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Katie Harriett Brenner, Psy.D., is a 2025 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

  • Karen Meteyer, PhD, Chairperson
  • Kate Evarts, PsyD, Committee Member
  • Gina Pasquale, PsyD, Committee Member

Professional photo of Dr. Katie Brenner smiling

Dr. Katie Brenner

Keywords

chronic pain, adult attachment, relationships, self-efficacy, transformative paradigm, phenomenological methodology

Document Type

Dissertation

Publication Date

2025

Abstract

Despite contemporary Western healthcare’s emphasis on the biopsychosocial model of illness, there has been relatively limited attention given to the way that attachment relationships, as part of the social sphere of the model, impact individuals’ chronic pain experiences and management. Attachment influences help-seeking behaviors, sense of self-efficacy, coping skills, and communication abilities, all of which are implicated in pain experience and management. As such, this dissertation examines the question: Do attachment experiences influence how individuals perceive and manage chronic pain? This study expands on the existing research by conceptualizing attachment as a fluid experience that varies across relationships and circumstances, building upon the adult attachment categories identified by Bartholomew and Horowitz (1991; secure, preoccupied, dismissing, fearful). The study first reviews the existing literature on chronic pain, attachment theory, the pain-attachment link, impacts of attachment on pain experience and communication, self-efficacy as a mediating factor, and sociopolitical factors of pain management. Using a transformative, qualitative paradigm, five individuals with chronic pain diagnoses were interviewed using open-ended, narratively-formatted questions to amplify individual experiences of how intrapersonal and interpersonal relationships shape pain experiences. Using phenomenological methodology, thematic analysis (Braun & Clarke, 2006) was used to identify themes across participant interviews, focusing on intersections between relationships and chronic pain. Unlike traditional thematic analysis, each data segment was also coded for attachment experiences, based on the descriptions and categories set forth by Bartholomew and Horowitz (1991), to explore how these mapped onto themes. Seventeen themes were identified, grouped into four categories: helplessness, disconnection, isolation, and regeneration. The helplessness category corresponded to preoccupied attachment, reflecting low self-efficacy and a reliance on others for pain management. Disconnection and isolation were associated with dismissing attachment, stemming from feelings of being misunderstood by peers, healthcare providers, and loved ones. Regeneration aligned with secure attachment, where participants experienced higher self-efficacy and interpersonal connection. Findings suggest that participants experienced their pain as most manageable when they viewed themselves and others as efficacious and responsive, as is characteristic of secure attachment experiences. Implications, limitations, and suggestions for future research and action are explored. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center

(https://etd.ohiolink.edu).

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ORCID No.: 0009-0000-2393-9414

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