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:: Volume 20, Issue 6 (Bimonthly 2017) ::
Feyz 2017, 20(6): 539-550 Back to browse issues page
Efficacy of dialectical behavior therapy techniques in reducing problems of patients with preoccupied attachment style having chronic musculoskeletal pain: a single case study
Maryam Amini-Fasakhoudi *, Majid Mahmoud Alilou, Karineh Tahmassian, Abbas Bakhshipour-Roudsari
Department of Clinical Psychology, University of Tabriz, Tabriz, I. R. Iran. , amini.maryam329@gmail.com
Abstract:   (2457 Views)

Background: Pain is a degenerative and disabling condition which is accompanied by several psychological variables. Therefore, this study aimed to investigate the effectiveness of dialectical behavior therapy techniques in reducing the catastrophizing, fear of movement, pain-induced disability, and pain intensity in patients with preoccupied attachment style suffering musculoskeletal chronic pain.

Materials and Methods: The Study was conducted as a single subject research based on multiple-baseline design. The participants were two women patients suffering chronic back pain that were selected through purposive method from among clients of Pain Clinic of Tabriz, based on pain specialist diagnosis, clinical interview and screening tools.  Pain Catastrophizing Questionnaire, Tampa Scale for Kinesiophobia, Pain Disability Questionnaire, Visual Analogue Scale, and also relationships scales Questionnaire were filled by subjects in 5th, 7th, 9th, 11th, 14th baseline sessions and the follow up session. In order to study the treatment results drawing symptom severity diagram and mean base line reduction related to single subject studies.

Results: Results indicate that average score of catastrophizing, fear of movement, pain disability, and pain intensity were decreased in both patients from baseline to follow up  (33.25 to 16.5), (45.75 to 21), (17.5 to 7), and (213.75 to 90), respectively. In addition, during the treatment the average score of attachment security in both patients was increased from 1.25 to 2.3.

Conclusion: Dialectical behavior therapy was effective in increasing secure attachment and decreasing pain-related problems in patients with musculoskeletal pain. Thence, it is recommended that the study be done with larger samples in future.

Keywords: Dialectical Behavior Therapy, Chronic musculoskeletal pain, Preoccupied attachment style, Catastrophizing, Fear of movement, Pain disability, Pain intensity
Full-Text [PDF 326 kb]   (1905 Downloads)    
Type of Study: Research | Subject: medicine, paraclinic
Received: 2017/01/28 | Accepted: 2017/01/28 | Published: 2017/01/28
1. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1986; 6(3): 249.
2. Sullivan MJ, Lynch ME, Clark AJ, Mankovsky T, Sawynok J. Catastrophizing and treatment outcome: Impact on response to placebo and active treatment outcome. Contemporary Hypnosis 2008; 25(3-4): 129-140.
3. Kremer R, Granot M, Yarnitsky D, Crispa K, Fadel S, Best L, et al. The role of pain catastrophizing in the prediction of acute and chronic post operative pain. Open Pain 2013; 6: 176-182.
4. Meredith PJ, Strong J, Feeney JA. Evidence of a relationship between adult attachment variables and appraisals of chronic pain. Pain Res Manag 2007; 10(4): 191-200.
5. Cano A, Leonard MT, Franz A. The significant other version of the pain catastrophizing scale (pcs-s): Preliminary validation. Pain 2005; 119(1-3): 26-37.
6. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85(3): 317–32.
7. Scott W, Wideman TH, Sulliva MJ. Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury. Clin J Pain 2014; 30(3): 183-90.
8. Doménech J, Sanchis-Alfonso V, Espejo B. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain. Knee Surg Sports Traumatol Arthroscopy 2014; 17(3): 1-6.
9. Sullivan MJL, Tripp DA, Santor D. Gender differences in pain and pain behavior: the role of catastrophizing. Cogn Ther Res 2000; 24: 121–34.
10. Meredith PJ, Strong J, Feeney JA. The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain 2006; 120(1-2): 44–52.
11. Row AC, Carnelley KB, Harwood J, Micklewright D, Russoum L, Rennie CL, et al. The effect of attachment orientation priming on pain sensitivity in pain-free individuals. J Soc Pers Relation 2012; 29(4): 488-507.
12. Meredith P, Ownsworth T, Strong J. A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clin Psychol Rev 2008; 28(3): 407-29.
13. Meredith PJ. A review of the evidence regarding associations between attachment theory and experimentally induced pain. Curr Pain Headache Rep 2013; 17(4): 326-34.
14. Walsh TM, Symons DK, McGrath PJ. Relations between young children's responses to the depiction of separation and pain experiences. Attach Hum Devel 2004; 6(1): 53−71.
15. Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: the dynamics, development, and cognitive consequences of attachment-related strategies. Mot Emo 2003; 27(2): 77-102.
16. Bartholomew K. Avoidance of intimacy: an attachment perspective. J Soc Pers Relations 1990; 7(2): 147–78.
17. Mikulincer M, Shaver PR. Adult attachment and affect regulation. In J, Cassidy, PR, Shaver (Eds), Handbook of attachment. Structure, Dynamics, and change. (pp. 503-533). New York: Guilford Press; 2007.
18. Ciechanowski PS, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain 2003; 104(3): 627–37.
19. Meredith PJ, Strong J, Feeney JA. Evidence of a relationship between adult attachment and appraisals of chronic pain. Pain Res Manag 2005; 10(4): 191–200.
20. Sambo CF, Howard M, Kopelman M, Williams S, Fotopoulou A. Knowing you care: Effectts of perceived empathy and attachment style on pain perception. Pain 2010; 151(3): 687-93.
21. Pan Y, Zhang D, Liu Y, Ran G, Teng Z. The effects of attachment style and security priming on the perception of others pain. J Soc Pers Relation 2016; 30(4): 1-25.
22. Linton SJ. A transdiagnostic approach to pain emotion. J Appl Biobehav Res 2013; 18(2): 82-103.
23. Linton SJ. Applying dialectical behavior therapy to chronic pain: A case study. Scand J Pain 2010; 1: 50–4.
24. Cordon SL, Brown KW, Gibson PR. The role of mindfulness-Based stress reduction on perceived stress. Preliminary evidence for the moderatoring role of attachment style. J Cog Psychotherapy: An International Quarterly 2009; 23(3): 25-28.
25. Feigenbaum J. Dialectical behavior therapy. J Ment Health 2007; 16(1): 51-68.
26. Bouchard M, Target M, Lecours S, Fonagy P, Tremblay L, Schachter A, et al. Mentalization in adult attachment narratives: Reflective functioning, mental states, and affect elaboration compared. Psychoa Psychol 2008; 25(1): 47-66.
27. Cordon SL, Finney SJ. Measurement invariance of the Mindful Attention Awareness Scale across adult attachment style. Meas Evalu Couns Dev 2008; 40: 228-45.
28. Walsh JJ, Balint MG, Smolira DR, Fredericksen LK, Madsen S. Predicting individual differences in mindfulness: The role of trait anxiety, attachment anxiety and attentional control. Pers Individ Dif 2009; 46: 94-9.
29. Mallinckrodt B , Wei MF. Attachment, social competencies, social support, and psychological distress. J Couns Psychol 2005; 52: 358-67.
30. Goodall K, Trejnowska A, Darling S. The relationship between dispositional mindfulness, attachment security and emotion regulation. Pers Individ Dif 2012; 52(5): 622-6.
31. Pepping CA, Davis PJ, O’DonovanA. Individual differences in attachment and dispositional mindfulness: The mediating role of emotion regulation. Pers Individ Dif 2013; 54(3): 453-6.
32. Caldwell JG, Shaver P. Mediators of the link between adult attachment and mindfulness. An Int J Pers Relat 2013; 7(2): 299-310.
33. Snyder R, Shapiro S, Treleaven D. Attachment theory and mindfulness. J Child Fam Stud 2012; 21(5): 709-17.
34. Reynolds D. Mindful parenting: a group approach to enhancing reflective capacity parents and infants. J Child Psychol 2012; 29(3): 357-74.
35. Sahdra BK, Maclean KA, Ferrer E, Shaver PP, Rosenberg EL, Jacobs TL, et al. Enhanced response inhabitation during intensive meditation training predicts improvements in self-reported adaptive socioemotional functioning. Emotion2011; 11(2): 299-312.
36. Campbell JM. Statistical comparison of four effect size for single-subject design. Behav Modif 2004; 28(2): 234-46.
37. Ogels BM, Lunnen KMQ, Bonesteel K. Clinical significance: History, Application and current practice. Clin Psychol Rev 2001; 21(3): 421-46.
38. Griffin DW, Bartholomew K. Models of the self and other: fundamental dimensions underlying measures of adult attachment. J Pers Soc Psychol 1994; 67(3): 430–45.
39. Backstrom M, Holmes BM. Measuring adult attachment: Seif-report instruments. Scandinavian J Psychol 2001; 42(1): 79-86.
40. Amini M, Bakhshipour Rodsari A. Investigating reliability, validity and factor structure of the Persian version of the Relationship Scale Questionnaire. J Family Res 2015; 11(3): 333-52. [in Persian]
41. Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: Development and validation. Psychol Assess1995; 7(4): 432-524.
42. Mohammadi S, Dehghani M, Heidari M, Sedaghat M, Khatibi A. The evaluation of pain- related psychological similarities among patients with musculoskeletal chronic pain and their spouses. J Behave Sci 2013; 7(1): 57-66. [in Persian]
43. Kori SH, Miller RP, Todd DD. Kinesophobia: A new view of chronic pain behaviour. Pain Manag 1990; 3(1): 35-43.
44. Jafari H, Ebrahimi E, Salavati M, Kamali M, Fata L. Tampa Scale for Kinesiophobia: cross-cultural adaptation, factor structure, and psychometric properties in Iranian low back pain patients. J Rehab 2010; 11(1): 15-22. [in Persian]
45. Afsharnejad T, Rezaie S, Yosef zadeh S. The relation fear of movement and pain intensiting physical disability in patients suffering chronic low back pain. Rehabil 2010; 11 (2): 21-28. [in Persian]
46. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983; 8(2): 141-4.
47. Mesgarian F, Asghari Moghadam M, Shaeiri M, Broumand A, Maroufi N, Ebrahimi I, Nayeb Aghaee H. The relation between acceptance of pain and reduced pain intensity and disability among chronic pain patients. Res Behav 2012; 10(3): 194-203.
48. Khatibi A, Dehghani M, Sharpe L, Asmundson GJG, Pouretemad H. Selective attention towards painful faces among chronic pain patients: Evidence from a modified version of the dot-probe. Pain 2009; 142(1): 42-7.
49. Besharat MA. Explanation of personality disorders based on attachment theory. Contemp Psychol 2008; 2(8): 41-44. [in Persian]
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Amini-Fasakhoudi M, Mahmoud Alilou M, Tahmassian K, Bakhshipour-Roudsari A. Efficacy of dialectical behavior therapy techniques in reducing problems of patients with preoccupied attachment style having chronic musculoskeletal pain: a single case study . Feyz. 2017; 20 (6) :539-550
URL: http://feyz.kaums.ac.ir/article-1-3250-en.html

Volume 20, Issue 6 (Bimonthly 2017) Back to browse issues page
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