Psychological Trauma Exposure and Pain-Related Outcomes Among People with Chronic Low Back Pain: Moderated Mediation by Thought Suppression and Social Constraints.
Psychological Trauma Exposure and Pain-Related Outcomes Among People with Chronic Low Back Pain: Moderated Mediation by Thought Suppression and Social Constraints.
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慢性腰痛患者的心理创伤暴露和疼痛相关结果：思想抑制和社会约束的适度调解。
DOI：
10.1007/s12160-016-9838-0
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Burns,JohnW
中科院分区：
文献类型：
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作者：
Pegram,SheriE;Lumley,MarkA;Jasinski,MatthewJ;Burns,JohnW
慢性腰痛（CLBP）影响了大约三分之一的美国成年人，并影响了三个核心调整或结果领域：疼痛、身体功能和情绪功能。虽然CLBP受到生物、心理和社会因素的影响，但心理创伤性生活事件的经历似乎是增加疼痛强度、干扰和抑郁的一个特别有效的危险因素。然而，将创伤暴露与这些疼痛相关结果联系起来的机制尚不清楚。本研究探讨了创伤性生活事件影响CLBP患者疼痛调节的两种相关但不同的认知和社会机制：思想抑制和社会约束。接触创伤性事件通常会导致侵入性思维，也就是说，对该事件产生无法控制和痛苦的认知。侵入性想法似乎源于试图抑制或压抑与创伤性事件有关的记忆和情绪，并导致负面情绪和身体症状的发展和持续。Wegner的讽刺过程模型解释了思想抑制对症状的影响。思想抑制反而增加了思想的可及性，导致反刍和痛苦的增加[4,5]。思想抑制已被证明可以预测创伤暴露者的精神病理，超出了应对策略和情绪调节bb0的影响。更普遍的是，包括思想抑制在内的认知情感回避策略会导致疼痛。例如，与健康对照组相比，慢性盆腔疼痛患者不仅有更高水平的创伤经历，如虐待，而且情绪和思想抑制bb0。面对——而不是抑制或压抑——创伤记忆对于促进事件的情感处理和最终解决至关重要。然而，反讽过程模型没有考虑到社会环境所起的关键作用。社会认知加工模型解释了一个人的社会环境特征如何影响侵入性思想的加工和表达[10]。具体来说，社会环境可以加重或减轻创伤对症状的影响。那些支持和鼓励披露而不是抑制的环境通过肯定和确认思想和感受，促进对创伤相关思想的洞察，提供应对建议，减少痛苦和觉醒来促进创伤恢复[10,11]。也就是说，鼓励情感表达和表露的社会环境既可以减少思想压抑，也可以减轻其对症状的有害影响。
Chronic low back pain (CLBP) affects approximately one third of adults in the USA [1] and impacts the three core adjustment or outcome domains: pain, physical functioning, and emotional functioning [2]. Although CLBP is influenced by biological, psychological, and social factors, the experience of psychologically traumatic life events appears to be a particularly potent risk factor for increased pain intensity, interference, and depression [3]. The mechanisms linking trauma exposure to these pain-related outcomes, however, are not clear. This study examined two related but distinct cognitive and social mechanisms through which traumatic life events might affect pain adjustment in people with CLBP: thought suppression and social constraints. Exposure to a traumatic event commonly results in intrusive thoughts, that is, uncontrollable and distressing cognitions about the event. Intrusive thoughts appear to arise from attempts to inhibit or suppress memories and emotions related to the traumatic event and contribute to the development and persistence of negative emotions and physical symptoms [4]. Wegner’s ironic process model accounts for the influence of thought suppression on symptoms. Thought suppression paradoxically increases the accessibility of the thoughts, resulting in increased rumination and distress [4, 5]. Thought suppression has been shown to predict psychopathology among trauma-exposed people, beyond the influence of coping strategies and emotion regulation [6]. More generally, cognitiveaffective avoidance strategies, including thought suppression, contribute to pain. For example, compared to healthy controls, patients with chronic pelvic pain have higher levels not only of traumatic experiences such as abuse but also of emotion and thought suppression [7].Confronting—rather than inhibiting or suppressing—memories of trauma is crucial for facilitating emotional processing of the event and its eventual resolution [8]. However, the ironic process model does not consider the crucial role played by the social environment. The social cognitive processing model explains how characteristics of one’s social environment influence the processing and expression of intrusive thoughts [9]. Specifically, social environments can exacerbate or attenuate the effects of trauma on symptoms. Those environments that support and encourage disclosure rather than inhibition facilitate trauma recovery by affirming and validating thoughts and feelings, promoting insight into trauma-related thoughts, providing coping advice, and reducing distress and arousal [10, 11]. That is, social environments that encourage emotional expression and disclosure can both reduce thought suppression and attenuate its deleterious effects on symptoms.