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Journal of Behavioral Medicine

, Volume 31, Issue 3, pp 201–212 | Cite as

Effects of written anger expression in chronic pain patients: making meaning from pain

  • Jennifer E. Graham
  • Marci Lobel
  • Peter Glass
  • Irina Lokshina
Article

Abstract

Based on prior research demonstrating benefits of emotional disclosure for chronically ill individuals and evidence that anger is particularly problematic in chronic pain sufferers, outpatients from a chronic pain center (N = 102) were randomly assigned to express their anger constructively or to write about their goals non-emotionally in a letter-writing format on two occasions. Letters were coded for degree of expressed anger and meaning-making (speculation and insight into conditions that precipitated anger). Over a 9 week period, participants in the anger-expression group (n = 51) experienced greater improvement in control over pain and depressed mood, and marginally greater improvement in pain severity than the control group (n = 51). Degree of expressed anger uniquely accounted for intervention effects and meaning-making mediated effects on depressed mood. These findings suggest that expressing anger may be helpful for chronic pain sufferers, particularly if it leads to meaning-making.

Keywords

Chronic pain Anger expression Written emotional disclosure Meaning-making Depression Control 

Notes

Acknowledgments

This study was funded by awards from the American Psychological Association and Stony Brook University to Jennifer Graham. Marci Lobel received support from NIH Grant R01HD39753. We thank Drs. Susan Brennan and Anne Moyer for advice with study methodology, the director (Dr. Carole Agin), physicians, staff, and patients at the pain center, and our capable team of research assistants.

References

  1. Affleck, G., Tennen, H., Zautra, A., Urrows, S., Abeles, M., & Karoly, P. (2001). Women’s pursuit of personal goals in daily life with fibromyalgia: A value-expectancy analysis. Journal of Consulting and Clinical Psychology, 69, 587–596.PubMedCrossRefGoogle Scholar
  2. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  3. Brehm, J. W. (1999). The intensity of emotion. Personality and Social Psychology Review, 3, 2–22.PubMedCrossRefGoogle Scholar
  4. Burns, J. W., Bruehl, S., & Quartana, P. J. (2006). Anger management style and hostility among patients with chronic pain: Effects of symptom-specific physiological reactivity during anger- and sadness- recall interviews. Psychosomatic Medicine, 68, 786–793.PubMedCrossRefGoogle Scholar
  5. Coyne, J. C. (1976). Toward an interactional description of depression. Psychiatry, 39, 28–40.PubMedGoogle Scholar
  6. Davidson, K., MacGregor, M. W., Stuhr, J., Dixon, K., & MacLean, D. (2000). Constructive anger verbal behavior predicts blood pressure in a population-based sample. Health Psychology, 19, 55–64.PubMedCrossRefGoogle Scholar
  7. Deffenbacher, J. L., Oetting, E. R., & DiGiuseppe, R. A. (2002). Principles of empirically supported interventions applied to anger management. The Counseling Psychologist, 30, 262–280.CrossRefGoogle Scholar
  8. DeGood, D. E., & Tait, R. C. (2001). Assessment of pain beliefs, pain coping. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 320–345). New York: The Guilford Press.Google Scholar
  9. Duckro, P. N., Chibnall, J. T., & Tomazic, T. J. (1994). Anger, depression, and disability: A path analysis of relationships in a sample of chronic posttraumatic headache patients. Headache, 35, 7–9.CrossRefGoogle Scholar
  10. Eggly, S., & Tzelepis, A. (2001). Relational control in difficult physician-patient encounters: Negotiating treatment for pain. Journal of Health Communication, 6, 323–333.PubMedCrossRefGoogle Scholar
  11. Feldman, S. I., Downey, G., & Schaffer-Neitz, R. (1999). Pain, negative mood, and perceived support in chronic pain patients: A daily diary study of people with reflex sympathetic dystrophy syndrome. Journal of Consulting and Clinical Psychology, 67, 776–785.PubMedCrossRefGoogle Scholar
  12. Fernandez, E. (2002). Anxiety, depression, and anger in pain. Canada: The University of Toronto Press, Inc.Google Scholar
  13. Fernandez, E., & Turk, D. C. (1995). The scope and significance of anger in the experience of chronic pain. Pain, 61, 165–175.PubMedCrossRefGoogle Scholar
  14. Flor, H., Fydrich, T., & Turk, D. C. (1992). Efficacy of multi-disciplinary pain treatment centers: A meta-analytic review. Pain, 49, 221–230.PubMedCrossRefGoogle Scholar
  15. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychology Bulletin, 132, 823–865.CrossRefGoogle Scholar
  16. Gatchel, R. J., & Turk, D. C. (1999). Interdisciplinary treatment of chronic pain patients. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 435–444). New York: The Guilford Press.Google Scholar
  17. Geisser, M. E., Roth, R. S., & Robinson, M. E. (1997). Assessing depression among persons with chronic pain using the Center for Epidemiological Studies Depression Scale and the Beck Depression Inventory: A comparative analysis. The Clinical Journal of Pain, 13, 163–170.PubMedCrossRefGoogle Scholar
  18. Hadjistavropoulos, H. D., MacLeod, F. K., & Asmundson, G. J. G. (1999). Validation of the chronic pain coping inventory. Pain, 80, 471–481.PubMedCrossRefGoogle Scholar
  19. Hamilton, N. A., Karoly, P., & Kitzman, H. (2004). Self-regulation and chronic pain: The role of emotion. Cognitive Therapy and Research, 28, 559–576.CrossRefGoogle Scholar
  20. Hanson, R. W., & Gerber, K. E. (1990). Coping with chronic pain: A guide to patient self-management. New York: The Guilford Press.Google Scholar
  21. Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74, 797–816.PubMedCrossRefGoogle Scholar
  22. Jack, D. C. (2001). Understanding women’s anger: A description of relational patterns. Health Care for Women International, 22, 385–400.PubMedCrossRefGoogle Scholar
  23. Jensen, M. P., Karoly, P., & Huger, R. (1987). The development and preliminary validation of an instrument to assess patients’ attitudes toward pain. Journal of Psychosomatic Research, 31, 393–400.PubMedCrossRefGoogle Scholar
  24. Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997). Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychology, 16, 331–340.PubMedCrossRefGoogle Scholar
  25. Kerns, R. D., Rosenberg, R., & Jacob, M. C. (1994). Anger expression and chronic pain. Journal of Behavioral Medicine, 17, 57–67.PubMedCrossRefGoogle Scholar
  26. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The West-Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain, 23, 345–356.PubMedCrossRefGoogle Scholar
  27. Langens, T. A., & Schuler, J. (2007). Effects of written emotional expression: The role of positive expectancies. Health Psychology, 26, 174–182.PubMedCrossRefGoogle Scholar
  28. Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.Google Scholar
  29. Leventhal, H., Idler, E. L., & Leventhal, E. A. (1999). The impact of chronic illness on the self system. In R. J. Contrada & R. D. Ashmore (Eds.), Self, social identity, and physical health (pp. 185–208). New York: Oxford University Press.Google Scholar
  30. Lewis, W. A., & Butcher, A. M. (1992). Anger, catharsis, the reformulated frustration-aggression hypothesis, and health consequences. Psychotheraphy, 29, 385–392.Google Scholar
  31. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.PubMedCrossRefGoogle Scholar
  32. McKnight, P. E., McKnight, K. M., Sidani, S., & Figueredo, A. J. (2007). Missing data: A gentle introduction. New York: The Guilford Press.Google Scholar
  33. Morris, D. B. (1999). Sociocultural and religious meanings of pain. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 118–131). New York: The Guilford Press.Google Scholar
  34. Okifuji, A., Turk, D. C., & Curran, S. L. (1999). Anger in chronic pain: Investigations of anger targets and intensity. Journal of Psychosomatic Research, 47, 1–12.PubMedCrossRefGoogle Scholar
  35. Park, C. L., & Blumberg, C. J. (2002). Disclosing trauma through writing: Testing the meaning-making hypothesis. Cognitive Therapy and Research, 26, 597–616.CrossRefGoogle Scholar
  36. Park, C. L., & Fenster, J. R. (2004). Stress-related growth: Predictors of occurrence and correlates with psychological adjustment. Journal of Social and Clinical Psychology, 23, 195–215.CrossRefGoogle Scholar
  37. Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1, 115–144.CrossRefGoogle Scholar
  38. Pennebaker, J. W. (1997). Writing about emotional experience as a therapeutic process. Psychological Science, 8, 162–166.CrossRefGoogle Scholar
  39. Pennebaker, J. W., Mayne, T. J., & Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863–871.PubMedCrossRefGoogle Scholar
  40. Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243–1254.PubMedCrossRefGoogle Scholar
  41. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  42. Riley, J. L., Zawacki, T. M., Robinson, M. E., & Geisser, M. E. (1999). Empirical test of the factor structure of the West Haven-Yale Multidimensional Pain Inventory. The Clinical Journal of Pain, 15, 24–30.PubMedCrossRefGoogle Scholar
  43. Robinson, M. E., & Riley, J. L. (1999). The role of emotion in pain. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 74–88). New York: The Guilford Press.Google Scholar
  44. Rusting, C. L., & Nolen-Hoeksema, S. (1998). Regulating responses to anger: Effects of rumination and distraction on angry mood. Journal of Personality and Social Psychology, 74, 790–803.PubMedCrossRefGoogle Scholar
  45. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.PubMedCrossRefGoogle Scholar
  46. Schnoll, R. A., Rothman, R. L., Wielt, D. B., Lerman, C., Pedri, H., Wang, H., Babb, J., Miller, S. M., Movsas, B., Sherman, E., Ridge, J. A., Unger, M., Langer, C., Goldberg, M., Scott, W., & Cheng, J. (2005). A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients. Annals of Behavioral Medicine, 30, 1–11.PubMedCrossRefGoogle Scholar
  47. Seco, G. V., Izquierdo, M. C., Garcia, M. P. F., & Diez, F. J. H. (2006). A comparison of the Bootstrap-F, Improved General Approximation, and Brown-Forsythe multivariate approaches in a mixed repeated measures design. Educational and Psychological Measurement, 66, 35–62.CrossRefGoogle Scholar
  48. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–184.PubMedCrossRefGoogle Scholar
  49. Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA, 281, 1304–1309.PubMedCrossRefGoogle Scholar
  50. Smyth, J. M., True, N., & Souto, J. (2001). Effects of writing about traumatic experiences: The necessity for narrative structuring. Journal of Social and Clinical Psychology, 20, 161–172.CrossRefGoogle Scholar
  51. Spera, S. P., Buhrfeind, E. D., & Pennebaker, J. W. (1994). Expressive writing and coping with job loss. Academy of Management Journal, 37, 722–733.CrossRefGoogle Scholar
  52. Spielberger, C. D. (1999). Professional manual for the State-Trait Anger Expression Inventory-2. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
  53. SPSS. (2005). Linear mixed effects modeling in SPSS: An introduction to the MIXED procedure.Google Scholar
  54. Tait, R. C. (1999). Evaluation of treatment effectiveness in patients with intractable pain: Measures, methods. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 457–480). New York: The Guilford Press.Google Scholar
  55. Tait, R., & Silver, R. C. (1989). Coming to terms with major negative life events. In J. S. Ulman & J. A. Bargh (Eds.), Unintended thought (pp. 351–382). New York: Guilford Press.Google Scholar
  56. Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. The American Psychologist, 38, 1161–1173.CrossRefGoogle Scholar
  57. Tennen, H., & Affleck, G. (1990). Blaming others for threatening events. Psychological Bulletin, 108, 209–232.CrossRefGoogle Scholar
  58. Thoresen, C. E., Harris, A. H. S., & Luskin, F. (2000). Forgiveness and health: An unanswered question. In M. E. McCullough, K. I. Pargament, & C. E. Thoresen (Eds.), Forgiveness: Theory, research, and practice (pp. 254–280). New York: Guilford Press.Google Scholar
  59. Turk, D. C., & Flor, H. (1999). Chronic pain: A biobehavioral perspective. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain (pp. 18–34). New York: The Guilford Press.Google Scholar
  60. Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70, 678–690.PubMedCrossRefGoogle Scholar
  61. Zautra, A., Smith, B., Affleck, G., & Tennen, H. (2001). Examinations of chronic pain and affect relationships: Application of a dynamic model of affect. Journal of Consulting and Clinical Psychology, 69, 786–795.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jennifer E. Graham
    • 1
  • Marci Lobel
    • 2
  • Peter Glass
    • 3
  • Irina Lokshina
    • 3
  1. 1.Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Department of PsychologyStony Brook UniversityStony BrookUSA
  3. 3.Department of AnesthesiologyStony Brook UniversityStony BrookUSA

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