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Although cross-sectional research indicates that attachment insecurity and pain self-efficacy are associated with pain intensity in chronic pain populations, little is known about their long-term effects on pain, and about the directionality of associations between these constructs. Furthermore, whereas attachment is a relational concept, few studies on genito-pelvic pain have espoused a couples\u2019 perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>Using a prospective dyadic design, the present study aimed to examine the directionality of the associations among attachment dimensions, pain self-efficacy, and pain intensity in couples coping with provoked vestibulodynia (PVD). A second aim was to test whether pain self-efficacy mediated the attachment-pain association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>213 couples coping with PVD completed self-report questionnaires at baseline (T1) and at a 2-year follow-up (T2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>(1) Experiences in Close Relationships \u2013 Revised; (2) Painful Intercourse Self-Efficacy Scale; and (3) 10-point Numerical Rating Scale for pain intensity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Autoregressive cross-lagged models revealed that women\u2019s greater attachment anxiety and avoidance at T1 predicted their greater pain intensity at T2. Women\u2019s greater attachment anxiety at T1 predicted their poorer pain self-efficacy at T2, and poorer pain self-efficacy in women at T1 predicted their higher pain intensity at T2. A mediation model showed that women\u2019s lower pain self-efficacy at T2 fully mediated the association between women\u2019s higher attachment anxiety at T1 and their higher pain intensity at T2. Partners\u2019 attachment dimensions did not predict their own or women\u2019s pain self-efficacy nor pain intensity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Results suggest that greater attachment anxiety may contribute to women with PVD\u2019s lower confidence that they can manage their pain, which leads to long-term persistent pain. This study highlights the importance of assessing attachment and pain self-efficacy in women with genito-pelvic pain and to consider interventions targeting these variables, as they have far-reaching consequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strength &amp; Limitations<\/jats:title><jats:p>The use of longitudinal and dyadic data inform interpersonal processes and the long-term implications of attachment and pain self-efficacy in PVD. The use of self-report measures may introduce a social desirability and recall bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This prospective dyadic study adds to a body of literature on PVD and chronic pain by empirically supporting theoretical models on attachment, pain self-efficacy, and persistent pain, and supports the role of psychosocial factors in the adjustment to PVD.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.08.012","type":"journal-article","created":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T04:29:24Z","timestamp":1569472164000},"page":"1803-1813","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["Self-Efficacy Mediates the Attachment-Pain Association in Couples with Provoked Vestibulodynia: A Prospective Study"],"prefix":"10.1093","volume":"16","author":[{"given":"V\u00e9ronique","family":"Charbonneau-Lefebvre","sequence":"first","affiliation":[{"name":"D\u00e9partement de Psychologie, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Pier","family":"Vaillancourt-Morel","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychologie, Universit\u00e9 du Qu\u00e9bec \u00e0 Trois-Rivi\u00e8res , Trois-Rivi\u00e8res, Qu\u00e9bec , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey","family":"Brassard","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychologie, Universit\u00e9 de Sherbrooke , Sherbrooke, Qu\u00e9bec , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Steben","sequence":"additional","affiliation":[{"name":"Clinique A , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Bergeron","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychologie, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,9,26]]},"reference":[{"key":"2023041407072284600_","doi-asserted-by":"crossref","first-page":"40.e1","DOI":"10.1016\/j.ajog.2013.09.033","article-title":"Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population-based estimates from 2 geographic regions","volume":"210","author":"Harlow","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"2023041407072284600_","first-page":"82","article-title":"A\u00a0population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia?","volume":"58","author":"Harlow","year":"2003","journal-title":"J\u00a0Am Med Womens Assoc (1972)"},{"key":"2023041407072284600_","first-page":"772","article-title":"2003 ISSVD terminology and classification of vulvodynia: A historical perspective","volume":"49","author":"Moyal-Barracco","year":"2004","journal-title":"J\u00a0Reprod Med"},{"key":"2023041407072284600_","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/00926230701866083","article-title":"Do psychosexual factors play a role in the etiology of provoked vestibulodynia? 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