Emotion Regulation in the Management of Fear of Pain: Subjective and Psychophysiological Correlates

Abstract

Research have shown the relationship between pain and emotion, proposing emotions as determinants and consequences of the subjective pain experience. Thus, pain can be modulated by positive and negative emotions, with numerous studies showing that inducing negative affect is related to higher pain intensity and lower pain tolerance. One of the emotions that has been identified as a critical one for pain experience is fear of pain, since it has been associated to avoidance behaviours such as disengage of daily activities, contributing to the maintaining and chronicity of pain. Emotion regulation strategies have shown to be effective in improving pain-related outcomes, as well as fear of pain. Among these strategies, cognitive reappraisal and acceptance have aroused a great interest, due to their role in first line interventions for chronic pain such as Acceptance and Commitment Therapy or Cognitive and Behavioural Therapy, among other approaches. In laboratory settings, the effects of these strategies have been often studied with experimental paradigms focused on pain induction. However, the effects of emotion regulation strategies using specific paradigms to study fear of pain associated to threat anticipation have been little explored. In addition, although several studies have shown the relevance of cognitive and emotion regulation flexibility for the management of negative emotions and well-being, it has not been explored in relation to fear of pain. Taking into account the relevance of fear of pain in the development of detrimental pain-related responses and the chronification of pain, the general aim of the present doctoral thesis was to expand the knowledge about the role of emotion regulation in the management of threatening situations arising from a possible future pain. For this purpose, four studies were conducted: a systematic review, two experimental studies, and the validation of a questionnaire of cognitive flexibility. Overall, results showed that cognitive reappraisal is not necessarily associated with decreased physiological responses in the management of pain. In fact, emotion regulation strategies included in our study might not be effective to manage fear of pain when the anticipation of thermal aversive stimuli produces low anxiety levels. Likewise, the implementation of larger repertoires of emotion regulation strategies was also not associated with better fear of pain management. Additionally, the results obtained in the present dissertation suggested that individuals tend to use acceptance under low anticipatory fear of pain contexts, which also was the strategy most effective in that context. Future studies should explore the role of distinct emotion regulation strategies using environments with higher ecological validity, which would allow studying the changing pain characteristics to better understand the influence of context-sensitivity on the emotion regulation process.