The Relationship Between Emotional Schema and Pain Perception in the Elderly: The Mediation Role of Emotional Regulation

Document Type : Original Article

Authors

1 Department of Psychology, Feizoleslam Non-Governmental Non-Profit Institute of Higher Education, Khomeinishahr, Iran

2 Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran

3 Department of Psychology, Tabaran Institute of Higher Education, Mashhad, Iran

Abstract

According to the ever-increasing trend of the elderly population in Iran, addressing issues related to this group of the society appears to be of great importance. In this regard, the purpose of the present study was to consider the mediating role of emotional regulation in the relationship between emotional schema and pain perception in the elderly. The statistical population of the current study included all the elderly members of the centers for aging in Shiraz, Iran, among whom 251 (104 male, 147 female) who suffer from pain at least in one area of their body, were selected using convenience sampling. Data were gathered using Leahy’s Emotional Schema Scale (LESS), Gratz and Roemer’s Difficulties in Emotional Regulation Scale (DERS) as well as the McGill’s Pain Questionnaire (MPQ), and were analyzed by Structural Equations Modeling in SPSS-24 and LISREL- 10.20 software. The results of Structural Equations Modeling indicated that the extracted model has a good fit with the empirical data. Moreover, results revealed that using limited emotional regulation strategies is able to mediating the relationship between emotional schemas of consensus, rumination, expression and numbness with pain perception in the elderly. Therefore, according to the role that emotional schemas and difficulties in emotional regulation can paly in predicting the pain perception in elderly, paying attention to these factors in preparing education and therapeutic intervention seems crucial.
Rrferences
Adriany, K., Cendoroglo, M., & Santos, F. (2017). Anxiety disorder in elderly persons with chronic pain: Frequency and associations. Revista Brasileira de Geriatria e Gerontologia, 20, 91-98. https://doi.org/10.1590/1981-22562017020.160033
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A Meta-analytic review. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Bagi, M., & Abbasi-Shavazi, M. (2021). More responsibilities at the older ages: the study of trends and patterns of elderly living arrangements in Iran. Social Development & Welfare Planning, (in press). [Persian] https://doi.org/10.22054/qjsd.2021.52456.1991
Baumeister, R. F. (2016). Toward a general theory of motivation: Problems, challenges, opportunities, and the big picture. Motivation and Emotion, 40, 1-10. https://doi.org/10.1007/s11031-015-9521-y
Bruehl, S., Chung, O. Y., & Burns, J. W. (2006). Anger expression and pain: An Overview of findings and possible mechanisms. Journal of Behavioral Medicine, 29 (6), 593-606. https://doi.org/10.1007/s10865-006-9060-9
Bruehl, S., Chung, O. Y., Burns, J. W., & Biridepalli, S. (2003). The Association between anger expression and chronic pain intensity: Evidence for partial mediation by endogenous opioid dysfunction. Pain, 106, 317–324. https://doi.org/10.1016/S0304-3959(03)00319-1
Burns, J. W., Kubilus, A., & Bruehl, S. (2003). Emotion induction moderate effects of anger management style on acute pain sensitivity. Pain, 106, 109–118.  https://doi.org/10.1016/s0304-3959(03)00298-7
Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusion: The Metacognition Questionnaire. Jornal of Anxiety Disorder, 11, 297- 315. https://doi.org/10.1016/s0887-6185(97)00011-x
Cheatle, MD., Foster, S., Pinkett, A., Lesneski, M., Qu, D., Dhingra, L. (2016). Assessing and managing sleep disturbance in patients with chronic pain. Anesthesiology Clinics, 34(2), 379–393. https://doi.org/10.1016/j.anclin.2016.01.007
Cox, B. J., Kuch, K., Parker, J. D., Shulman, I. D., Evans, R. J. (1994). Alexithymia in somatoform disorder patients with chronic pain. Journal of Psychosomatic Research, 38(6), 523–527. https://doi.org/10.1016/0022-3999(94)90049-3
Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: A Misdirected problem-solving model. Pain, 132(3), 233–236. https://doi.org/10.1016/j.pain.2007.09.014
Eccleston, C., Crombez, G., Aldrich, S., & Stannard, C. (2001). Worry and chronic pain patients: A Description and analysis of individual differences. European Journal of Pain, 5(3), 309–318. https://doi.org/10.1053/eujp.2001.0252
Ghorbani, F., Khosravani, V, Sharifi Bastan, F.,&  Jamaati Ardakani, R. (2017). The Alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients.Psychiatry Research,252,223-230. https://doi.org/10.1016/j.psychres.2017.03.005
Gilliam, W., Burns, J. W., Quartana, P., Matsuura, J., Nappi, C., & Wolffand, B. (2010). Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal × emotion regulation model. Journal of Behavioral Medicine, 33(3), 191-199. https://doi.org/10.1007/s10865-009-9245-0
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation. Guilford Press. (pp. 3-24).
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation. New York: Guilford Press. (pp. 3-24).
Hamilton, N. A., Zautra, A.J., & Reich, J. (2007). Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis. Clinical Journal of Pain, 23(2), 165-172. https://doi.org/10.1097/AJP.0b013e31802b4f58
Hasenbring, M., Hallner, D., & Klasen, B. (2001). Psychological mechanisms in the transition from acute to chronic pain: over- or underrated? Schmerz, 15(6), 442– 447. https://doi.org/10.1007/s004820100030
Helme, R. D., & Gibson, S. J. (2000). Epidemiology of Pain. In Crombie, I. K., Croft, P. R., Linton, S. J. (Eds), Pain in Older People. Seattle: IASP Press. (pp. 15-29).
Hirsh, A., Kratz, A., Molton, I., Ehde, D., & Jensen, M. (2011). Pain acceptance is associated with key psychosocial outcomes in adults with multiple sclerosis and chronic pain. The Journal of Pain, 12 (4). 76. https://doi.org/10.1016/j.jpain.2011.02.311
Kalantari, K. (2009). Structural equation modeling in socio-economic research. Tehran: Farhang_Saba press. [Persian]
Keefe, F. J., Lumley, M., Anderson, T., Lynch, T., & Carson, K. (2001). Pain and emotion: New research directions. Journal of Clinical Psychology, 57(4), 587-607. https://doi.org/ 10.1002/jclp.1030
Khanzadeh, M., Saeediyan, M., Hosseinchari, M., & Edrissi, F. (2012). Factor structure and psychometric properties of difficulties in emotional regulation scale. International Journal of Behavioral Sciences, 6(1), 87-96. [Persian]
Khanzadeh, M., Edrisi, F., Mohammadkhani, Sh., & Saeediyan, M. (2013). Factor structure and psychometric properties of Emotional Schema Scale on students. Journal of Clinical Psychology, 11(3), 91-119. [Persian]
Khosravi, M., Sadighi, S., Moradi, Sh., & Zendehdel, K. (2013). Persian-McGill pain questionnaire translation, adaptation and reliability in cancer patients: a brief report. Tehran University of Medical Sciences Journal, 71(1),53-58. [Persian]
Kring, A, M & Sloan, D.M. (2010). Emotion regulation and psychopathology. Guilford Press.
Leahy, R. L. (2002). A Model of emotional schemas. Cognitive and Behavioral Practice, 9(3), 177–190. https://doi.org/10.1016/S1077-7229(02)80048-7
Leahy, R. L. (2007). Emotional schemas and resistance to change in anxiety disorders. Cognitive and Behavioral Practice, 14(1), 36-45. https://doi.org/10.1016/j.cbpra.2006.08.001
Leahy, R. L. (2010). Emotional schemas and resistance to change in anxiety disorders. In D. Sookman, & R. L. Leahy (Ed.), Treatment resistant anxiety disorders. New York: Routledge. (pp. 135-160).
Lumley, M. A., Smith, J. A., & Longo, D. J. (2002). The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastophizing and depression. Journal of Psychosomatic Research, 53(3), 823–30. https://doi.org/10.1016/S0022-3999(02)00337-9
Malik, N. A. (2020). Revised definition of pain by ‘International Association for the study of pain’: Concepts, challenges and compromises. Anaesth. pain intensive care, 24(5), 481-483. https://doi.org/10.1097/j.pain.0000000000001939
Melzack, R. (1975). The McGill pain questionnaire: Major properties and scoring methods. Pain, 1(3), 277-299. https://doi.org/10.1016/0304-3959(75)90044-5
Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 19(15), 971-979. https://doi.org/10.1126/science.150.3699.971
Mesquita, B. (2016). The legacy of Nico H. Frijda (1927-2015). Cognition & Emotion, 30(4), 603–608. https://doi.org/10.1080/02699931.2015.1132681
Miller, T. W., & Kraus, R. (1990). An overview of chronic pain. Hosp Community Psychiatry, 41(4), 433- 440. https://doi.org/10.1176/ps.41.4.433
Rezaei Dehnavi, S., Tavakkoli, G., Montajabian, Z. (2020). The Effectiveness of Positive Psychotherapy on Pain Perception and Death Anxiety in the Elderly. Aging Psychology, 5(4), 321-332. [Persian] https://doi.org/10.22126/jap.2020.4969.1397
Ruiz-Aranda, D., Salguero, J. M., & Fernandez-Berrocal, P. (2009). Emotional regulation and acute pain perception in women. The Journal of Pain, 11(6), 564-569. https://doi.org/10.1016/j.jpain.2009.09.011
Smith, H. (2009). Current therapy of pain. London: Elsevier.
Sullivan, M. J. L., Thorn, B. E., Haythornthwaite, J. A. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain,17(1), 52–64. https://doi.org/10.1097/00002508-200103000-00008
Sullivan, M. J., Rodgers, W. M., & Kirsch, I. (2001). Catastrophizing, depression, and expectancies for pain and emotional distress. Pain, 91(2), 147–154. https://doi.org/10.1016/s0304-3959(00)00430-9
Thorn, B. E., Ward, L. C., Sullivan, M. J. L., & Boothby, J. L. (2003). Communal coping model of catastrophizing: Conceptual model building. Pain, 106(2), 1–2. https://doi.org/10.1016/s0304-3959(03)00228-8
Van Middendorp, H., Lumley, M. A., & Moerbeek, M. (2010). Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: A diary study. European Journal of Pain, 14(2), 176–182. https://doi.org/10.1016/j.ejpain.2009.03.007
Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculto-skeletal pain, a state of the art. Pain, 85(3), 317-332. https://doi.org/10.1016/S0304-3959(99)00242-0
Zis, P., Daskalaki, A., Bountouni, I., Sykioti, P., Varrassi, G., & Paladini, A. (2017). Depression and chronic pain in the elderly: links and management challenges. Clinical interventions in aging, 12, 709–720. https://doi.org/10.2147/CIA.S113576

Keywords


Rrferences
Adriany, K., Cendoroglo, M., & Santos, F. (2017). Anxiety disorder in elderly persons with chronic pain: Frequency and associations. Revista Brasileira de Geriatria e Gerontologia, 20, 91-98. https://doi.org/10.1590/1981-22562017020.160033
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A Meta-analytic review. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Bagi, M., & Abbasi-Shavazi, M. (2021). More responsibilities at the older ages: the study of trends and patterns of elderly living arrangements in Iran. Social Development & Welfare Planning, (in press). [Persian] https://doi.org/10.22054/qjsd.2021.52456.1991
Baumeister, R. F. (2016). Toward a general theory of motivation: Problems, challenges, opportunities, and the big picture. Motivation and Emotion, 40, 1-10. https://doi.org/10.1007/s11031-015-9521-y
Bruehl, S., Chung, O. Y., & Burns, J. W. (2006). Anger expression and pain: An Overview of findings and possible mechanisms. Journal of Behavioral Medicine, 29 (6), 593-606. https://doi.org/10.1007/s10865-006-9060-9
Bruehl, S., Chung, O. Y., Burns, J. W., & Biridepalli, S. (2003). The Association between anger expression and chronic pain intensity: Evidence for partial mediation by endogenous opioid dysfunction. Pain, 106, 317–324. https://doi.org/10.1016/S0304-3959(03)00319-1
Burns, J. W., Kubilus, A., & Bruehl, S. (2003). Emotion induction moderate effects of anger management style on acute pain sensitivity. Pain, 106, 109–118.  https://doi.org/10.1016/s0304-3959(03)00298-7
Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusion: The Metacognition Questionnaire. Jornal of Anxiety Disorder, 11, 297- 315. https://doi.org/10.1016/s0887-6185(97)00011-x
Cheatle, MD., Foster, S., Pinkett, A., Lesneski, M., Qu, D., Dhingra, L. (2016). Assessing and managing sleep disturbance in patients with chronic pain. Anesthesiology Clinics, 34(2), 379–393. https://doi.org/10.1016/j.anclin.2016.01.007
Cox, B. J., Kuch, K., Parker, J. D., Shulman, I. D., Evans, R. J. (1994). Alexithymia in somatoform disorder patients with chronic pain. Journal of Psychosomatic Research, 38(6), 523–527. https://doi.org/10.1016/0022-3999(94)90049-3
Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: A Misdirected problem-solving model. Pain, 132(3), 233–236. https://doi.org/10.1016/j.pain.2007.09.014
Eccleston, C., Crombez, G., Aldrich, S., & Stannard, C. (2001). Worry and chronic pain patients: A Description and analysis of individual differences. European Journal of Pain, 5(3), 309–318. https://doi.org/10.1053/eujp.2001.0252
Ghorbani, F., Khosravani, V, Sharifi Bastan, F.,&  Jamaati Ardakani, R. (2017). The Alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients.Psychiatry Research,252,223-230. https://doi.org/10.1016/j.psychres.2017.03.005
Gilliam, W., Burns, J. W., Quartana, P., Matsuura, J., Nappi, C., & Wolffand, B. (2010). Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal × emotion regulation model. Journal of Behavioral Medicine, 33(3), 191-199. https://doi.org/10.1007/s10865-009-9245-0
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation. Guilford Press. (pp. 3-24).
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation. New York: Guilford Press. (pp. 3-24).
Hamilton, N. A., Zautra, A.J., & Reich, J. (2007). Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis. Clinical Journal of Pain, 23(2), 165-172. https://doi.org/10.1097/AJP.0b013e31802b4f58
Hasenbring, M., Hallner, D., & Klasen, B. (2001). Psychological mechanisms in the transition from acute to chronic pain: over- or underrated? Schmerz, 15(6), 442– 447. https://doi.org/10.1007/s004820100030
Helme, R. D., & Gibson, S. J. (2000). Epidemiology of Pain. In Crombie, I. K., Croft, P. R., Linton, S. J. (Eds), Pain in Older People. Seattle: IASP Press. (pp. 15-29).
Hirsh, A., Kratz, A., Molton, I., Ehde, D., & Jensen, M. (2011). Pain acceptance is associated with key psychosocial outcomes in adults with multiple sclerosis and chronic pain. The Journal of Pain, 12 (4). 76. https://doi.org/10.1016/j.jpain.2011.02.311
Kalantari, K. (2009). Structural equation modeling in socio-economic research. Tehran: Farhang_Saba press. [Persian]
Keefe, F. J., Lumley, M., Anderson, T., Lynch, T., & Carson, K. (2001). Pain and emotion: New research directions. Journal of Clinical Psychology, 57(4), 587-607. https://doi.org/ 10.1002/jclp.1030
Khanzadeh, M., Saeediyan, M., Hosseinchari, M., & Edrissi, F. (2012). Factor structure and psychometric properties of difficulties in emotional regulation scale. International Journal of Behavioral Sciences, 6(1), 87-96. [Persian]
Khanzadeh, M., Edrisi, F., Mohammadkhani, Sh., & Saeediyan, M. (2013). Factor structure and psychometric properties of Emotional Schema Scale on students. Journal of Clinical Psychology, 11(3), 91-119. [Persian]
Khosravi, M., Sadighi, S., Moradi, Sh., & Zendehdel, K. (2013). Persian-McGill pain questionnaire translation, adaptation and reliability in cancer patients: a brief report. Tehran University of Medical Sciences Journal, 71(1),53-58. [Persian]
Kring, A, M & Sloan, D.M. (2010). Emotion regulation and psychopathology. Guilford Press.
Leahy, R. L. (2002). A Model of emotional schemas. Cognitive and Behavioral Practice, 9(3), 177–190. https://doi.org/10.1016/S1077-7229(02)80048-7
Leahy, R. L. (2007). Emotional schemas and resistance to change in anxiety disorders. Cognitive and Behavioral Practice, 14(1), 36-45. https://doi.org/10.1016/j.cbpra.2006.08.001
Leahy, R. L. (2010). Emotional schemas and resistance to change in anxiety disorders. In D. Sookman, & R. L. Leahy (Ed.), Treatment resistant anxiety disorders. New York: Routledge. (pp. 135-160).
Lumley, M. A., Smith, J. A., & Longo, D. J. (2002). The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastophizing and depression. Journal of Psychosomatic Research, 53(3), 823–30. https://doi.org/10.1016/S0022-3999(02)00337-9
Malik, N. A. (2020). Revised definition of pain by ‘International Association for the study of pain’: Concepts, challenges and compromises. Anaesth. pain intensive care, 24(5), 481-483. https://doi.org/10.1097/j.pain.0000000000001939
Melzack, R. (1975). The McGill pain questionnaire: Major properties and scoring methods. Pain, 1(3), 277-299. https://doi.org/10.1016/0304-3959(75)90044-5
Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 19(15), 971-979. https://doi.org/10.1126/science.150.3699.971
Mesquita, B. (2016). The legacy of Nico H. Frijda (1927-2015). Cognition & Emotion, 30(4), 603–608. https://doi.org/10.1080/02699931.2015.1132681
Miller, T. W., & Kraus, R. (1990). An overview of chronic pain. Hosp Community Psychiatry, 41(4), 433- 440. https://doi.org/10.1176/ps.41.4.433
Rezaei Dehnavi, S., Tavakkoli, G., Montajabian, Z. (2020). The Effectiveness of Positive Psychotherapy on Pain Perception and Death Anxiety in the Elderly. Aging Psychology, 5(4), 321-332. [Persian] https://doi.org/10.22126/jap.2020.4969.1397
Ruiz-Aranda, D., Salguero, J. M., & Fernandez-Berrocal, P. (2009). Emotional regulation and acute pain perception in women. The Journal of Pain, 11(6), 564-569. https://doi.org/10.1016/j.jpain.2009.09.011
Smith, H. (2009). Current therapy of pain. London: Elsevier.
Sullivan, M. J. L., Thorn, B. E., Haythornthwaite, J. A. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain,17(1), 52–64. https://doi.org/10.1097/00002508-200103000-00008
Sullivan, M. J., Rodgers, W. M., & Kirsch, I. (2001). Catastrophizing, depression, and expectancies for pain and emotional distress. Pain, 91(2), 147–154. https://doi.org/10.1016/s0304-3959(00)00430-9
Thorn, B. E., Ward, L. C., Sullivan, M. J. L., & Boothby, J. L. (2003). Communal coping model of catastrophizing: Conceptual model building. Pain, 106(2), 1–2. https://doi.org/10.1016/s0304-3959(03)00228-8
Van Middendorp, H., Lumley, M. A., & Moerbeek, M. (2010). Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: A diary study. European Journal of Pain, 14(2), 176–182. https://doi.org/10.1016/j.ejpain.2009.03.007
Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculto-skeletal pain, a state of the art. Pain, 85(3), 317-332. https://doi.org/10.1016/S0304-3959(99)00242-0
Zis, P., Daskalaki, A., Bountouni, I., Sykioti, P., Varrassi, G., & Paladini, A. (2017). Depression and chronic pain in the elderly: links and management challenges. Clinical interventions in aging, 12, 709–720. https://doi.org/10.2147/CIA.S113576