Abstract
BackgroundFibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self‐reported affect, and (b) resting heart rate variability (HRV).MethodsParticipants were 46 patients with fibromyalgia (M age = 45.4 years; 39 females) and 46 matched healthy controls (M age = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end‐of‐day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood.ResultsResults indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability.ConclusionsCurrent findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability.SignificanceThis study provides novel insight in the link between emotion regulation indices,that is, heart‐rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice.
Highlights
Chronic pain patients often experience a myriad of physical, cognitive and emotional problems, challenging daily life tasks (Taylor et al, 2016)
negative affect (NA) instability moderated the association between daily pain and daily disability ratings, indicating a stronger association between pain severity and disability for patients who are more unstable in their NA
We examined how Group and each index of heart rate variability (HRV) were related to NA instability, while controlling for the mean level of NA (Model 1a and 1b; see Figure 1)
Summary
Chronic pain patients often experience a myriad of physical, cognitive and emotional problems, challenging daily life tasks (Taylor et al, 2016). Unsuccessful regulation of high levels of negative affect, often experienced as a consequence of pain, when pain is intense, or its impact (e.g. due to missing days at work or school; Vos et al, 2012) may maintain and/or worsen pain or limit functioning of pain patients (Koechlin et al, 2018) Based on this idea, it has been hypothesized that indicators of impaired emotion regulation, such as increased affective instability— that is, the tendency to experience unusually large and/or frequent changes in affect—and decreased levels of resting heart rate variability (HRV)—that is, a biomarker of latent emotion regulation capacity (Holzman & Bridgett, 2017; Tracy et al, 2016)—would be associated with worse outcomes in people suffering chronic pain. For each of the hypotheses, we explored the role of PA instead of NA instability
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