Positive affect as a factor of resilience in the pain—negative affect relationship in patients with rheumatoid arthritis

Department of Behavioural Sciences and Statistics, Institute of Basic Medical Science, University of Oslo, POB 1111 Blindern, N-0317 Oslo, Norway.
Journal of Psychosomatic Research (Impact Factor: 2.74). 05/2006; 60(5):477-84. DOI: 10.1016/j.jpsychores.2005.08.010
Source: PubMed


The purpose of this study is to examine positive affect (PA) as a factor of resilience in the relationships between pain and negative affect (NA) in a sample of patients with rheumatoid arthritis.
Forty-three patients (30 women; mean age, 57 years) were interviewed weekly by telephone for 8 weeks. Multilevel modeling was applied to study the within-week relationships among the variables.
There was a Pain x PA interaction effect on NA (beta=-0.05, P<.01) indicating a weaker relationship between pain and NA in weeks with more PA. Pain (beta=0.37, P<.002), interpersonal stress (beta=2.42, P<.001), depression (beta=0.26, P<.01), average perceived stress (beta=10.80, P<.001), and also weekly PA (beta=-0.1, P<.01) had a main effect upon NA.
Positive affect is most influential in reducing NA during weeks of higher pain and may be a factor of resilience, helping patients experiencing pain fluctuations as less distressful than at lower levels of PA.

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    • "The M treatment focused on developing two distinct sets of skills: one to reduce the negative impact of pain and stress episodes on mood, symptoms, and functioning and the other to enhance positive affective engagement. The inclusion of training to boost positive engagement, a focus not included in many mindfulness programs, is based on research pointing to the value of drawing on positive resources to interrupt automatic responding to pain and other stressors (e.g., Strand et al., 2006). The ultimate purpose of targeting emotion regulation was to position individuals to make more intentional (vs. "
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    ABSTRACT: Objective: This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA). Method: One hundred forty-three RA patients were randomized to 1 of the 3 treatment conditions. CBT-P targeted pain-coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; E provided information regarding RA pain and its management. At pre- and posttreatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects. Results: Multilevel models compared groups in the magnitude of within-person change in daily pain and stress reactivity from pre- to posttreatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E. Conclusions: For individuals with RA, M produces the broadest improvements in daily pain and stress reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life.
    Full-text · Article · Nov 2014 · Journal of Consulting and Clinical Psychology
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    • "In contrast, positive affect is defined by a person's capacity for positive emotion-bound processes like enthusiasm, determination, engagement and alertness [1]. An association between both positive and negative affect has been established across a number of chronic pain states including osteoarthritis, rheumatoid arthritis, and chronic low back pain [2] [3] [4] [5] [6] [7] [8] [9]; however, the relationship between affect and fibromyalgia may be particularly relevant. For patients with fibromyalgia, not only are high rates of depression and anxiety commonly observed [10] [11] [12] and associated with greater symptom severity and poorer functional outcomes [13] [14], but such psychiatric comorbidity implies that the broader spectrum of negative affect is likely present and important. "
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    ABSTRACT: Background and aims Affect balance reflects relative levels of negative affect (NA) and positive affect (PA) and includes four styles: Healthy (low NA/high PA), Depressive (high NA/low PA), Reactive (high NA/high PA) and Low (low NA/low PA). These affect balance styles may have important associations with clinical outcomes in patients with fibromyalgia. Herein, we evaluated the severity of core fibromyalgia symptom domains as described by the Outcomes Research in Rheumatology-Fibromyalgia working group in the context of the four affect balance styles. Methods Data from 735 patients with fibromyalgia who completed the Brief Pain Inventory, Multidimensional Fatigue Inventory, Profile of Mood States, Medical Outcomes Sleep Scale, Multiple Ability Self-Report Questionnaire, Fibromyalgia Impact Questionnaire-Revised, Medical Outcomes Study Short Form-36, and Positive and Negative Affect Schedule were included in this analysis. Results The majority (51.8%) of patients in our sample had a Depressive affect balance style; compared to patients with a Healthy affect balance style, they scored significantly worse in all fibromyalgia symptom domains including pain, fatigue, sleep disturbance, dyscognition, depression, anxiety, stiffness, and functional status (P = <.001 to .004). Overall, patients with a Healthy affect balance style had the lowest level of symptoms, while symptom levels of those with Reactive and Low affect balance styles were distributed in between those of the Depressive and Healthy groups. Conclusions and implications The results of our cross-sectional study suggest that having a Healthy affect balance style is associated with better physical and psychological symptom profiles in fibromyalgia. Futures studies evaluating these associations longitudinally could provide rationale for evaluating the effect of psychological interventions on affect balance and clinical outcomes in fibromyalgia.
    Full-text · Article · Jul 2014 · Scandinavian Journal of Pain
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    • "In addition, high NA (particularly anger, anxiety, boredom and sadness) was the most important predictor of higher current and subsequent pain levels, followed by depressive mood (Litt et al., 2004). Findings also indicate that PA may moderate the effect of NA and lower pain intensity ratings, as these results were consistently found over a several week to 6-month time span (Strand et al., 2006; Litt et al., 2004; Zautra et al., 2005). Most notably, those with higher PA used more adaptive and less maladaptive coping (i.e., catastrophizing), whereas those with more NA used more maladaptive coping and had more pain and activity limitations , resulting in increased functional disability (Zautra et al., 1995). "
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    ABSTRACT: Over 116 million Americans experience chronic pain, incurring an annual cost of $635bn in healthcare and lost work. Acceptance-based therapies have gained increasing recognition for improving functional outcomes. In our online chronic pain sample, we predicted that (1) patients would cluster into low, medium and high groups of chronic pain acceptance and (2) positive affect, negative affect and perceived disability scores would differ overall by cluster, with the most positive outcomes found in the high cluster and the least found in the low cluster. Participants completed the Chronic Pain Acceptance Questionnaire, Positive and Negative Affect Scales and the Pain Disability Index. A k-means cluster analysis was conducted using activity engagement (AE) and pain willingness (PW) totals from the Chronic Pain Acceptance Questionnaire. As predicted, cluster analysis specified three groups: low AE/low PW, high AE/high PW and medium AE/medium PW. Significant multivariate analysis of covariance results were obtained according to Wilks' (0.55), F(6,266)=15.39, p<0.01, and indicated differences in positive affect, negative affect and perceived disability within each cluster. Follow-up analyses of covariance revealed mean differences in the predicted directions: the high-high group showed the most positive affect and the least negative affect and perceived disability. Conversely, the low-low group displayed the least positive affect (M=20.28, SD=7.86), the most negative affect (M=28.05, SD=9.33) and perceived disability (M=49.57, SD=9.46). The presence of these clusters introduces key questions about the possibility of creating tailored interventions based on cluster profiles. Copyright (c) 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Feb 2014 · Clinical Psychology & Psychotherapy
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