[논문]Adult attachment and approaches to activity engagement in chronic pain

Andrews, Nicole E; Meredith, Pamela J; Strong, Jenny; Donohue, Genevieve F

Adult attachment and approaches to activity engagement in chronic pain

Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur, v.19 no.6, 2014년, pp.317 - 327

Andrews, Nicole E (Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland) , Meredith, Pamela J , Strong, Jenny (Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland) , Donohue, Genevieve F

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Individuals with chronic pain exhibit a wide range of coping mechanisms, some of which are maladaptive (eg, activity avoidance or overactivity). The authors of this study aimed to investigate whether individuals may be predisposed to develop a particular maladaptive coping mechanism based on their attachment style (dismissing, preoccupied, fearful or secure), which represents a core feature of their personality.BACKGROUND:The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning.OBJECTIVE:To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework.METHODS:A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression).RESULTS:Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing.CONCLUSIONS:These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.

Abstract

HISTORIQUE :L’attitude habituelle des personnes souffrant de douleur chronique envers l’activité physique influe sur leur fonctionnement quotidien. L’évitement des activités quotidiennes et l’activité excessive (qui exacerbent considérablement la douleur) s’associent parfois tous deux à plus de douleur, à un taux plus élevé d’invalidité physique et à un fonctionnement psychologique plus négatif.OBJECTIF :Donner un aperçu de l’acquisition d’une attitude mésadaptée envers l’activité en cas de douleur chronique, selon la théorie de l’attachement.MÉTHODOLOGIE :Un échantillon de 164 adultes atteints de douleur chronique ont transmis leurs mesures autodéclarées d’attachement, d’attitude envers l’activité et de cognitions de la douleur. Des analyses de médiation ont été entreprises pour examiner l’association directe entre les variables liées à l’attachement et les attitudes mésadaptées envers l’activité, ainsi que pour vérifier le rôle médiateur des cognitions de la douleur (catastrophisation et suppression de la pensée).RÉSULTATS :Les résultats ont démontré que des taux plus élevés d’attachement solide s’associent à un taux plus faible d’évitement de l’activité, entièrement médiés par des taux plus faibles de catastrophisation de la douleur. Des taux plus élevés d’attachement de type préoccupé ou craintif s’associent directement à des taux plus élevés de suractivité, tandis que des taux plus élevés d’attachement de type préoccupé s’associent à des taux plus élevés d’évitement de l’activité, médiés partiellement par des taux plus élevés de catastrophisation de la douleur. Enfin, des taux plus élevés d’attachement de type craintif s’associaient indirectement à des taux plus élevés d’évitement de l’activité, en raison de taux plus élevés de catastrophisation.CONCLUSIONS :À première vue, ces résultats appuient la suggestion selon laquelle un attachement fragile peut favoriser l’acquisition de profils d’activité invalidants en cas de douleur chronique.

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Adult attachment and approaches to activity engagement in chronic pain

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