Insecure attachment, mentalizing, and pain aspects in patients with chronic pain
Chronic pain is a serious and still poorly understood disease, that involves experiencing enduring pain complaints that persist for more than three months. Two related vulnerability factors, insecure attachment and mentalizing difficulties, have been repeatedly found among patients with chronic pain. While the current treatment of chronic pain does not focus on these factors, they might contribute to problems in the client-therapist relationship that are often reported. It is however still unclear how insecure attachment and mentalizing relate to the core complaint of patients with chronic pain: the pain itself. This study proposed mentalizing as a mediating mechanism through which insecure attachment might relate to aspects of pain. Chronic pain patients of the Meander hospital in Amersfoort (N = 17) completed a questionnaire measuring anxious and avoidant attachment, performed a verbal mentalizing task, and answered questions about the intensity, duration, and sites of their pain. Mediation analyses showed that neither type of insecure attachment related to mentalizing, and no evidence of mediation in relation to pain outcomes was found. However, controlling for age and gender, higher avoidant attachment related to a higher number of pain sites. Also, mentalizing difficulties were found, which related to longer pain duration only in men. Study results emphasize that future therapy of chronic pain needs to consider mentalizing difficulties. Further research could focus on identifying changeable mechanisms through which avoidant attachment relates to more widespread chronic pain.
Supervisor: Vanessa van Ast