Effect of Emotion Regulation Strategies on the Pain Experience
Pain, an unpleasant subjective and multidimensional experience associated with actual or potential tissue damage, is fundamentally a psychological phenomenon with emotional components. As such, the multi-component coordination of processes by which emotions are moderated, emotional regulation (ER), is of particular interest. Two primary ER strategies are reappraisal and suppression. Few studies have explored the effects of suppression and reappraisal on pain outcomes. The purpose of this study was to examine: 1) differences among suppression, reappraisal, and monitoring-control experimental conditions (i.e., conditions involving verbal instruction to engage in specific ER strategies) on indicators of pain and affect; 2) the relationship between participants’ self-reported suppression and reappraisal tendencies with pain threshold/tolerance; 3) if participants’ tendencies to use either suppression or re-appraisal interacted with experimental condition instructions. Of the 151 participants recruited, 142 completed the study. Participants first completed the Emotion Regulation Questionnaire (Gross & John, 2003) to quantify their typical self-reported suppression and reappraisal use and then completed pain threshold and tolerance tasks involving use of an advanced thermal stimulator. Subsequently, a baseline resting period occurred before participants were randomly assigned to either a suppression (n = 53), reappraisal (n = 48), or monitoring (n = 41) condition. They then completed a 10-trial pain task and a recovery period. Self-report measures of pain intensity, pain unpleasantness, anxiety, and tension were collected before randomization, following the pain task, and following recovery. Facial expressions, heart rate, and galvanic skin response were recorded during the baseline, 10-trial pain task, and recovery periods. The Facial Action Coding System (Ekman, Friesen, & Hager, 2002) was used to quantify general and pain-related facial activity. An automated program was used to quantify expressions related to emotional states. Consistent with biopsychosocial formulations of the pain experience (Hadjistavropoulos et al., 2011), this study demonstrated that psychological processes significantly moderate both verbal (e.g., self-report) and nonverbal (e.g., facial expressions) pain expressions. Namely, using reappraisal strategies to regulate a painful experience was related to significantly lower pain intensity, pain unpleasantness, anxiety, and tension ratings as well as reduced general and pain-related facial activity compared to not using an ER strategy. Similarly, using suppression strategies was also related with lower self-reported pain intensity ratings as well as general and pain-related facial activity. Yet, unlike reappraisal, using suppression was not related to reductions in pain unpleasantness, anxiety, and tension ratings. Unexpectedly, no relationship between a person’s self-reported tendency to use suppression or reappraisal, and pain threshold or tolerance emerged. Moreover, typical self-reported tendencies were not found to interact with experimental condition assignment. Finally, the frequency of six emotional facial displays were not clearly related to exposure to thermal stimuli or to specific ER strategies. The results suggest that using reappraisal and to some extent suppression, may have some clinical implications in the regulation of acute phasic pain. Nonetheless, more research should be conducted to clarify the relationship between ER and pain, particularly the relationship between suppression and pain. Research is also needed to further examine the clinical implications of these findings.
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Faculty of Graduate Studies and Research, University of Regina