The moderating role of attachment insecurities in the association between social and physical pain

Journal of Research in Personality 53 (2014) 193–200

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The moderating role of attachment insecurities in the association between social and physical pain María Teresa Frías ⇑, Phillip R. Shaver University of California, Davis, 135 Young Hall, One Shields Avenue, Davis, CA 95616-8686, United States

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Article history: Available online 22 October 2014 Keywords: Attachment anxiety Attachment avoidance Social exclusion Physical pain sensitivity

a b s t r a c t We examined the effects of social exclusion and attachment insecurities (anxiety, avoidance) on physical pain sensitivity, hypothesizing that anxiety would predict greater physical pain sensitivity only following social exclusion. Participants were either included in or excluded from a computer-based ball-tossing game and then completed a coldpressor task. Anxious men showed greater physical pain sensitivity when excluded, but not when included. Moreover, individuals (men and women) high on both anxiety and avoidance showed greater physical pain sensitivity when excluded, but not when included. Conclusions: Anxious individuals’ heightened physical pain sensitivity following exclusion is a manifestation of hyperactivation of their attachment systems, and when threatened, avoidant individuals who are also high in anxiety are less successful in deactivating their attachment systems. Ó 2014 Elsevier Inc. All rights reserved.

1. Introduction According to attachment theory (Bowlby, 1982), people’s early experiences with caregivers shape their views of themselves, others, and relationships across the lifespan. Such views (labeled internal working models in the theory) affect the way individuals, later in life, cope with stress (e.g., Mikulincer, Florian, & Weller, 1993), interact with loved ones (e.g., Hazan & Shaver, 1987), and perceive and react to painful stimuli (e.g., Ciechanowski, Sullivan, Jensen, Romano, & Summers, 2003; DeWall, Deckman, Pond, & Bonser, 2011; MacDonald & Kingsbury, 2006). In the present study, we examine associations between adult attachment orientations and individuals’ sensitivity to physical pain, which involves brain regions also associated with social pain (e.g., dorsal anterior cingulate cortex (dACC) and right ventral prefrontal cortex (RVPFC; Eisenberger, Lieberman, & Williams, 2003)). We hypothesized that attachment insecurity, indicated by measures of adult attachment anxiety and avoidance, would be associated with sensitivity to physical pain following social exclusion. Bowlby (1973, 1980, 1982) proposed that human beings are born with an innate attachment system that organizes their behavior in ways that promote survival, mainly by maintaining proximity to a preferred caregiver, called an attachment figure. ⇑ Corresponding author at: Department of Psychology, University of California, Davis, United States. E-mail addresses: [email protected] (M.T. Frías), [email protected] (P.R. Shaver). http://dx.doi.org/10.1016/j.jrp.2014.10.003 0092-6566/Ó 2014 Elsevier Inc. All rights reserved.

Across the life span, the attachment system is continuously activated by stimuli that are interpreted as threats, such as novelty, loud noises, darkness, unwanted separation from attachment figures, and physical pain. The extent to which caregivers are sensitive and responsive to an individual’s needs for love and protection from threats shape the individuals’ views of themselves, others, and relationships. Sensitive and responsive caregivers early in one’s life promote a sense of attachment security, characterized by positive views of self and others and positive expectations about the course of social relationships. In contrast, insensitive and unresponsive caregivers promote negative evaluations of self and/or others that can result in one or both of two major forms of insecurity: attachment-related anxiety and attachment-related avoidance (see Mikulincer & Shaver, 2007, for a review). Individuals whose caregivers were inconsistent or erratic, being sometimes overinvolved and overprotective and sometimes insensitive and unresponsive, tend to develop high levels of attachment-related anxiety. Such individuals tend to worry that a partner will not be available and supportive in times of need, which heightens their efforts to maintain closeness. Individuals whose caregivers were consistently unresponsive to their expressed needs tend to develop attachment-related avoidance. They distrust relationship partners’ goodwill and capacity to help, and they therefore attempt to be independent and self-reliant (Brennan, Clark, & Shaver, 1998). The negative views and expectations that highly anxious and avoidant individuals hold about themselves and others make them sensitive to social pain or rejection (Downey & Feldman,

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1996; Feldman & Downey, 1994; Mikulincer, Dolev, & Shaver, 2004). Social pain refers to ‘‘a specific emotional reaction to the perception that one is being excluded from desired relationships or being devaluated by desired relationship partners’’ (MacDonald & Leary, 2005, p. 202). It can be caused by a variety of experiences, including rejection, death, and separation from a loved one (MacDonald & Leary, 2005). Sensitivity to social pain varies among individuals and involves expecting, readily perceiving or imagining, and overreacting to social rejection. Individuals who are especially high on social pain sensitivity tend to attribute hurtful intentions to others’ insensitive behavior, be dissatisfied in their relationships, and exaggerate their partners’ dissatisfaction with them in relationships (Downey & Feldman, 1996; Feldman & Downey, 1994). According to Social Pain Theory (MacDonald & Leary, 2005), both social and physical pain involve the same neural system, presumably because the physical pain system was already in place when social rejection became important in evolutionary history. Hence, factors that cause either physical or social pain are associated with increases in both kinds of pain, and that factors that alleviate one of those two kinds of pain are also associated with a decrease in the other kind (see MacDonald & Leary, 2005, for a review). Several studies have provided evidence for this association. For example, social rejection is associated with college students’ and community adults’ experiences of social pain (e.g., Williams, Cheung, & Choi, 2000) and with college students’ experiences of physical pain (e.g., Eisenberger, Jarcho, Lieberman, & Naliboff, 2006). Acetaminophen, a widely used physical pain suppressant (e.g., Anderson, 2008), also reduces college students’ feelings of social pain (DeWall et al., 2010). Moreover, recent findings have shown that oxytocin, a neuropeptide associated with the reduction of physical pain (Wang et al., 2013), reduces undergraduates’ cortisol levels following social exclusion (Linnen, Ellenbogen, Cardoso, & Joober, 2012). The degree of physical pain experienced following social exclusion has been shown to depend on the perceived magnitude of exclusion (Bernstein & Claypool, 2012; Borsook & MacDonald, 2010). But the association is not linear. Up to a certain point, an increase in the magnitude of the real or threatened social exclusion is associated with an increase in individuals’ physical pain sensitivity (Bernstein & Claypool, 2012). However, when the magnitude of the social threat is perceived as very strong, exclusion decreases, rather than increases, physical pain sensitivity. In such cases, social exclusion leads to temporary physical and emotional numbness, which reduces suffering and enables the individual to cope without feeling overly distressed (DeWall & Baumeister, 2006). There is also evidence for an association between attachment insecurities and social and physical pain. According to Baldwin and Kay (2003), secure individuals (those scoring low on measures of attachment anxiety and avoidance) should be less sensitive to social pain, because their generally positive outlook on relationships, based on a history of positive experiences, should protect them from having strong negative reactions to rare experiences of rejection or exclusion. Given the overlap between social and physical pain processes, secure individuals might also be relatively insensitive to physical pain. Several studies have provided support for this possibility; for example, relatively low levels of attachment anxiety and avoidance have been associated with less behavioral disability among chronic-pain patients (Meredith, Strong, & Feeney, 2006) and lower sensitivity to experimentally induced physical pain among otherwise pain-free college students and community members (Andrews, Meredith, & Strong, 2011; Rowe et al., 2012). Research also based on generally pain-free college students has found that self-reported social pain sensitivity is associated

with dispositional attachment anxiety (Baldwin & Kay, 2003; Cassidy, Shaver, Mikulincer, & Lavy, 2009; Downey & Feldman, 1996; Feldman & Downey, 1994) and can be reduced by ‘‘security priming,’’ an experimental procedure that momentarily increases a person’s sense of security (Cassidy et al., 2009). Attachment anxiety has also been related to greater sensitivity to experimentally induced physical pain among otherwise pain-free college students (Eisenberger et al., 2011; Wilson & Ruben, 2011) and among generally pain-free community adults (Wilson & Ruben, 2011). Moreover, among pain-free college students, attachment anxiety has also been related to greater activation in the dACC and the anterior insula, brain regions associated with the experience of physical pain, after being rejected from a computer-simulated ball tossing game (Cyberball; DeWall et al., 2012). Additionally, experimentally induced attachment security (which should temporarily lower anxiety and avoidance) was related to activity in the ventromedial prefrontal cortex (VMPFC) of female college students, a neural region associated with safety signaling that is activated in response to threats (Eisenberger et al., 2011). Attachment anxiety has been associated with greater physical pain sensitivity among chronic-pain patients (Davies, Macfarlane, MacBeth, Morriss, & Dickens, 2009; MacDonald & Kingsbury, 2006; McWilliams, Cox, & Enns, 2000) and among otherwise pain-free individuals (MacDonald & Kingsbury, 2006). Attachment anxiety has also been associated with worse psychological concomitants of physical pain such stress, worry, and depression (i.e., Ciechanowski et al., 2003), and with catastrophizing thoughts related to physical pain among college students, chronic-pain patients, and community adults (Ciechanowski et al., 2003; MacDonald, 2008; Rowe et al., 2012). According to MacDonald (2008), this tendency of anxious individuals to overreact to physical pain is motivating by desiring more social support. Based on these findings, we expected attachment anxiety to be associated with high physical pain sensitivity following social exclusion. The relationship between attachment-related avoidance and self-reported social pain sensitivity following social exclusion has been inconsistent. In several studies involving college students, Downey and Feldman (1996); Feldman & Downey (1994) and Baldwin and Kay (2003) found a positive association between avoidance and self-report measures of social pain following social exclusion. However, Besser and Priel (2009) failed to find such an association in a sample of otherwise pain-free community members using other indicators of social pain such as self-reports of negative emotions, expressions of anger, somatic symptoms, and self-devaluation. In other studies, a negative association between avoidance and indicators of social pain has been found. For example, after experiencing a laboratory social rejection, avoidant college students displayed less activation of the dACC and the anterior insula, two brain regions that are generally more active following rejection (DeWall et al., 2012). It seems possible that the variable results are due in part to the other form of attachment insecurity: attachment anxiety. Avoidant individuals who are not also high in attachment anxiety may be able to suppress reactions to rejection and exclusion, but those who are anxious as well as avoidant may be especially vulnerable to heightened pain sensitivity. Finally, physical and social pain are similarly associated with various personality traits, such as self-esteem (e.g., Blackhart, Nelson, Knowles, & Baumeister, 2009; Sommer & Baumeister, 2002) and neuroticism (e.g., Downey & Feldman, 1996; Goubert, Crombez, & Van Damme, 2004; Wade & Price, 2000), which are also known to be related to attachment anxiety (see Mikulincer & Shaver, 2007, for a review). Therefore, we included measures of self-esteem and neuroticism in the present study as possible statistical control variables.

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2. The present study Previous research on social pain suggests that it is closely related to the physical pain system in the brain, and hence that people who are sensitive to social pain may also be sensitive to physical pain. Previous studies on social pain in relation to attachment insecurities suggest that attachment anxiety is related to social-pain sensitivity, and that attachment-related avoidance is sometimes positively related to social-pain sensitivity and sometimes negatively related. In the present study, we examine the relation between attachment anxiety and avoidance, on one hand, and sensitivity to physical pain, on the other. Physical pain sensitivity is measured by the well-known coldpressor task (Baeyer, Piira, Chambers, Trapanotto, & Zeltzer, 2005). We hypothesized that attachment anxiety would be associated with greater physical pain sensitivity following social exclusion in the Cyberball game. Moreover, we hypothesized that, following social exclusion, attachment-related avoidance would be associated with heightened physical pain sensitivity only for participants who also scored high on anxiety (the group that Bartholomew and Horowitz, 1991, called ‘‘fearfully avoidant’’). 2.1. Method 2.1.1. Participants We examined the responses of 345 undergraduates (160 men and 185 women) from 18 to 26 years of age (M = 19.43I, SD = 1.78). Fifty-four point five percent of participants (n = 188) identified themselves as Asian, 25.5% (n = 88) as Caucasian, 16.2% (n = 56) as Hispanic or Latino, 0.6% (n = 2) as African American, and 3.2% (n = 11) endorsed ‘‘Other’’ race. (This ethnic diversity is typical of the student body at the University of California, Davis.) As for relationship status, 62.9% (n = 217) were single and not dating or seeing anyone at the time of the study, 22.6% (n = 78) were involved in one primary relationship and not seeing anyone else, 9.0% (n = 31) were casually dating or seeing one particular person, 2.6% (n = 9) were casually dating or seeing more than one person, 1.5% (n = 5) were married or cohabiting and not seeing anyone else, 0.9% (n = 3) were involved in one primary relationship but seeing other people as well, and 0.6% (n = 2) did not provide information regarding relationship status. Among those who were involved in either an exclusive or non-exclusive relationship (dating, cohabiting, or married), the relationship length was from one week to 84 months (M = 22.19, SD = 21.24). 2.1.2. Measures 2.1.2.1. Attachment insecurities. There are two methodological cultures, or traditions, in the study of adult attachment. One, based on the Adult Attachment Interview (AAI; Hesse, 2008; Main & Goldwyn, 1998), assesses ‘‘state of mind with respect to attachment,’’ which is closely tied to the ability to speak coherently about childhood attachment relationships with parents and other attachment figures. It has been shown to predict an adult parent’s child’s attachment pattern in the Strange Situation assessment procedure (Ainsworth, Blehar, Waters, & Wall, 1978). The other line of research uses self-report measures of adult attachment insecurities, such as the Experiences in Close Relationships questionnaire (ECR; Brennan et al., 1998), which have been shown to relate in theoretically predicted ways to numerous other individual and relationship-focused variables (see Mikulincer & Shaver, 2007, for a review). These measures focus on people’s self-reported beliefs, feelings, and behaviors in adult close relationships. Given that the present study deals with individuals’ reactions to the acute stress caused by social rejection by peers, we assessed attachment insecurities with the ECR. The ECR assesses two kinds of

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attachment insecurity: attachment anxiety (measured with 18 items concerning fear of rejection and abandonment; e.g., ‘‘I worry about being rejected or abandoned’’) and attachment-related avoidance (measured with 18 items concerning discomfort with closeness and interdependence; e.g., ‘‘I find it difficult to allow myself to depend on others’’). Both sets of items are evaluated on a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). In the present sample, Cronbach’s alphas were .88 and .90 for anxiety and avoidance. We also included measures of self-esteem and neuroticism, which are often correlated with anxiety or avoidance and have been related to physical pain sensitivity in some previous studies. 2.1.2.2. Self-esteem. Participants completed Rosenberg’s Selfesteem Scale (1965), which includes 10 items (e.g., ‘‘On the whole, I am satisfied with myself’’ (reverse-keyed), ‘‘I am able to do things as well as most other people’’) evaluated on a 4-point Likert-type scale ranging from 0 (strongly agree) to 3 (strongly disagree). Cronbach’s alpha was .88 in this sample. 2.1.2.3. Neuroticism. Participants completed the neuroticism subscale of the Big Five Inventory (John, Naumann, & Soto, 2008), which includes eight items (e.g., ‘‘I see myself as someone who . . .is relaxed, handles stress well (reverse-keyed), . . .worries a lot’’) rated on a 5-point Likert-type scale ranging from 1 (disagree strongly) to 5 (agree strongly). Cronbach’s alpha was .81 in this sample. 2.1.2.4. Positive and negative affect. To provide a check on the exclusion manipulation, participants completed the Positive and Negative Affect Scales (PANAS; Watson, Clark, & Tellegen, 1988). This measure includes 20 items, 10 measuring positive affect (e.g., ‘‘interested,’’ ‘‘excited,’’ ‘‘strong’’) and 10 measuring negative affect (‘‘distressed,’’ ‘‘upset,’’ ‘‘guilty’’). Items are rated on a 5-point scale ranging from 1 (very slightly or not at all) to 5 (extremely). In this sample, Cronbach’s alphas were .88 and .75 for positive and negative affect. 2.1.2.5. Felt exclusion. Participants also completed a post-experimental questionnaire that has been widely used as a manipulation check in previous research on cyberostracism (Williams et al., 2002). It includes 11 items distributed into four subscales: belonging (e.g., ‘‘I felt like an outsider’’; three items), control (e.g., ‘‘I felt like I had control over the course of the interaction,’’ reversekeyed; three items), meaningful existence (e.g., ‘‘I felt nonexistent’’; three items), and self-esteem (e.g., ‘‘I felt good about myself,’’ reverse-keyed; two items). Participants are asked to answer the questions according to how they felt while playing the Cyberball game and rate them on a 9-point scale ranging from 1 (not at all) to 9 (very much). Cronbach’s alphas were .81, .69, .88, and .80, for belonging, control, meaningful existence, and selfesteem. Cronbach’s alpha for the scale as a whole was .93; therefore, we computed a single measure of felt exclusion to be used in subsequent analyses. This measure also includes two openended questions regarding the extent to which participants felt included in the game: (1) ‘‘What percent of the throws were thrown to you?’’ and (2) ‘‘To what extent were you included by the other participants in the game?’’ Participants responded to the latter question with phrases such as ‘‘very little’’ and ‘‘somewhat included.’’ 2.1.3. Procedure Approximately one week before the experimental session, participants completed self-report measures of attachment insecurities, self-esteem, and neuroticism. Each experimental session involved one experimenter, two confederates, and one ‘actual’

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participant. After signing the consent form, the experimenter introduced the participant and the two confederates to an experiment allegedly involving a simple computer task and mild discomfort of the kind often experienced in daily life. The experimenter explained that the participant and the two confederates would be playing an online computer-based ball-tossing game called Cyberball (Williams et al., 2000). The participant was led to believe that s/he was playing the game with the two confederates, but in fact the game was controlled by the computer. Each participant was assigned to one of two conditions, inclusion or exclusion. In the inclusion condition, the participant was fully included in the game, which means s/he received 33% of the throws. In the exclusion condition, the participant received only two throws at the beginning of the game and thereafter was excluded. When the Cyberball game was over, the experimenter announced that the next activity had to be completed one participant at a time, and asked the actual subject to go first. The experimenter then asked the two confederates to step outside the room, and proceeded to the coldpressor task with the actual subject – a task that has been widely used in previous studies involving physical pain sensitivity (e.g., Andrews et al., 2011; Baeyer et al., 2005; Brown, Sheffield, Leary, & Robinson, 2003). For this task, the experimenter instructed the participant to put and keep his/her non-dominant forearm and hand in a bucket of ice water (at a temperature between 1 and 2 °C degrees) for as long as s/he could tolerate the pain. The experimenter ended the activity when the participant took his/her arm out of the water or after 3 min had elapsed. The experimenter recorded the length of time, in seconds, that the arm was held in the ice water. Shorter periods of time (i.e., fewer seconds) were considered indicative of greater pain sensitivity. For the sake of clarity, we reverse-scored this variable —by multiplying it by minus one— to create a physical pain sensitivity variable (PPS). Participants then completed the PANAS and the felt exclusion questionnaires. Finally, they were thanked and thoroughly debriefed about the purpose of the study and the confederates’ roles in the Cyberball game. 2.2. Results 2.2.1. Preliminary results 2.2.2.1. Manipulation check. In the exclusion condition, open-ended responses to the question about the extent to which the participant felt included in the game reflected a sense of having been excluded (e.g., ‘‘very little,’’ ‘‘not much,’’ ‘‘not included’’), and responses of all but two participants in the inclusion condition reflected a sense of having been included (e.g., ‘‘about equally,’’ ‘‘fairly included,’’ ‘‘fairly equal’’). Two participants in the inclusion condition reported not having felt included in the game (‘‘none’’ and ‘‘not very included’’). Overall, however, the results suggest that we were successful in inducing different levels of inclusion in the two experimental conditions. In terms of the quantitative manipulation checks, being in the inclusion condition was positively associated with positive affect (t (343) = 2.82, p < .01, d = .30; M inclusion = 2.27 vs. M exclusion = 2.04) and with self-reported percentage of throws received during the game (t (337) = 29.05, p < .001, d = 3.19; M inclusion = 40.90 vs. M exclusion = 7.60) and negatively associated with negative affect (t (343) = 4.54, p < .001, d = .49; M inclusion = 1.33 vs. M exclusion = 1.55) and felt exclusion (t (341) = 25.97, p < .001, d = 2.81; M inclusion = 3.90 vs. M exclusion = 6.36). 2.2.2.2. Correlational analyses. There were three significant gender differences: (1) Women displayed higher pain sensitivity than men, on average removing their arms from the ice water sooner than men (t (343) = 3.21, p < .01, d = .34; M men = 91.02 s vs. M

women = 70.30 s). (2) Among men, being included was positively associated with lower pain sensitivity (t (158) = 2.14, p < .05, d = .34; M exclusion = 81.69 s vs. M inclusion = 101.18 s), but this was not the case for women (t (183) = .21, p < .83, d = .03; M exclusion = 69.44 s vs. M inclusion = 71.24 s). (3) Women also scored higher in neuroticism (t (343) = 3.95; p < .001, d = .43; M men = 2.82 vs. M women = 3.13). Because of the gender differences, correlations between the other main study variables were computed separately for men and women. The results are shown in Table 1. Among men, but not among women, being in the exclusion condition was positively associated with PPS; avoidance and anxiety were significantly correlated; and avoidance was correlated with neuroticism. For both sexes, attachment anxiety was positively associated with neuroticism and negatively associated with self-esteem, and self-esteem was negatively associated with neuroticism. 2.2.2. Predicting physical pain sensitivity We first log transformed the variable PPS to normalize it. We then performed a hierarchical regression analysis, following the guidelines of Aiken and West (1991), to determine the unique main effects and interactions of gender, experimental condition, and attachment anxiety and avoidance on PPS (Table 2). In a preliminary analysis, we centered all of the continuous predictor variables (as recommended by Aiken & West, 1991) – including anxiety, avoidance, self-esteem and neuroticism – and used them to predict PPS. Neither self-esteem nor neuroticism was associated with PPS (as can also be seen in Table 1), and the significant interactions involving the other variables remained the same (as indicated by a subsequent analysis). We will therefore focus on analyses conducted without those two variables. In Step 1 of the analysis summarized in Table 2, we entered the main effects of gender, experimental condition, anxiety, and avoidance. In Step 2 we entered the six possible two-way interactions: (1) gender and condition, (2) gender and anxiety, (3) gender and avoidance, (4) condition and anxiety, (5) condition and avoidance, and (6) anxiety and avoidance. In Step 3 we entered all three-way interactions: (1) gender, condition, and anxiety, (2) gender, condition, and avoidance, and (3) condition, anxiety, and avoidance. In the fourth step, the four-way interaction was entered but was not significant, allowing us to ignore it. Given that the change in the explained variance from Model 2 to Model 3 was significant, we retained and interpreted Model 3. The results revealed the already mentioned significant effect of gender, with men keeping their arms submerged in the ice water longer (indicated in this analysis by lower PPS. There were also two significant three-way interactions; the first among gender, condition, and anxiety, and the second among condition, anxiety, and avoidance. To interpret the three-way interaction of gender, condition, and anxiety, we examined the two-way interaction between gender and anxiety separately for the included and the excluded participants (Fig. 1). The interaction between gender and anxiety was significant for the excluded participants (b = .24, p = .02, f2 = .04) but not for the included participants (b = .07, p = .45, f2 = .003). We then conducted a simple slope test to examine the effects of anxiety separately for men and women only within the excluded group. For excluded men, anxiety had a significant effect on PPS (b = .23, p = .04, f2 = .06), but this effect was opposite in direction and not significant for the excluded women (b = .14, p = .19, f2 = .02). This indicates that, among men, attachment anxiety increased PPS following exclusion. To interpret the three-way interaction of condition, anxiety, and avoidance, we examined the two-way interaction between avoidance and condition separately for participants high and low in anxiety (Fig. 2). The interaction between avoidance and condition was

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M.T. Frías, P.R. Shaver / Journal of Research in Personality 53 (2014) 193–200 Table 1 Zero-order correlations among all variables, separately for men (N = 160) and women (N = 185). M 1. 2. 3. 4. 5. 6.

SD

1

a

Condition PPS Anxiety Avoidance Self-esteem Neuroticism

79.81 4.02 3.49 3.28 2.99

59.96 .97 .93 .68 .72

2 *

1 .02 .01 .04 .07 .05

.17 1 .01 .03 .08 .03

3

4

5

6

.10 .15 1 .06 .24** .52**

.10 .09 .28** 1 .27** .05

.14 .03 .39** .47** 1 .51**

.06 .05 .48** .32** .58** 1

Note: We also correlated relationships length with these variables; none of the correlations were significant. PPS = Physical Pain Sensitivity. PPS values are expressed in magnitude, regardless of their direction. Correlations above and below the 1’s diagonal correspond to men and women, respectively. a Condition was coded 1 for exclusion and 0 for inclusion. * Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed).

Table 2 Hierarchical regression analysis predicting physical pain sensitivity (N = 345). Model

Change statistics

Predictor

b

t

p

.00

Gendera Conditionb Anxiety Avoidance

.19 .07 .05 .04

3.54 1.22 .90 .81

<.01 .22 .37 .42

.03

.48

Gender Condition Anxiety Avoidance Gender  Condition Gender  Anxiety Gender  Avoidance Condition  Anxiety Condition  Avoidance Anxiety  Avoidance

.26 .00 .02 .04 .11 .09 .02 .04 .00 .08

3.39 .06 .23 .41 1.22 1.29 .28 .49 .03 1.30

<.01 .95 .82 .68 .22 .20 .78 .63 .97 .20

.06

.02

Gender Condition Anxiety Avoidance Gender  Condition Gender  Anxiety Gender  Avoidance Condition  Anxiety Condition  Avoidance Anxiety  Avoidance Gender  Condition  Anxiety Gender  Condition  Avoidance Gender  Anxiety  Avoidance Condition  Anxiety  Avoidance

.25 .01 .14 .02 .09 .09 .03 .18 .01 .04 .24 .08 .05 .20

3.34 .14 1.33 .19 1.02 .85 .26 1.70 .08 .44 2.21 .71 .62 2.58

<.01 .89 .19 .85 .31 .40 .80 .09 .94 .66 .03 .48 .53 .01

Adjusted R2

p

1

.03

2

3

Note: The dependent variable, physical pain sensitivity, was log transformed. a Gender was coded such that men = 1 and women = 0. b Condition was coded such that exclusion = 1 and inclusion = 0.

Fig. 1. Physical pain sensitivity as a function of gender, anxiety, and condition (exclusion vs. inclusion). Units on the Y-axis are standardized scores.

significant among participants high in anxiety (b = .29, p = .01, f2 = .04) but not among participants low in anxiety (b = .18, p = .09, f2 = .02). We conducted a simple slope test to interpret the interaction between condition and avoidance among participants high in anxiety, finding that the effect of avoidance on PPS

was significant only among the excluded participants (b = .27, p = .01, f2 = .08) but not among the included participants (b = .14, p = .21, f2 = .02). These results indicate that, following social exclusion, individuals high on both anxiety and avoidance are especially sensitive to physical pain.

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Fig. 2. Physical pain sensitivity as a function of condition (exclusion vs. inclusion), anxiety, and avoidance. Units on the Y-axis are standardized scores.

3. Discussion We examined associations between attachment anxiety and avoidance, on the one hand, and physical pain sensitivity, on the other, after participants were excluded from or included in a Cyberball game. We hypothesized that among excluded, but not included, participants, attachment anxiety and attachment-related avoidance would predict greater physical pain sensitivity (PPS). Our results supported the hypothesis but were qualified by gender: Among men, but not among women, anxiety and avoidance were positively associated with PPS following exclusion. First, we found a main effect of gender, with men exhibiting lower pain sensitivity than women. This result fits with previous research indicating that men are generally less sensitive to pain (Alabas, Tashani, Tabasam, & Johnson, 2012; Castro-Sanchez et al., 2012; Fillingim, King, Ribeiro-Dasilva, Rahim-Williams, & Riley, 2009; Meredith et al., 2006), perhaps for physiological reasons or because gender roles affect the way individuals self-regulate pain and pain expressions, and lead men to interpret and express vulnerability to pain less openly or quickly than women (Alabas et al., 2012; Keogh, Hamid, Hamid, & Ellery, 2004). We also found a significant interaction among gender, condition, and anxiety, with high anxiety predicting greater pain sensitivity among excluded men. This association between anxiety and physical pain is consistent with the previously documented tendency of anxious individuals to overreact to threats and stressors (e.g., Shaver, Mikulincer, & Chun, 2008), partly to attract and hold their attachment figures’ attention (Mikulincer & Shaver, 2008). In the present study, being excluded from the Cyberball game may have activated anxious men’s attachment systems, which made them more sensitive to physical pain in the coldpressor task. When anxious mens’ attachment systems were not activated (when they were included in the Cyberball game), however, they did not differ in their physical pain sensitivity compared to their low-anxiety counterparts. It is important to note that the association between anxiety and physical pain sensitivity was different for men and women, with anxiety being associated with greater sensitivity only among men. It seems possible that women’s generally high physical pain sensitivity across conditions kept us from observing a significant association between anxiety and physical pain sensitivity among women. However, the absence of such an association does not mean that women were not bothered by being excluded from the Cyberball game. They did show other signs of social pain: higher negative affect and lower positive affect than reported by female participants who were included in the game. There was also a significant interaction among condition, anxiety, and avoidance, with a combination of high anxiety and high avoidance predicting greater pain sensitivity among excluded male and female participants. Previous research had yielded inconclusive evidence concerning the effects of social exclusion on avoidant individuals’ pain systems. Avoidant individuals have been characterized as deactivating their attachment systems following a

threatening social stimulus by downplaying the potential dangers of threats and not expressing their negative emotional reactions to them (e.g., Shaver et al., 2008). However, survey studies (Baldwin & Kay, 2003; Downey & Feldman, 1996; Feldman & Downey, 1994) have documented high self-reported social pain sensitivity following social exclusion, suggesting that avoidant individuals hyperactivate, rather than deactivate, their attachment systems when confronted with outright rejection or ostracism. Our results suggest that the way in which avoidant individuals cope with social pain, either by deactivating or hyperactivating their attachment systems, depends on their level of attachment anxiety. Avoidant individuals’ preferred strategy for dealing with social pain, deactivation of their attachment system, is less likely to be successful when attachment anxiety is also high (fearful attachment style). Evidence from other studies has suggested that deactivation of the attachment system is a cognitively demanding task, and that highly avoidant individuals’ ability to deactivate their attachment systems depends on them not being overly stressed and on having cognitive resources available (e.g., Mikulincer et al., 2004). Future research should be conducted to replicate and extend our results. If dispositional attachment insecurities have a significant effect on physical pain sensitivity following social exclusion, it seems possible that experimentally induced attachment security would buffer such effects. Previous research has documented that security priming – an experimental procedure used to momentarily boost attachment security – overrides the detrimental effects of dispositional attachment insecurity on prosocial behavior (Mikulincer, Shaver, Sahdra, & Bar-On, 2013). Therefore, it seems possible that security priming could override the detrimental effects that social exclusion on individuals’ physical pain sensitivity, especially in the case of individuals who are both anxious and avoidant. Effect sizes were fairly small, probably because many variables contribute to the length of time a person holds his or her hand in ice water on a particular occasion. It would be useful in future studies to measure pain sensitivity in additional ways and perhaps to make the exclusion manipulation stronger, although this might present ethical problems. By taking a closer look at the effect sizes, we discovered that the influence of attachment anxiety on PPS was small for all excluded participants; however, the effect was three times as large among excluded men as it was among excluded women (f2 = .04 vs. .003). Furthermore, although the influence of attachment-related avoidance on PPS was small for all excluded participants, it was four times as large among excluded highly anxious participants as among excluded low-anxious participants (f2 = .08 vs. .02). Taken together, these results suggest that attachment insecurities play a small role in the experience of physical pain following social exclusion, but they modify one another and are modified by gender. The present study has limitations. Although previous studies using PPS have relied on the number of seconds participants kept their hands in ice water as a measure of pain tolerance (or physical

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pain sensitivity, when reverse scored; e.g., MacDonald, 2008), it is possible that this paradigm assesses individual differences in selfregulation of reactions to painful stimuli, rather than differences in the experience of pain per se. In future studies, it would be worthwhile to use multiple indicators of reactions to pain: pain threshold (the point at which a stimulus is perceived as painful), pain tolerance (which might be assessed more accurately by allowing participants to keep their hands in the ice water beyond 3 min), self-reports of degree of pain at various points along the tolerance continuum. It may also be a limitation of our study that it relied on selfreport measures of personality traits (i.e., attachment insecurities, self-esteem, and neuroticism), although these are well-researched measures with extensive evidence for their construct and predictive validity. Answers to some of the scale items might have been affected by gender or gender roles – for example, if it is easier for women than for men to report attachment anxiety or low selfesteem. But again, many studies have obtained predicted effects of attachment anxiety and other traits with no interactions with gender. 4. Conclusions Our results suggest that attachment anxiety and avoidance moderate the association between social and physical pain. Following exclusion from a computer-based-ball-tossing game (social pain), anxious and avoidant individuals tend to activate their attachment systems, which increases their sensitivity to physical pain. Anxious individuals cope with this heightened sensitivity by overreacting to a physically painful stimulus. Avoidant individuals have the ability to suppress such heightened sensitivity, but this ability is reduced when they are also high on attachment anxiety. 5. Funding This research was supported by a grant to the first author from the Mexican National Council for Science and Technology (Consejo Nacional de Ciencia y Tecnología, CONACYT). References Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage. Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Earlbaum. Alabas, O. A., Tashani, O. A., Tabasam, G., & Johnson, M. I. (2012). Gender role affects experimental pain responses: A systematic review with meta-analysis. European Journal of Pain, 16, 1211–1223. http://dx.doi.org/10.1002/j.15322149.2012.00121.x. Anderson, B. J. (2008). Paracetamol (acetaminophen): Mechanisms of action. Pediatric Anesthesia, 18, 915–921. http://dx.doi.org/10.1111/j.14609592.2008.02764.x. Andrews, N. E., Meredith, P. J., & Strong, J. (2011). Adult attachment and reports of pain in experimentally induced pain. European Journal of Pain, 15, 523–530. http://dx.doi.org/10.1016/j.ejpain.2010.10.004. Baeyer, C. L. v., Piira, T., Chambers, C. T., Trapanotto, M., & Zeltzer, L. K. (2005). Guidelines for the cold pressor task as an experimental pain stimulus for use with children. Pain, 6, 218–227. http://dx.doi.org/10.1016/j.pain.2005.01.349. Baldwin, M. W., & Kay, A. C. (2003). Adult attachment and the inhibition of rejection. Journal of Social and Clinical Psychology, 22, 275–293. http://dx.doi.org/ 10.1521/jscp.22.3.275.22890. Bernstein, M. J., & Claypool, H. M. (2012). Not all social exclusions are created equal: Emotional distress following social exclusion is moderated by exclusion paradigm. Social Influence, 7, 113–130. http://dx.doi.org/10.1080/ 15534510.2012.664326. Besser, A., & Priel, B. (2009). Emotional responses to a romantic partner’s imaginary rejection: The roles of attachment anxiety, covert narcissism, and selfevaluation. Journal of Personality, 77, 287–325. http://dx.doi.org/10.1111/ j.1467-6494.2008.00546.x. Blackhart, C. G., Nelson, B. C., Knowles, M. L., & Baumeister, R. F. (2009). Rejection elicits emotional reactions but neither causes immediate distress nor lowers self-esteem: A meta-analytic review of 192 studies on social exclusion.

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