ORIGINAL PAPER
Pain in relation to emotion regulatory resources and self-compassion: a non-randomized correlational study involving recollected early childhood experiences and insecure attachment
 
More details
Hide details
Submission date: 2018-07-11
Final revision date: 2019-02-05
Acceptance date: 2019-02-05
Online publication date: 2019-03-06
Publication date: 2019-03-07
 
Health Psychology Report 2019;7(1):19–31
 
KEYWORDS
TOPICS
ABSTRACT
Background:
Pain is common in most diseases and is usually treated by medical and physical approaches (medications, exercise). Limited attention has been given to whether non-medical approaches (such as emotion regulation abilities including self-compassion) can help further reduce the pain experienced. Scleroderma (systemic sclerosis), a painful and complex autoimmune connective tissue and vascular disease, was examined in this study in relation to psychological aspects of pain and the links of pain to (1) early life experiences, (2) current insecure attachment style, (3) physiological arousal (negative, hyper-arousal), and (4) personal emotion regulation (self-compassion). Knowledge about these relationships may help in the treatment of pain.

Participants and procedure:
Participants (120) from Australia (39) and the United Kingdom (81) completed an online or a hard copy survey; 78 participants remained for analysis after screening.

Results:
We found that poor or limited positive early life experiences and a current insecure (dismissive) attachment style contributed significantly to experiencing elevated levels of pain. We also found that negative early life experiences and limited emotion regulation (low self-compassion) predicted hyper-arousal, which in turn was associated with experienced pain. Insecure dismissive attachment style and hyper-arousal were significantly correlated.

Conclusions:
These findings suggest that negative childhood experiences and an insecure dismissive attachment style may determine how emotional experiences are regulated or managed by individuals in disease-related pain. Implications include that interventions addressing attachment style and self-compassion may help reduce pain in the individuals concerned, thus helping supplement the effectiveness of current medication and physical approaches.

 
REFERENCES (68)
1.
Ainsworth, M. D. (1985). Patterns of infant-mother attachments: antecedents and effects on development. Bulletin of the New York Academy of Medicine, 61, 771–791.
 
2.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Erlbaum.
 
3.
Angelopoulos, N. V., Drosos, A. A., & Moutsopoulos, H. M. (2001). Psychiatric symptoms associated with scleroderma. Psychotherapy and Psychosomatics, 70, 145–150.
 
4.
Bakermans-Kranenburg, M. J., Juffer, F., & Van IJzendoorn, M. H. (1998). Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference? Infant Mental Health Journal, 19, 202–219.
 
5.
Benrud-Larson, L. M., Haythornthwaite, J. A., Heinberg, L. J., Boling, C., Reed, J., White, B., & Wigley, F. M. (2002). The impact of pain and symptoms of depression in scleroderma. Pain, 95, 267–275.
 
6.
Bowlby, J. (1997). Attachment and Loss (Vol.1): Attachment. London, UK: Pimlico (Original work published in 1969).
 
7.
Bowlby, J. (1998). Attachment and Loss (Vol. 2): Separation anger and anxiety. London, UK: Pimlico (Original work published in 1973).
 
8.
Brewin, C. R., Firth-Cozens, J., Furnham, A., & McManus, C. (1992). Self-criticism in adulthood and recalled childhood experience. Journal of Abnormal Psychology, 101, 561–566.
 
9.
Briggs, S. R., & Cheek, J. M. (1986). The role of factor analysis in the development and evaluation of personality scales. Journal of Personality, 54, 106–148.
 
10.
Burke, A. L., Mathias, J. L., & Denson, L. A. (2015). Psychological functioning of people living with chronic pain: A meta-analytic review. British Journal of Clinical Psychology, 5, 345–360. https://doi.org/10.1111/bjc.12....
 
11.
Burns, J. W. (2006). Arousal of negative emotions and symptom specific reactivity in chronic low back pain patients. Emotion, 6, 309–319.
 
12.
Castelnuovo, G., Giusti, E. M., Manzoni, G. M., Saviola, D., Gatti, A., Gabrielli, S., …, & Tamburin, S. (2016). Psychological considerations in the assessment and treatment of pain in neurorehabilitation and psychological factors predictive of therapeutic response: Evidence and recommendations from the Italian consensus conference on pain in neurorehabilitation. Frontiers in Psychology, 7, 468.
 
14.
Chifflot, H., Fautrel, B., Sordet, C., Chatelus, E., & Sibilia, J. (2008). Incidence and prevalence of systemic sclerosis: a systematic literature review. Seminars in Arthritis and Rheumatism, 37, 223–235.
 
15.
Davies, K. A., Macfarlane, G. J., McBeth, J., Morriss, R., & Dickens, C. (2009). Insecure attachment style is associated with chronic widespread pain. Pain, 143, 200–205.
 
16.
Depue, R. A., & Morrone-Strupinsky, J. V. (2005). A neurobehavioral model of affiliative bonding: Implications for conceptualizing a human trait of affiliation. Behavioural and Brain Sciences, 28, 313–349.
 
17.
Every, G. S., & Lating, J. M. (2002). The link from stress arousal to disease. In D. A. Meichenbaum (Ed.), Clinical guide to treatment of the human stress response (2nd ed.). New York, NY: Springer.
 
18.
Eyer, J. C., & Thorn, B. E. (2016). The Learning About My Pain study protocol: Reducing disparities with literacy-adapted psychosocial treatments for chronic pain: A comparative behavioural trial. Journal of Health Psychology, 21, 2063–2074. https://doi.org/10.1177/135910....
 
19.
Fonagy, P., & Allison, E. (2012). What is mentalization? The concept and its foundations in developmental research. In N. Midgley & I. Vrouva (Eds.), Minding the child: Mentalization-based interventions with children, young people and their families (pp. 11–34). London, UK: Routledge.
 
20.
Forsythe, L. P., Romano, J. M., Jensen, M. P., & Thorn, B. E. (2012). Attachment style is associated with perceived spouse responses and pain-related outcomes. Rehabilitation Psychology, 57, 290–300. https://doi.org/10.1037/a00300....
 
21.
Freedman, R. R., & Ianni, P. (1983). Role of cold and emotional stress in Raynaud’s disease and scleroderma. British Medical Journal (Clinical Research Ed.), 287, 1499–1502.
 
22.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581–624. https://doi.org/10.1037/0033-2....
 
23.
Gilbert, P. (2001). Evolutionary approaches to psychopathology: the role of natural defences. Australian and New Zealand Journal of Psychiatry, 35, 17–27.
 
24.
Gilbert, P., Baldwin, C., Irons, M. W., Baccus, J. R., & Palmer, M. (2006). Self-criticism and self-warmth: an imagery study exploring their relation to depression. Journal of Cognitive Psychotherapy, 20, 183–200.
 
25.
Gilbert, P. (2007). Psychotherapy and Counselling for Depression (3rd ed.). London, UK: Sage.
 
26.
Gilbert, P., McEwan, K., Mitra, R., Franks, L., Richter, A., & Rockliff, H. (2008). Feeling safe and content: A specific affect regulation system. Relationship to depression, anxiety, stress and self-criticism. The Journal of Positive Psychology, 3, 182–191.
 
27.
Gilbert, P. (2012). Human nature and suffering. New York, NY: Psychological Press (Original work published in 1989).
 
28.
Giuggioli, D., Manfredi, A., Colaci, M., & Ferri, C. (2010). Oxycodone in the long-term treatment of chronic pain related to scleroderma skin ulcers. Pain Medicine, 11, 1500–1503.
 
29.
Griffin, D. W., & Bartholomew, K. (1994). The metaphysics of measurement: the case of adult attachment. In K. Bartholomew & D. P. Perlman (Eds.), Advances in personal relationships: Attachment processes in adult relationships (Vol. 5, pp. 17–52). London, UK: Kingsley.
 
30.
Hammad, M., Barsky, A., & Regestein, Q. (2001). Correlation between somatic sensation inventory scores and hyper-arousal scale scores. Psychosomatics, 42, 29–34.
 
31.
Heit, S., Graham, Y., & Nemeroff, C. B. (1999). Neurobiological effects of early trauma. The Harvard Mental Health Letter, 16, 4–6.
 
32.
Hyphantis, T. N., Tsifetaki, N., Pappa, C., Voulgan, P. V., Siafaka, V., Bai, M., Alamanos, Y., Drosos, A. A., & Mavreas, V. (2007). Clinical features and personality traits associated with psychological distress in systemic sclerosis patients. Journal of Psychosomatic Research, 62, 47–56.
 
33.
International Association for the Study of Pain – IASP (2012). Definition of pain. Retrieved from www.iasp-pain.org.
 
34.
Irons, C., Gilbert, P., Baldwin, M. W., Baccus, J. R., & Palmer, M. (2006). Parental recall, attachment relating and self-attacking/self-reassurance: Their relationship with depression. British Journal of Clinical Psychology, 45, 297–308.
 
35.
Jensen, M. P., & Turk, D. C. (2014). Contributions of psychology to the understanding and treatment of people with chronic pain: Why it matters to all psychologists. American Psychologist, 69, 105–118. https://doi.org/10.1037/a00356....
 
36.
Johnson, S. R., Hawker, G. A., & Davis, A. M. (2005). The health assessment questionnaire disability index and scleroderma health assessment questionnaire in scleroderma trials: the evaluation of their measurement properties. American College of Rheumatology, 53, 256–262.
 
37.
Juffer, F., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2014). Attachment-based interventions: Sensitive parenting is the key to positive parent-child relationships. In P. Holmes & S. Farnfield (Eds.), The Routledge Handbook of Attachment: Implications and Interventions (pp. 83–103). London, UK: Routledge.
 
38.
Kaiser, R. S., Mooreville, M., & Kannan, K. (2015). Psychological interventions for the management of chronic pain: A review of current evidence. Current Pain & Headache Reports, 19, 43. https://doi.org/10.10007/s1191....
 
39.
Kearney, K. G., & Hicks, R. E. (2017). Self-Compassion and Breast Cancer in 23 Cancer Respondents: Is the Way You Relate to Yourself a Factor in Disease Onset and Progress? Psychology, 8, 14–26.
 
40.
Keefe, F. J., Porter, L. S., & Labban, J. (2006). Emotion regulation processes in disease-related pain: a couples-based perspective. In D. Snyder, J. Simpson, & J. Hughes (Eds.), Emotion regulation in couples and families: pathways to dysfunction and health (pp. 207–229). Washington, DC: American Psychological Association.
 
41.
Kratz, A. L., Davis, M. C., & Zautra, A. J. (2012). Attachment predicts daily catastrophizing and social coping in women with pain. Health Psychology, 31, 278–285. https://doi.org/10.1037/a00252....
 
42.
Lee-Chiong, T., Gebhart, G. F., Mattay, R. A. (2010). Chest Pain. In R. J. Mason, V. C. Broaddus, T. Martin, T. King Jr., D. Schraufnagel, J. F. Murray, & J. A. Nadel (Eds.), Murray and Nadel’s Textbook of Respiratory Medicine (5th ed., Vol. 1, pp. 647–660). Philadelphia, PA: Saunders Elsevier.
 
43.
Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L., Schubiner, H., & Keefe F. J. (2011). Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology, 67, 942–968. https://doi.org/10.1002/jclp.2....
 
44.
Martinez, M. P., Miro, E., Sanchez, A. I., Mundo, A., & Martinez, E. (2012). Understanding the relationship between, attachment style, pain, appraisal and illness behaviour in women. Scandinavian Journal of Psychology, 53, 54–63.
 
45.
McWilliams, L. A., Cox, B. J., & Enns, M. W. (2000). Impact of adult attachment styles on pain and disability associated with arthritis in a nationally representative sample. The Clinical Journal of Pain, 16, 360–364.
 
46.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure dynamics and change. New York, NY: Guilford Press.
 
47.
Miller, H., Rehberger, P., Gunther, C., & Schmitt, J. (2012). Determinants of disability, quality of life and depression in dermatological patients with systemic scleroderma. British Journal of Dermatology, 166, 343–353.
 
48.
Neff, K. D. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–101.
 
49.
Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250.
 
50.
Neff, K. D., Kilpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139–154.
 
51.
Pace, T., Negi, L. T., Ademe, D., Cole, S., Sivilli, T., Brown, T., Issa, M. J., & Raison, C. L. (2009). Effect of compassion meditation on neuroendocrine, innate immune and behavioural responses to psychosocial stress. Psychoneuroendocrinology, 34, 87–98.
 
52.
Phillips, J. R., Hopwood, B., Stroud, R., Dieppe, P. A., & Toms, A. D. (2017). The characterisation of unexplained pain after knee replacement. British Journal of Pain, 11, 203–209.
 
53.
Pope, J. (2011). Measures of systematic sclerosis (scleroderma). Arthritis Care and Research, 63, S98–S111. https://doi.org/10.1002/acr.20....
 
54.
Rainville, P., Boa, Q. V. H., & Chretien, P. (2005). Pain-related emotions modulate experimental pain perception and autonomic responses. Pain, 118, 306–318.
 
55.
Richter, A., Gilbert, P., & McEwan, K. (2009). Development of an early memories of warmth and safeness scale and its relationship to psychopathology. Psychology and Psychotherapy: Theory, Research and Practice, 82, 171–184.
 
56.
Romeo, A., Tesio, V., Castelnuovo, G., & Castelli, L. (2017). Attachment style and chronic pain: Toward an interpersonal model of pain. Frontiers in Psychology, 8, 284. https://doi.org/10.3389/fpsyg.....
 
57.
Sachs-Ericsson, N., Blazer, D., Plant, A. E., & Arnow, B. (2005). Childhood sexual and physical abuse and the 1-year prevalence of medical problems in the national comorbidity survey. Health Psychology, 24, 32–40.
 
58.
Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Erlbaum.
 
59.
Schore, A. N. (2002). Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Australian and New Zealand Journal of Psychiatry, 36, 9–30.
 
60.
Selye, H. (1976). Forty years of stress research: Principal remaining problems and misconceptions. Canadian Medical Association Journal, 115, 53–56.
 
61.
Simm, R., & Barker, C. (2018). Five years of a community pain service solution-focused pain management programme: Extended data and reflections. British Journal of Pain, 12, 113–121.
 
62.
Simpson, J. A., & Rholes, W. S. (Eds.) (1998). Attachment theory and close relationships. New York, NY: Guilford Press.
 
63.
Steen, V. D., & Medsger, T. A. (1997). The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. Arthritis Rheumatology, 40, 1984–1991.
 
64.
Tan, G., Jensen, M. P., Thornby, J., & Sloan, P. A. (2008). Negative emotions, pain, and functioning. Psychological Services, 5, 26–35.
 
65.
Thakkar, R. R., & McCanne, T. R. (2000). The effects of daily stressors on physical health in women with and without a childhood history of sexual abuse. Child Abuse & Neglect, 24, 209–221.
 
66.
Van der Kolk, B. A., & Greenberg, M. S. (1987). The psychobiology of the trauma response: hyperarousal, constriction and addiction to traumatic re-exposure. In B. A. Van der Kolk (Ed.), Psychological trauma (pp. 63–88). Washington, DC: American Psychiatric Publishing.
 
67.
Williams-Judge, S. L. (2011). Pain perspective in scleroderma. The Rheumatologist. Retrieved from www.the-rheumatologist.org/art....
 
68.
Wren, A., Somers, T. J., Wright, M. A., Goetz, M. C., Leary, M. R., Fras, A. M., Huh, B. K., Rogers L. L., & Keefe, F. J. (2011). Self-compassion in patients with persistent musculoskeletal pain: Relationship of self-compassion to adjustment to persistent pain. Journal of Pain and Symptom Management, 43, 759–770.
 
eISSN:2353-5571
ISSN:2353-4184