Anger Suppression and Expression among Chronic Pain Patients

描述（由申请人提供）：慢性或持续性疼痛受情绪调节的影响。特别是，理论，轶事和实证研究表明，抑制或抑制愤怒对慢性疼痛的人来说是不适应的。一项研究表明，抑制与愤怒相关的想法、感受和行为会导致疼痛严重程度、疼痛行为和肌肉紧张度的增加。另一项研究表明，表达或披露情绪对慢性疼痛患者的价值。这两篇文献独立地讨论了情绪调节“硬币”的两面，而拟议的项目将把这些抑制和表达成分整合到一项研究中。我们认为，在引发愤怒的事件中抑制愤怒会加剧疼痛，但抑制愤怒的表达可以逆转这种不利影响。提出了一项对360名慢性腰痛（CLBP）患者的实验室研究，CLBP是一种广泛而昂贵的痛苦。患者将被随机分为两组，一组在接受愤怒诱导方案时抑制自己的想法、感受和行为（抑制条件），另一组在接受愤怒诱导方案时不抑制（对照条件）。随后，患者将被随机分配至2种活跃表达条件之一（人际表达与私人表达）或无表达（对照）条件。最后，所有患者将接受疼痛行为任务，旨在引起轻度腰痛。这个完全交叉的设计将使我们能够测试愤怒抑制对后来的痛苦的影响，以检查这些影响是否可以通过愤怒表达来逆转，并测试人际语言表达是否比私人表达更有效。我们还将测试在言语表达和下椎旁肌反应期间表达的愤怒（与否认）程度是否介导抑制和表达条件的影响，以及性别、特质愤怒调节方式、述情障碍和创伤史是否调节条件的影响。我们预计，与不压抑愤怒相比，压抑愤怒会导致更多的疼痛报告和表现，但允许患者在压抑后口头表达将显示出抑制的有害影响已被避免或逆转的证据。这项研究的结果将有助于澄清抑制和/或表达愤怒的慢性疼痛患者之间的调整的影响。这些发现还将为寻求有问题的愤怒调节治疗提供动力，并将有助于告知如何评估和干预愤怒，这是患有各种痛苦疾病的患者通常会经历的。此外，研究结果将揭示特定的途径，通过这些途径，压抑的愤怒会导致疼痛，而表达的愤怒会使疼痛加剧，这可能会构成治疗干预的药物支持目标。总的来说，这项研究有助于我们的长期目标，这是指导发展的精神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的巨大社会和个人负担。

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.