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On the basis of the sample studied, the new back school proved to be an effective treatment for short and long-term reduction of pain-related stress and associated psychological aspects. Maladaptive, passive coping strategies and higher depression scores were associated with a higher probability of success in terms of pain reduction and functional improvement.

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Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

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ObjectiveThe theory of interpersonal problem behaviour (IPB) provides a more fundamental framework for understanding the psychosocial aspects of pain. The present study focused on the IPB, based on the Interpersonal Problem Circumplex (IPC), in persons with low back pain and its association with pain, psychological characteristics, and health care utilisation.MethodsIn a cross-sectional design, individuals with back pain (N = 88) and healthy control persons who matched by age, gender, and educational level (N = 88) were compared with regard to IPB. Furthermore, back pain patients classified by their IPB (N = 24 low, N = 48 moderate, N = 16 high) were compared regarding pain, depression, catastrophising, and health care utilisation.ResultsIn comparison to the healthy reference sample, a significant difference in the interpersonal problems of the low back pain group, with a tendency towards being overly ‘introverted’, ‘exploitable’, and ‘subassertive’, was revealed. In the back pain group, participants with elevated IPB showed significantly higher levels of pain intensity, functional disability, depression, catastrophising, and health care utilisation than participants with IPB in the normal range.ConclusionApplication of the Interpersonal Circumplex Model can help to characterize a subgroup of persons with low back pain. Increased general interpersonal problems are associated with elevated burden in pain-related, psychological, and health care-related variables. Future research should focus on the treatment opportunities for this subgroup, as well as on the influence of interpersonal problems during the course of back pain.

ZusammenfassungIm Rahmen des SOPHO-Net-Projektes, dessen Kernstudie eine randomisiert-kontrollierte Vergleichsstudie zur kognitiven bzw. psychodynamischen Kurzzeittherapie bei sozialer Angst war, wurde an einer Teilstichprobe von 88 Patienten aus 3 der 5 Zentren untersucht, ob der Behandlungserfolg, zu Therapiebeginn im Interview erhobene Bindungsmerkmale und negative Indikationen im Psychotherapieprozess in Zusammenhang stehen. Die negativen Indikatoren wurden mithilfe von Fremdratings mit der Vanderbilt Negative Indicators Scale (VNIS) erfasst, wobei jeweils eine frühe (dritte), eine mittlere (neunte) und eine späte Therapiesitzung (zweiundzwanzigste) im Hinblick auf negative Indikatoren untersucht wurden. Die Studie zeigte, dass negative Indikatoren insgesamt eher selten vorkommen, häufiger in der psychodynamischen Therapie, für die sich auch ein Zusammenhang zwischen negativen Indikatoren und Therapieergebnis zeigte. Entgegen der Erwartung waren die bei Therapiebeginn erhobenen Bindungsmerkmale nicht auf negative Indikatoren bezogen.

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