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

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.

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.

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.

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.