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

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          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.

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          A meta-analysis of the association between adherence to drug therapy and mortality.

          To evaluate the relation between adherence to drug therapy, including placebo, and mortality. Meta-analysis of observational studies. Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality. Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11). Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.
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            The Experiences in Close Relationship Scale (ECR)-short form: reliability, validity, and factor structure.

            We developed a 12-item, short form of the Experiences in Close Relationship Scale (ECR; Brennan, Clark, & Shaver, 1998) across 6 studies. In Study 1, we examined the reliability and factor structure of the measure. In Studies 2 and 3, we cross-validated the reliability, factor structure, and validity of the short form measure; whereas in Study 4, we examined test-retest reliability over a 1-month period. In Studies 5 and 6, we further assessed the reliability, factor structure, and validity of the short version of the ECR when administered as a stand-alone instrument. Confirmatory factor analyses indicated that 2 factors, labeled Anxiety and Avoidance, provided a good fit to the data after removing the influence of response sets. We found validity to be equivalent for the short and the original versions of the ECR across studies. Finally, the results were comparable when we embedded the short form within the original version of the ECR and when we administered it as a stand-alone measure.
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              Models of the self and other: Fundamental dimensions underlying measures of adult attachment.

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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                14 March 2019
                March 2019
                : 8
                : 3
                : 364
                Affiliations
                [1 ]Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; corinna_schroeter@ 123456t-online.de (C.S.); eva.neubauer@ 123456med.uni-heidelberg.de (E.N.); marcus.schiltenwolf@ 123456med.uni-heidelberg.de (M.S.)
                [2 ]Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany; Johannes.Ehrenthal@ 123456med.uni-heidelberg.de
                [3 ]School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD 4072, Australia; p.meredith@ 123456cqu.edu.au
                [4 ]School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, QLD 4701, Australia
                [5 ]Institute of Psychosocial Prevention at the Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany; paul.schroeder-pfeifer@ 123456med.uni-heidelberg.de
                [6 ]CONICET and Universidad de Buenos Aires, C1053 CABA, Buenos Aires, Argentina; jmgomezpenedo@ 123456gmail.com
                Author notes
                [* ]Correspondence: ann-christin.pfeifer@ 123456med.uni-heidelberg.de ; Tel.: +49-0-6221-5635492
                Author information
                https://orcid.org/0000-0002-2981-9189
                https://orcid.org/0000-0003-0835-4172
                Article
                jcm-08-00364
                10.3390/jcm8030364
                6463073
                30875841
                fa858331-99b6-4ddb-b4a2-883cacfb369a
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 07 February 2019
                : 05 March 2019
                Categories
                Article

                chronic pain,attachment theory,attachment-informed intervention

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