The Relationship Between Attachment Style, Deterministic Thinking, and Sources of Self-knowledge with the Response Rate to Pain Treatment in Patients with Chronic Non-specific Low Back Pain

Abstract

Background: Chronic non-specific low back pain (CNLBP) is influenced by psychological and interpersonal factors that may be associated with differences in treatment outcomes. Objectives: This study aimed to examine the associations between attachment styles, deterministic thinking, and sources of self-knowledge and changes in pain intensity following physiotherapy in patients with chronic non-specific low back pain. Methods: This observational correlational study included 152 patients with CNLBP who were recruited from physiotherapy clinics in Tehran, Iran, in 2023. Participants completed the Adult Attachment Inventory, Deterministic Thinking Questionnaire (DTQ), and Sources of Self-Knowledge Scale (SSKS). Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline (before the first physiotherapy session) and after completion of the tenth physiotherapy session. Treatment response was defined as the reduction in pain intensity from baseline to the post-treatment assessment. Pearson correlation coefficients and separate linear regression analyses were performed using SPSS version 25. Results: Response to pain treatment showed significant positive correlations with a secure attachment style (r = 0.377, P < 0.001) and self-observation (r = 0.306, P < 0.001), whereas significant negative correlations were observed with deterministic thinking (r = -0.200, P < 0.05), social feedback (r = -0.257, P < 0.01), and social comparison (r = -0.276, P < 0.01). Regression analysis indicated that a secure attachment style (β = 0.089, P < 0.001), self-observation (β = 0.040, P < 0.05), and deterministic thinking (β = -0.010, P < 0.05) were significantly associated with treatment response. Conclusions: The findings indicate that several psychological characteristics, particularly secure attachment, self-observation, and deterministic thinking, are associated with differences in pain improvement following physiotherapy in patients with chronic non-specific low back pain. These results underscore the potential relevance of psychological factors in explaining variability in treatment outcomes; however, the observational correlational design of the study precludes causal inferences.