@phdthesis{Haspert2023,
  author    = {Haspert, Valentina},
  title     = {Improving acute pain management with emotion regulation strategies: A comparison of acceptance, distraction, and reappraisal},
  doi       = {10.25972/OPUS-29866},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-298666},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Pain conditions and chronic pain disorders are among the leading reasons for seeking medical help and immensely burden patients and the healthcare system. Therefore, research on the underlying mechanisms of pain processing and modulation is necessary and warranted. One crucial part of this pain research includes identifying resilience factors that protect from chronic pain development and enhance its treatment. The ability to use emotion regulation strategies has been suggested to serve as a resilience factor, facilitating pain regulation and management. Acceptance has been discussed as a promising pain regulation strategy, but results in this domain have been mixed so far. Moreover, the allocation of acceptance in Gross's (1998) process model of emotion regulation has been under debate. Thus, comparing acceptance with the already established strategies of distraction and reappraisal could provide insights into underlying mechanisms. This dissertation project consisted of three successive experimental studies which aimed to investigate these strategies by applying different modalities of individually adjusted pain stimuli of varying durations. In the first study (N = 29), we introduced a within-subjects design where participants were asked to either accept (acceptance condition) or react to the short heat pain stimuli (10 s) without using any pain regulation strategies (control condition). In the second study (N = 36), we extended the design of study 1 by additionally applying brief, electrical pain stimuli (20 ms) and including the new experimental condition distraction, where participants should distract themselves from the pain experience by imagining a neutral situation. In the third study (N = 121), all three strategies, acceptance, distraction, and reappraisal were compared with each other and additionally with a neutral control condition in a mixed design. Participants were randomly assigned to one of three strategy groups, including a control condition and a strategy condition. All participants received short heat pain stimuli of 10 s, alternating with tonic heat pain stimuli of 3 minutes. In the reappraisal condition, participants were instructed to imagine the pain having a positive outcome or valence. The self-reported pain intensity, unpleasantness, and regulation ratings were measured in all studies. We further recorded the autonomic measures heart rate and skin conductance continuously and assessed the habitual emotion regulation styles and pain-related trait factors via questionnaires. Results revealed that the strategies acceptance, distraction, and reappraisal significantly reduced the self-reported electrical and heat pain stimulation with both durations compared to a neutral control condition. Additionally, regulatory efforts with acceptance in study 2 and with all strategies in study 3 were reflected by a decreased skin conductance level compared to the control condition. However, there were no significant differences between the strategies for any of the assessed variables. These findings implicate similar mechanisms underlying all three strategies, which led to the proposition of an extended process model of emotion regulation. We identified another sequence in the emotion-generative process and suggest that acceptance can flexibly affect at least four sequences in the process. Correlation analyses further indicated that the emotion regulation style did not affect regulatory success, suggesting that pain regulation strategies can be learned effectively irrespective of habitual tendencies. Moreover, we found indications that trait factors such as optimism and resilience facilitated pain regulation, especially with acceptance. Conclusively, we propose that acceptance could be flexibly used by adapting to different circumstances. The habitual use of acceptance could therefore be considered a resilience factor. Thus, acceptance appears to be a promising and versatile strategy to prevent the development of and improve the treatment of various chronic pain disorders. Future studies should further examine factors and circumstances that support effective pain regulation with acceptance.},
  subject      = {Schmerzforschung},
  language  = {en}
}