Anger Suppression and Expression among Chronic Pain Patients

描述(申请人提供)：慢性或持续性疼痛受情绪调节的影响。特别是，理论、轶事和经验研究表明，压制或抑制愤怒对慢性疼痛患者来说是不适应的。一项研究表明，抑制与愤怒相关的想法、感觉和行为会导致感觉到的疼痛严重程度、疼痛行为和肌肉紧张程度的增加。第二项研究表明，表达或透露情绪对慢性疼痛患者的价值。这两篇文献独立地论述了情绪调节“硬币”的两个方面，拟议的项目将把这些抑制和表达的组成部分整合到一个单一的研究中。我们认为，在引发愤怒的事件中抑制愤怒会加剧疼痛，但表达被抑制的愤怒可以逆转这种有害的影响。一项针对360名慢性下腰痛(CLBP)患者的实验室研究被提出。慢性下腰痛是一种广泛且代价高昂的疾病。患者将被随机分为两组：要么抑制他们的思想、感觉和行为(抑制条件)，要么不抑制(控制条件)，同时接受愤怒诱导方案。随后，患者将被随机分为两种活跃表达条件(人际表达与私人表达)中的一种或无表达(对照)条件。最后，所有患者都将接受一项旨在引发轻微下腰痛的疼痛行为任务。这一完全交叉的设计将允许我们测试愤怒抑制对后来疼痛的影响，检查这些影响是否可以被愤怒表达逆转，并测试人际语言表达是否比私下表达更有效。我们还将测试言语表达时表达的愤怒程度(与否认相比)和下椎旁肌的反应性是否中介抑制和表达条件的影响，以及性别、特质愤怒调节方式、述情障碍和创伤病史是否中介条件的影响。我们预计，与不压抑相比，压抑愤怒会带来更多的痛苦报告和表现，但允许患者在压抑之后口头表达的证据将表明，压抑的有害影响已经避免或逆转。这项研究的结果将有助于澄清在慢性疼痛患者中抑制和/或表达愤怒对适应的影响。这些发现还将为寻求有问题的愤怒调节的治疗方法提供动力，并将有助于了解如何评估和干预愤怒，愤怒是患有各种痛苦医疗条件的患者通常经历的。此外，研究结果将揭示压抑的愤怒导致疼痛以及表达的愤怒缓解疼痛的具体途径，这可能会构成治疗干预的经验支持的目标。总体而言，这项研究有助于我们的长期目标，即指导开发经验性支持的评估和干预程序，以改善慢性疼痛的情绪调节，从而减少慢性疼痛和残疾带来的巨大社会和个人负担。 与公共健康相关：愤怒调节似乎影响慢性疼痛的严重程度。一项研究表明，抑制与愤怒相关的想法、感觉和行为会导致疼痛加剧，而另一项研究表明，表达或揭示愤怒对慢性疼痛患者的价值。通过一项大型实验室研究，我们打算更多地了解最初的愤怒抑制和随后的疼痛严重程度之间的联系，言语愤怒表达是否可以逆转这些影响，以及认知和生理机制是否将愤怒调节与疼痛联系在一起；所有这些都着眼于揭示潜在的治疗过程，这些过程可能会减轻愤怒抑制的有害影响。

DESCRIPTION (provided by applicant): Chronic or persistent pain is influenced by the regulation of emotion. In particular, theory, anecdote, and empirical research suggest that suppressing or inhibiting anger is maladaptive for people with chronic pain. One line of research shows that suppressing the thoughts, feelings and behaviors associated with anger leads to increases in perceived pain severity, pain behavior, and muscle tension. A second line of research suggests the value of expressing or disclosing emotions for people with chronic pain. These two literatures have independently addressed two sides of the emotion regulation "coin," and the proposed project will integrate these suppression and expression components into a single study. We propose that suppression of anger during an anger-inducing event exacerbates pain, but that the expression of inhibited anger can reverse this detrimental effect. A laboratory study of 360 patients with chronic low back pain (CLBP) -- a widespread and costly affliction - is proposed. Patients will be randomized to either suppress their thoughts, feelings, and behaviors (suppression condition) or to not suppress (control condition) while exposed to an anger-induction protocol. Subsequently, patients will be randomized to 1 of 2 active expression conditions (interpersonal expression vs. private expression) or to a no expression (control) condition. Finally, all patients will undergo a pain behavior task designed to provoke mild low back pain. This fully crossed design will allow us to test effects of anger suppression on later pain, to examine whether these effects can be reversed by anger expression, and to test whether interpersonal verbal expression is more effective than private expression. We will also test whether the degree of anger (vs. denial) expressed during verbal expression and reactivity of lower paraspinal muscles mediate effects of suppression and expression conditions, and whether gender, trait anger regulation style, alexithymia, and trauma history moderate effects of condition. We expect that anger suppression will lead to greater reports and displays of pain than not suppressing, but that patients allowed to verbally express following suppression will show evidence that the detrimental effects of suppression have been avoided or reversed. Results of this research will help clarify the implications of suppressing and/or expressing anger for adjustment among chronic pain patients. The findings also will provide an impetus to pursue therapeutic treatments for problematic anger regulation, and will help inform how to assess and intervene with anger, which is commonly experienced by patients suffering from a variety of painful medical conditions. Moreover, results will reveal specific pathways by which suppressed anger causes pain, and expressed anger alleviates it, that may then constitute empirically-supported targets for therapeutic interventions. Overall, this research contributes to our long-term objective, which is to guide the development of empirically-supported assessment and intervention procedures to improve emotion regulation in chronic pain, thereby decreasing the tremendous social and personal burden of chronic pain and disability. PUBLIC HEALTH RELEVANCE: Anger regulation appears to affect chronic pain severity. One line of research shows that suppressing the thoughts, feelings and behaviors associated with anger leads to worsening pain, whereas a second line of research suggests the value of expressing or disclosing anger for people with chronic pain. With a large laboratory study, we intend to learn more about associations between initial anger suppression and subsequent pain severity, whether verbal anger expression can reverse these effects, and whether cognitive and physiological mechanisms link anger regulation and pain; all with an eye toward uncovering potential therapeutic processes that may alleviate the detrimental impact of anger suppression.