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Abstract
Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ2/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.
Highlights
Chronic pain has been defined as pain that lasts or recurs for more than 3 months beyond the normal recovery time [1]
The purpose of the present study was to test a model of the associations between Behavioral Inhibition System (BIS)/Behavioral Approach System (BAS) activation and affect in individuals with chronic musculoskeletal pain, and to investigate the mediating role of emotion regulation strategies in these associations
We hypothesized that BIS activation would be directly and indirectly associated with negative affect, and that the indirect path would be facilitated by the association between the BIS and emotional suppression
Summary
Chronic pain has been defined as pain that lasts or recurs for more than 3 months beyond the normal recovery time [1]. Chronic pain is a complex phenomenon that is known to have a negative impact on physical [4, 5] and psychological function [6]. Individuals with chronic pain are more likely to report more fear [7], anxiety [8], depressive symptoms [9], and negative mood in general [10] than those without this condition. They are more likely to report having more posttraumatic stress disorder symptoms [11]
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