Dyadic interventions and attachment style in patient and caregiver populations coping with chronic pain

Abstract

Background: Chronic Pain is increasingly conceptualised as a phenomenon dictated by social context and close relationships, with some interventions electing to include a significant other in the treatment process. Moreover, research regarding attachment style and chronic pain is limited, particularly in regards to how the attachment style of significant others influences the patient’s pain experience. Aims: This thesis had two aims; to systematically review the literature investigating dyadic interventions in chronic pain populations (Chapter 1), and to use Conditional Process Analysis and Hierarchical Regression to explore how attachment style influences established aspects of pain experience (Chapter 2). Method: Controlled studies exploring the efficacy of dyadic psychosocial interventions targeting distress were reviewed systematically. The empirical study employed Conditional Process Analysis and Hierarchical Regression to investigate the predictive capacity of both patients and partner attachment in predicting Depression, Self-Efficacy, Pain Disability and Psychological Flexibility. Results: Findings of the systematic review indicate that dyadic interventions are effective in reducing distress, but due to the limited quality of evidence, it is not yet possible to determine whether they are superior to patient-only interventions. The results of the empirical study suggest that attachment avoidance in patients has unique predictive capacity in depression and self-efficacy outcomes. Partner attachment avoidance was found to influence levels of the patient’s psychological flexibility. Findings from the empirical study suggest that avoidant attachment may amplify the relationship between pain intensity, pain catastrophizing and psychological distress; assessing the attachment style of patients may help to tailor psychological intervention to patient need. Avoidant partners may influence patient levels of psychological flexibility, and therefore interpersonal attachment could be a future consideration in Acceptance and Commitment Therapy Trials.