Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain

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.

<p>The Mediating Role of Cognitive Emotion Regulation in BIS/BAS Sensitivities, Depression, and Anxiety Among Community-Dwelling Older Adults in China</p>

“…42 One previous study suggests that the association between BIS and negative affect is mediated by expressive suppression. 21 These findings are in line with our results. One possible explanation for our surprising finding is that the behavioral inhibition induced by BIS may suppress elderly people's ability to face their thoughts, thus making adaptive strategies more difficult.…”

“…However, our results are inconsistent with those of studies on adults with chronic pain, which find no association between BAS and emotional regulation. 21 One possible explanation for this inconsistency is that individuals in pain may find it difficult to perform adaptive cognitive emotion regulation strategies, and thus may show weaker relationships between BAS and adaptive strategies. 39 Further, socioemotional selectivity theory states that older people can more effectively adjust their emotions, 40 which may suggest that those with higher BAS sensitivity are more apt to implement adaptive strategies effectively.…”

“…20 Another suggests that two commonly used emotional strategies-expressive suppression and cognitive reappraisal-partially mediate the association between BIS activation and negative effects, but find no correlation between BAS activation and these strategies. 21 However, BAS sensitivity may affect depression only under certain conditions such as low cognitive reappraisal scores. 22 A recent longitudinal study of German adolescents shows that high BAS sensitivity can predict higher adaptive emotional strategies.…”

A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients

“…Consistent with the previous idea, research in the past decades has shown psychological factors clearly contribute to a better understanding of the experience of chronic pain (Edwards et al, 2016; Linton et al, 2018; Serrano-Ibáñez et al, 2018). For instance, catastrophizing, a maladaptive form of thinking characterized by a tendency to exaggerate, worry, and anticipate the worst possible consequences of an event (Leung, 2012; Ramírez-Maestre et al, 2017), has been consistently associated with poorer health status of pain patients across numerous investigations (Vancleef and Peters, 2006; Burns et al, 2015; Fallon et al, 2015; Ramírez-Maestre et al, 2017) and has become a fundamental outcome in pain research (Williams et al, 2013).…”

Complex Role of Hypnotizability in the Cognitive Control of Pain

“…High BIS is associated with enhanced attention, arousal and vigilance, high BAS with impulsivity, bipolar and attention deficit/ hyperactivity (De Pascalis et al, 2010 ). In particular, BIS/BAS modulates pain in patients with headache (Jensen et al, 2015 ) and muskuloskeletal pain (Serrano-Ibáñez et al, 2018 ).…”