Efficacy of dialectical behavior therapy techniques in reducing problems of patients with preoccupied attachment style having chronic musculoskeletal pain: a single case study

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

Self-efficacy as a predictor of patient-reported outcomes in adults with congenital heart disease

OBJECTIVE: Self-efficacy is a known predictor of patient-reported outcomes in individuals with acquired diseases. With an overall objective of better understanding patient-reported outcomes in adults with congenital heart disease, this study aimed to: (i) assess self-efficacy in adults with congenital heart disease, (ii) explore potential demographic and medical correlates of self-efficacy and (iii) determine whether self-efficacy explains additional variance in patient-reported outcomes above and beyond known predictors. METHODS: As part of a large cross-sectional international multi-site study (APPROACH-IS), we enrolled 454 adults (median age 32 years, range: 18-81) with congenital heart disease in two tertiary care centres in Canada and Switzerland. Self-efficacy was measured using the General Self-Efficacy (GSE) scale, which produces a total score ranging from 10 to 40. Variance in the following patient-reported outcomes was assessed: perceived health status, psychological functioning, health behaviours and quality of life. Hierarchical multivariable linear regression analysis was performed. RESULTS: Patients' mean GSE score was 30.1 ± 3.3 (range: 10-40). Lower GSE was associated with female sex ( p = 0.025), not having a job ( p = 0.001) and poorer functional class ( p = 0.048). GSE positively predicted health status and quality of life, and negatively predicted symptoms of anxiety and depression, with an additional explained variance up to 13.6%. No associations between self-efficacy and health behaviours were found. CONCLUSIONS: GSE adds considerably to our understanding of patient-reported outcomes in adults with congenital heart disease. Given that self-efficacy is a modifiable psychosocial factor, it may be an important focus for interventions targeting congenital heart disease patients' well-being