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患者来说是不适应的。一项研究表明，压抑与愤怒相关的思想、感觉和行为会导致感知疼痛严重程度、疼痛行为和肌肉紧张程度的增加。第二项研究表明，对患有慢性疼痛的人来说，表达或透露情绪是有价值的。这两篇文献独立地研究了情绪调节“硬币”的两个方面，本项目将把这些抑制和表达成分整合到一个单一的研究中。我们认为，在引起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扭转这种有害的影响。一项针对360名慢性腰痛（CLBP）患者的实验室研究——一种广泛且昂贵的疾病。当暴露于愤怒诱导协议时，患者将被随机分配抑制他们的思想、感觉和行为（抑制条件）或不抑制（控制条件）。随后，患者将被随机分配到2种活跃表达条件（人际表达与私人表达）中的1种或无表达（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。这种完全交叉的设计将允许我们测试愤怒抑制对后期疼痛的影响，检查这些影响是否可以通过愤怒表达逆转，并测试人际语言表达是否比私人表达更有效。我们还将测试言语表达时表达的愤怒程度（相对于否认）和下棘旁肌肉的反应性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，压抑愤怒比不压抑愤怒会导致更多的痛苦报告和表现，但允许患者在压抑之后口头表达将显示出抑制的有害影响已经避免或逆转的证据。本研究结果将有助于阐明抑制和/或表达愤怒对慢性疼痛患者调整的影响。研究结果还将推动对有问题的愤怒调节进行治疗，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普遍经历的。此外，研究结果将揭示抑制愤怒导致疼痛和表达愤怒减轻疼痛的具体途径，这可能会构成治疗干预的经验支持目标。总的来说，本研究有助于我们的长期目标，即指导经验支持的评估和干预程序的发展，以改善慢性疼痛和残疾的情绪调节，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. 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.