Emotion regulation variability and chronic pain: An ecological momentary assessment study

Chronic pain is a significant public health problem associated with increased healthcare utilization and decreased quality of life. Mechanistic research focused on identifying vulnerabilities for the experience and impact of chronic pain is of critical importance to understanding and managing this public health burden. Emotion regulation, a cognitive-affective process involving attempts to influence the type, timing, and intensity of emotions has been linked to pain experience across multiple studies. Yet, conceptualizations have often focused on "adaptive" vs. "maladaptive" regulatory strategies. Variability in the type, number, and frequency of emotion regulation strategies across situations and over time has been associated with positive adjustment, is a critical component of emotion regulation flexibility, and may more comprehensively capture the way emotion regulation operates in the context of chronic pain. Therefore, the current study of 48 (77.1% female; Mage = 29.92 years, SD = 5.20 years) college students with self-reported chronic pain examined the impact of pain intensity, interference, and negative affect on emotion regulation variability. Participants completed 5 surveys a day for 7 days. Mixed-effects location scale models found that higher average levels of pain intensity, interference, and negative affect were associated with a greater number of strategies used to regulate pain experience, but in an invariable manner over time. Similarly, momentary increases in pain were associated with decreased intraindividual variation in emotion regulation strategy use. Overall, the results provide empirical evidence for the importance of emotion regulation variability in understanding both the variability and underlying mechanisms of evidence-based behavioral treatments for pain, informing broader models of flexibility in pain.