Effectiveness of an Attachment-Informed Working Alliance in Interdisciplinary Pain Therapy.

Ann-Christin Pfeifer,Johannes Ehrenthal,Corinna Schroeter,Marcus Schiltenwolf,Eva Neubauer,Juan Martin Gomez Penedo,Pamela Meredith,Paul Schröder-Pfeifer

doi:10.3390/jcm8030364

Abstract

Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.

Highlights

Chronic pain syndromes are a result of complex interactions between biological, psychological, and social influences, including patients’ beliefs about their self-efficacy, hypervigilant monitoring of bodily sensations, and familial conflict or social support [1,2,3]
In terms of descriptive statistics, there were no significant differences between the three groups in terms of the core study variables
The results of the present study provide preliminary support for the utility of incorporating attachment-informed interventions with existing multimodal pain therapies in short-term outpatient settings

Summary

Introduction

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Methods

Conclusion