The Lone Wolf or the Support Group Enthusiast?

What type of person are you?? When tough times come around – whether it is stress at work, a painful injury, or forced participation in Secret Santa – what do you do? Some people, those lone wolf types, find relief in being alone, taking some time to regroup, and dealing with the problem themselves. Others, aka the support group enthusiasts, prefer to find an empathetic friend with whom to talk the problem through, discuss a million options, and come out refreshed and re-invigorated. This is often referred to in research as ‘attachment style’. There are two main hypothesized attachment styles: ‘avoidant’ (lone wolf) and ‘anxious’ (support group enthusiast).

Chiara Sambo and colleagues recently published an intriguing study that investigated whether observation of a person in pain could affect that person’s pain levels. Specifically, they were interested to see if the presence of an empathic observer affected a person’s self-reported pain (VAS) in response to noxious thermal stimuli. They modified two things: 1) social presence (participant either got noxious stimuli alone or with an observer present) and 2) perceived empathy (when observers were present they were thought of as having either high-empathy versus low-empathy for the participant). Importantly, Sambo et al were also interested in whether differences in a person’s attachment style would modulate the effects of social presence and perceived empathy on pain.

Interestingly, (and contrary to their predictions), they found that the presence of an observer and their high ‘perceived’ empathy were not associated with lower pain ratings. However, this was elucidated when they investigated further. They found that the effect of perceived empathy and social presence on pain ratings was predicted by the participants’ attachment styles. Higher scores on attachment anxiety significantly predicted lower pain ratings in the presence of a ‘high-empathic’ observer compared to a ‘low-empathic’ observer (eg, if you are a support group enthusiast you have lower pain when a person who can really understand what you are going through is present). In contrast, higher scores on attachment avoidance significantly predicted lower pain ratings when participant experienced pain alone than when they experienced pain in the presence of an observer (eg, if you are a lone wolf, you experience less pain when no one else is there watching).

A fascinating result and a good thing to consider when treating patients – identifying a patient’s attachment style may help guide our interaction. In fact, I’d be curious to see if attachment style predicted patient care-seeking…do we, as clinicians, even see the lone wolves?

Tasha Stanton

Tasha is a Canadian living in Australia, who consistently disappoints people at conferences when she speaks and doesn’t have a hint of a ‘Strayan accent. She was originally trained as a Physiotherapist at the University of Alberta, Canada and then apparently couldn’t get enough of school so she completed a Master’s degree studying spinal biomechanics. She then decided that she liked beaches more than 4 feet of snow and moved to Australia to complete her PhD at The George Institute for Global Health. Luckily she is able to use the advanced skills attained during her PhD to expertly wash Prof Chris Maher’s car.

Sambo CF, Howard M, Kopelman M, Williams S, & Fotopoulou A (2010). Knowing you care: effects of perceived empathy and attachment style on pain perception. Pain, 151 (3), 687-93 PMID: 20869808


  1. Tess Hamers says:

    As a lone wolf I find that people don’t tend to see your pain and if they do it’s usually because you’ve been brought to breaking point because of their persistence to find out what’s wrong when you would rather be alone and deal with it on your own, I find I get angry if someone tries to help me or come near me when I’m upset and sometimes snap at them, but most of the time I put on a happy face so I can suffer in silence without being harassed by other people.

  2. Tasha Stanton says:

    David – solid points made about the traditional support groups and I tend to agree. While not entirely the same situation as yours, I ran pain workshops with chronic pain patients in the Workmans compensation system in Canada and it was pretty tough to gear myself up for doing it every week – for the exact reasons you suggest.

    Perhaps the usefulness of this research finding is less for promoting the use of traditional support groups (as my use of terminology seemed to suggest) and more about slightly changing techniques when treating patients. (I’m just throwing this speculation out there…this is not discussed at all in Samba et al’s article). Maybe for patients that have an avoidant type of attachment style, we are best trying to stay somewhat distant in therapy (eg, not being right there all the time while they do exercises, instead monitoring performance from a distance). In contrast, maybe for patients that have an anxious type of attachment style, we are best to be present (and empathic) while they are performing their exercises as this may decrease their pain levels. An interesting study to perform in real patients that’s for sure!

  3. Jo Oliver says:

    Hello David,
    Yes there is conflicting evidence re “attention or non attention” to the afflicted part and even Lorimer sits on the fence in this one. I try hard not to draw attention to my own problem part when visitors call, when just looking at it or “others” looking at it evokes pain, so I am in favour of less attention, and this works best for me.

  4. Tasha

    thanks for sharing…

    your article brought back painful, memories of Sunday afternoon’s Pain mechanism lectures I used to be invited to provide for a patient support group. Whatever the “attacnment” process of the members it was an unbelievably miserable atmosphere. The participants were waiting for the sales pitch (from the next monthly travelling road show), the hardcore had heard it all before, ” Is there anything new you can offer? question being an inciteful view of expectation, to those with downhearted resignation of living with a chronic condition and interpreting information in the light of restrictve thought processing.
    I’ve 23 clinical years on the clock dealing with spinal musculoskeletal dysfunction all day-every day (which I still love) but I would give very serious considerationto recommending support group participation. (or maybe just this one?)

    The balance between group support provided and creating a self contained world of perpetual misery is what I wrestle with.

    Interestingly, another part of our clinical practise deals with neurological disease and precicesly the same issues arise -although perhaps for diferent reasons. If I was a young Parkinson’s sufferer at high level function I would not want to be reminded of the possibilities down the road!

    Must be the lone wolf in me?



  5. Tasha Stanton says:

    Rebecca, thank you for commenting and for your insights as a “lone wolf”. I’ve been thinking about this issue of whether lone wolves would seek care for their problems and I definitely think it is not as straightforward as it sounds. I wonder if the distinction between lone wolf and support group enthusiast would better predict people seeking care in an acute pain type situation (eg, where the pain often goes away by itself). I could see in this case that the lone wolf may be more likely to try to tough it out. However, I think when we start talking about chronic pain it probably is an entirely different story…regardless of attachment style, the persistence of pain and the suffering that goes along with it, makes it absolutely necessary that someone seeks care.

    Bronnie, great comment as well. I’m not sure how the attachment style scale used in the present study compares with other scales that measure introversion/extroversion. If I find anything I’ll pop it up here. I have a feeling that you are probably right in that there would be a correlation between someone being introverted/lone wolf and extroverted/support group enthusiast.

  6. Jo Oliver says:

    Hi Ole. Yes the clinicians do see the patients, when the Surgeons Specialists, Doctors etc finally express their opinion “there is no cure, but I will arrange an appointment to see a Physio, who MAY be able to help with exercising the limb”….far too late sometimes months after the surgery! So this is when we become the lone wolf and rely on our own considerable research with the assistance of Lorimer’s group and their posts pointing us in the right direction, with credibility,honesty and often quite humbly addressing the fact that so far their is no cure.
    Is it possible that one day one of us could find the answer to this vexing question? It may just be a patient, not a clinician, But definitely someone who has followed all the material supplied by BIM, who is experiencing the actual pain?

  7. “do we, as clinicians, even see the lone wolves?”

    Ah, the patients whose spouse has insisted they’d see you 🙂

  8. Jo Oliver says:

    Many thanks Rebecca. Same goes for me! Lone Wolf is a coper, but needs assistance from BIM which we are capable of researching!

  9. I’m curious to see whether introversion/extraversion makes a difference to this finding. As an introvert, I need time away from people to maintain composure, while extraverts gain energy from being around people and actively seek them out. Those who prefer to share experiences and gain energy from being around people might respond as Sambo et al.’s high attachment anxiety group did, while people like me might be more like the low attachment anxiety group.
    I’d like to see more studies on attachment styles and pain behaviour before modifying clinician behaviour – I haven’t yet seen enough research to form an opinion about the relationship between the two variables yet.

  10. Rebecca Harkness says:

    Interesting reading. As a “lone wolf” in pain, I would suggest yes, you would see a lone wolf in pain.I find it hard 2 relate my CRPS as being the same as those folk within support groups,mainly because of the way they talk about & deal with it. Support groups 4 CRPS appear 2b very negative with the focus on how awful this condition is instead of emphasising how u can push forward through re-hab & find a more optimistic outcome. If I was part of the “empathy group” would I be more accepting of other folks opinions & happy 2 go down the usual paths with my CRPS ? Or would I find myself as a “lone wolf” researching this condition 4 a year until I found Dr Moseley’s methods ? My answer is of course the latter & my improvements speak 4 themselves. I have found the most important stage 4 empathy comes with my treating practitioners & their understanding of pain & CRPS. Without their knowledge of the “plastic/elastic brain & understanding of different techniques employed 2 ” re-train” the brain, it would b even harder 2 make progress & a future recovery. All the best, R.