought to extend two earlier studies exploring the relationships between adult attachment and communication of an acute pain experience, in anticipation of providing insight into individual differences in vulnerability in development of chronic pain. It was hypothesised that: (a) fearful attachment would be associated with perceptions of the pain as less intense, and (b) anxious attachment would be associated with lower pain thresholds. A convenience sample of 82 healthy adults completed self‐report measures of attachment, neuroticism, and negative affect prior to taking part in a coldpressor pain inducement task. Results demonstrated that fearful attachment was associated with lower levels of pain intensity throughout the coldpressor task. In addition, dismissing attachment was also associated with less intense pain, as well as increased coldpressor endurance (tolerance) in the presence of a known assessor. These associations were retained after controlling for measures of neuroticism, negative affect, age, and social desirability. The results of this study are consistent with the proposition that fearful and dismissing individuals tend to mask their underlying distress caused by the pain experience, potentially leading to difficulties coping with pain over time.Attachment theory has been proposed as a framework for understanding the development of chronic pain, with evidence supporting the overrepresentation of insecure attachment styles in chronic pain populations and links between insecure attachment and factors known to impact ones ability to cope with pain. The present study sought to extend two earlier studies exploring the relationships between adult attachment and communication of an acute pain experience, in anticipation of providing insight into individual differences in vulnerability in development of chronic pain. It was hypothesised that: (a) fearful attachment would be associated with perceptions of the pain as less intense, and (b) anxious attachment would be associated with lower pain thresholds. A convenience sample of 82 healthy adults completed self-report measures of attachment, neuroticism, and negative affect prior to taking part in a coldpressor pain inducement task. Results demonstrated that fearful attachment was associated with lower levels of pain intensity throughout the coldpressor task. In addition, dismissing attachment was also associated with less intense pain, as well as increased coldpressor endurance (tolerance) in the presence of a known assessor. These associations were retained after controlling for measures of neuroticism, negative affect, age, and social desirability. The results of this study are consistent with the proposition that fearful and dismissing individuals tend to mask their underlying distress caused by the pain experience, potentially leading to difficulties coping with pain over time.

It's very hard to change yourself: an exploration of overactivity in people with chronic pain using interpretative phenomenological analysis

Abstract Overactivity (activity engagement that significantly exacerbates pain) is a common term in the chronic pain literature. Overactivity is accepted clinically as a behaviour that adversely affects an individuals daily functioning and is the target of one of the most widely endorsed pain management strategies among health professionals (ie, activity pacing). Little research, however, has investigated links between overactivity behaviour and indicators of patient functioning, and activity pacing has not been evaluated as a stand-alone treatment specifically for individuals with chronic pain who are habitually overactive. Two studies, using qualitative research designs and interpretative phenomenological analyses, were conducted to provide insight into (1) why certain individuals develop habitual overactivity patterns in response to pain, (2) the impact of overactivity on daily functioning, and (3) the value of activity pacing as a treatment strategy for this population. Findings suggest that overactivity behaviour is complex, influenced by multiple factors, and negatively impacts on multiple quality-of-life domains. Some participants who were followed up 3 to 6 months after a pain management program were able to learn pacing strategies and enact behaviour change with health professional support; however, the majority reported difficulties changing their behaviour after treatment. It is suggested that provision of pacing education, alone, to chronic pain patients who engage in overactivity behaviour may not be effective in eliciting behavioural change. Key factors that participants believed to contribute to the development and maintenance of their overactive behaviour in this study should be considered in future clinical approaches and empirical investigations.

Enhancing retention of occupational therapists working in mental health: relationships between wellbeing at work and turnover intention.

BACKGROUND/AIM Occupational therapists working in mental health who experience burnout, low work engagement or poor job satisfaction are at risk of poor wellbeing at work and may be more likely to leave their jobs. The aim of this project was to explore factors associated with wellbeing at work and turnover intention in a sample of occupational therapists working in mental health. METHODS One hundred and three occupational therapists working in mental health in Queensland completed a survey exploring work/life balance, effort invested in work, rewards received from work, wellbeing at work (job satisfaction, burnout and work engagement) and turnover intention. Analyses were conducted to explore relationships between work/life balance, effort, reward, wellbeing at work and turnover intention. RESULTS All measures of wellbeing at work were significantly associated with turnover intention. A large proportion (33%) of the variance in turnover intention was predicted by job satisfaction. Perceptions of both work/life balance and effort invested in work, as well as perceived rewards in terms of recognition, prestige and personal satisfaction were significantly associated with work-related wellbeing scores. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY Results from this study deepen the understanding of factors associated with wellbeing at work and turnover intention for occupational therapists in mental health. This knowledge will support the development of interventions aimed at reducing turnover intention and enhancing retention of occupational therapists in the mental health workforce.

Attachment Styles and Factors affecting Career Choice of Occupational Therapy Students

Adult attachment theory, a theory of personality, has been connected to a range of factors that may contribute to ones professional choice, job satisfaction and performance. To date, the implications of this theory for the profession of occupational therapy have not been investigated. This study examined the adult attachment styles of 124 first and fourth year occupational therapy students at The University of Queensland in relation to factors affecting career choice and satisfaction with career choice. The results showed that the majority of the participants had a secure attachment style, were people orientated and were satisfied with their choice of career. In accordance with adult attachment theory, the participants with a secure attachment style rated people-orientated factors as important when choosing occupational therapy as a career and were more satisfied with their choice of career than the participants with an insecure attachment style. The study suggests that adult attachment style might warrant consideration in light of recruitment and retention.

Overactivity in chronic pain: is it a valid construct?

Overactivity is a frequently used term in chronic pain literature. It refers to the phenomenon whereby individuals engage in activity in a way that significantly exacerbates pain, resulting in periods of incapacity. Overactivity, as a construct, has been derived solely from patients’ self-reports, raising concerns about the legitimacy of the construct. Self-reported overactivity reflects an individual’s belief, collected retrospectively, that their earlier activity levels have resulted in increased levels of pain. This may be different to an individual actually engaging in activity in a way that significantly exacerbates pain. In the present study, a five-day observational study design was employed to investigate the validity of overactivity as a construct by examining the relationship between a self-report measure of overactivity, patterns of pain, and objectively measured physical activity over time. A sample of 68 adults with chronic pain completed a questionnaire investigating self-reported habitual engagement in overactivity and activity avoidance behaviour, before commencing five days of data collection. Over the five-day period participants wore an activity monitor, and recorded their pain intensity six times a day using a handheld computer. Associations were found between: 1) high levels of pain and both high overactivity and high avoidance, 2) high levels of overactivity and more variation in pain and objective activity across days, and 3) high levels of overactivity and the reoccurrence of prolonged activity engagement followed by significant pain increases observed in data sets. These results offer some preliminary support for the validity of overactivity as a legitimate construct in chronic pain.