Knowing you care: effects of perceived empathy and attachment style on pain perception.

Other people can have a significant impact on one's pain. Although correlational data abound, causal relationships between one's pain experience, individual traits of social relating (e.g. attachment style), and social factors (e.g. empathy) have not been investigated. Here, we studied whether the presence of others and 'perceived empathy' (defined as participants' knowledge of the extent to which observers felt they understood and shared their pain) can modulate subjective and autonomic responses to pain; and whether these influences can be explained by individual traits of pain coping and social attachment. Participants received noxious thermal stimuli via a thermode attached to their forearm and were asked to rate their pain. In separate blocks they were witnessed by (a) high-empathic and (b) low-empathic unfamiliar observers, and in a third condition (c) no observer was present (alone condition). We found that the effects of social presence and empathy on pain ratings depended on individual differences in attachment style. Higher scores on attachment anxiety predicted higher pain ratings in the low-empathy than in the high-empathy condition; and higher scores on attachment avoidance predicted lower pain ratings in the alone condition than with social presence. In addition, social presence decreased autonomic responses to pain irrespective of individual personality traits. To our knowledge this is the first time that adult attachment style has been shown to modulate the effects of social presence and 'perceived empathy' on experimentally induced pain. The results are discussed in relation to recent cognitive models of pain coping and attachment theory.