Causal Model of Pain Intensity Based on Attachment Styles Mediated by Early Maladaptive Schemas in Patients with Chronic Pain

Zandi Goharrizi, Golbarg; Ghorban Jahromi, Reza; Robatmili, Somaye; Zare Bahramabadi, Mahdi

doi:10.22055/psy.2022.40920.2856

Causal Model of Pain Intensity Based on Attachment Styles Mediated by Early Maladaptive Schemas in Patients with Chronic Pain

Document Type : Research Article

Authors

Golbarg Zandi Goharrizi ¹

Reza Ghorban Jahromi ²

somaye robatmili ²

Mahdi Zare Bahramabadi ³

¹ PhD student of General Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran.

² Assistant Professor, Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran.

³ Associate Professor, Counseling Department. Allameh Tabataba'i University, Tehran, Iran.

https://doi.org/10.22055/psy.2022.40920.2856

Abstract

Introduction
The aim of this study was to investigate the causal pattern of the relationship between attachment styles and pain intensity mediated by early maladaptive schemas and difficulty in regulating emotion in patients with chronic pain. Pain is classified not only as a perception but also as a mood and therefore separate from the five senses. Pain is a difficult subject conceptually, and its description and classification have always been difficult so it can be said that the only clear aspect of pain is that it shows the patient's state of mental suffering. The results of some studies have also shown the relationship between early maladaptive schemas and the difficulty of emotion regulation with pain intensity. In addition, disturbance in emotion regulation, which can be caused by the experiences of the first years of childhood, is also effective in predicting psychosomatic and psychological disorders and pain intensity. In general, according to what was mentioned, it seems that without considering psychological factors, it is not possible to improve or reduce the severity of pain, maintain quality of life, and adapt to chronic pain. Mediated by early maladaptive schemas and difficulty in emotion regulation.

Method
The research method is descriptive correlation and structural equation modeling. The population of this study was patients with chronic pain referred to the pain clinic of Erfan Hospital in Tehran in the second half of 2020 where 300 people with chronic pain were selected by convenience sampling. To collect data from the Westhawn-Yale Multidimensional Pain Questionnaire (WHI-MPI; Kerns et al., 1985), Adult Attachment Styles Inventory (AAI, Besharat, 2005), Young's Early Maladaptive Schemas Questionnaire (YSQ-SF; Young, 1999). And the Emotion Regulation Difficulty Scale (DERS; Gertz and Roemer, 2004). Data usage and analysis have been performed using structural equation methods.

Results
The sample of the present study included 300 patients with chronic pain. The average age of study participants (300 people) was reported to be approximately 40 years. The youngest was 20 years old and the oldest was 66 years old. Also, out of 300 people in the sample group, 83.7% (251 people) in the sample group are women and 16.3% (49 people) are men. The results showed that secure attachment style and anxiety through the mediating variables of hoarseness and inhibition, other orientation, and difficulty in emotion regulation, have a significant indirect effect on pain intensity in people with chronic pain.

Discussion
This means that early maladaptive schemas in the field of listening and restraint, other orientations and difficulty in regulating emotion play a mediating role in the relationship between attachment styles and pain intensity. Therefore, by considering the schemas of the field of distraction and inhibition, other orientations and difficulty in regulating emotion can play an effective role in the severity of pain in people with chronic pain. Based on the results, it was found that attachment styles have an indirect effect on pain intensity in patients with chronic pain, with difficult mediation in emotional regulation. Therefore, the results of the study showed that safe attachment style and anxiety through a difficult mediating variable in emotion regulation, has a significant indirect effect on pain intensity.

Keywords

Attachment styles

Chronic pain

Early maladaptive schemas

Emotion regulating

Pain intensity

Ahi, G., Mohammadifar, M., & Besharat, M. (2007). Ahi, Gh., Mohammadifar, M. A., & Besharat, M. A. (2007). [The psychometric properties of Young Schema Questionnaire-Short Form (YSQ-SF) Psychology & Educational Science, 37(3), 5-20.[Persian]

Bassak Nejad, S., Jabari, M. & Mavalizadeh, E. (2018). The Comparison of Early Maladaptive Schemas, Identity Styles and Parent-child Relations between Addicted and non-addicted women in Ahvaz. Quarterly Journal of Woman & Society,33(9),1-16. [Persian].

Besharat, M A. (2005). Investigating the psychometric properties of the Emotion Regulation Difficulty Scale. Research report, University of Tehran. [Persian]

Bidari, F., Amirfakhraei, A., & Zarei, E. (2021). The effectiveness of schema therapy on irrational beliefs and emotional self-regulation of women with marital conflict with early maladaptive schemas. Journal of Psychological Achievements, 28(2), 241-264. [Persian]

Besharat, M. A., & Bazazian, S. (2014). Evaluation of psychometric properties of cognitive emotion regulation questionnaire in a sample of Iranian society. Journal of the School of Nursing and Midwifery, 24(84), 61-70. [Persian]

Bowlby, J. (1989). Attachment and loss: Sadness and depression (Vol. 3). New York: Basic Books.

Coopersmith, S. (1981, 1987). Self-esteem inventories. Palo Alto: Consulting Psychologists Press.

Firoozi, M., Besharat, M., & Souri, Z. (2018). The predicting effect of attachment styles on pain catastrophizing, self-efficacy, and acceptance in patients with chronic pain. Journal of Anesthesiology and Pain, 8(3), 55-67. [Persian]

Field, A. (2009). Discovering Statistics Using SPSS. London: SAGE.

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initia validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.

Gratz, K. L., & Tull, M. T. (2010). Emotion regulation as a mechanism of change in acceptance- and mindfulness-based treatments. In R. Baer (Ed.), Assessin mindfulness and acceptance processes in clients: Illuminating the theory and process of change. Oakland, CA: New Harbinger Publications.

Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115, 850-855.

Haghighat, S. (2021). Relationship between attachment styles and cognitive errors with pain intensity and physical disability in people with chronic pain. PhD Thesis, Faculty of Psychology and Social Sciences, Islamic Azad University, Central Tehran Branch. [Persian]

Hamid, N., Ramezan Sa’atchi, L., & Mehrabizadeh Honarmand, M. (2013). Effect of cognitive-behavioral therapy on pain severity and mental health of women with chronic low back pain. Clinical Psychology Studies, 3(10), 96-113. [Persian]

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 42, 511-542.

Kerns, D. R., Turk, C. D., & Rudy, E. T. (1985). The West Haven Yale multidimensional pain inventory (WHYMPI). Pain, 23, 345e356.

Laczkovics, C., Fonzo, G., Bendixsen, B., Shpigel, E., Lee, I., Skala, K., & Huemer, J. (2018). Defense mechanism is predicted by attachment and mediates the maladaptive influence of insecure attachment on adolescent mental health. Current Psychology, 1-9.

Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25(3), 6-10.

Mirzamani, S., & Safari, A., & Holisaz, M., & Sadidi, A. (2007). Validation of the west haven-yale multidimensional pain inventory (whympi) for Iranian patients with chronic pain. QOM University of Medical Sciences Journal, 1(3), 13-24. [Persian]

McWilliams, L. A., & Asmundson, G. J. (2007). The relationship of adult attachment dimensions to pain-related fear, hyper vigilance, and catastrophizing. Pain, 127, 27-34.

Meredith, P, J., Strong, J., & Feeney, J.A. (2007). Adult attachment variables predict depression before and after treatment for chronic pain. European Journal of Pain, 11, 164-70.

Meredith, P., Ownsworth, T., & Strong, J. (2008). A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clinical Psychology Review, 28, 407-29.

Nesayan, A., & Asadi Gandomani, R. (2018). Prediction of emotion regulation based on attachment styles and perceived parenting styles in adolescents. Journal of Pediatric Nursing, 5(1), 1-10.

Oshri, A., Sutton, T. E., Clay-Warner, J., & Miller, J. D. (2015). Child maltreatment types and risk behaviors: Associations with attachment style and emotion regulation dimensions. Personality and Individual Differences, 73, 127-133.

Pauwels, E., Dierckx, E., Smits, D., Janssen, R., & Claes, L. (2018). Validation of the Young Schema Questionnaire-Short Form in a Flemish Community Sample. Psychologica Belgica, 58(1), 34-50.

Pfeifer, A. C., Amelung, D., Gerigk, C., Schroeter, C., Ehrenthal, J., Neubauer, E., & Schiltenwolf, M. (2016). Study protocol-efficacy of an attachment-based working alliance in the multimodal pain treatment. BMC Psychology, 4(1), 10.

Pickard, J. A., Caputi, P., & Grenyer, B. F. S. (2016). Mindfulness and emotional regulation as sequential mediators in the relationship between attachment security and depression. Personality and Individual Differences, 99, 179-183.

Racine, C. (2005). Does religious coping moderate the relationship between early maladaptive schemas and negative trait affect, college adjustment, and alcohol use? Ph.D. Dissertation. New York: New York University.

Ranjbar, A., & Janfada, M. (2021). The role of early maladaptive schemas and Stress Coping Strategies of mothers on the quality of life of children 1 to 6 years old during the COVID-19 Epidemic. Journal of Research in Psychological Health, 15(3), 71-85. [Persian]

Sepehrian Azar, F., Asadi Majreh, S., Asadnia, S., & Farnoodi, L. (2014). The relationship between attachment and coping styles with emotion dysregulation in adolescence. Studies in Medical Science (The Journal of Urmia University of Medical Sciences), 25(10), 922-930. [Persian]

Sanderson, C. A. (2019). Health psychology. New York: Willy.

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., & et al. (2015). Classification of chronic pain for ICD-11. Pain, 156(6), 1003-1007.

Taylor, R. E., Marshall, T., Mann, A., & Goldberg, D. P. (2012). Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychological Medicine, 42(4), 855-864.

Wearden, A., Perryman, K., & Ward, V. (2006). Adult attachment, reassurance seeking and hypochondriacal concerns in college students. Journal of Health Psychology, 11, 877-886.

Young, J. (1999). Cognitive therapy. Translated by Ali Sahebi and Hassan Hamidpour. Tehran: Arjmand. (2013).