Annals of Behavioral Medicine

, Volume 24, Issue 4, pp 326–335 | Cite as

Contrasting emotional approach coping with passive coping for chronic myofascial pain

  • Julie A. Smith
  • Mark A. Lumley
  • David J. Longo


Passive or emotion-focused coping strategies are typically related to worse pain and adjustment among chronic pain patients. Emotional approach coping (EAC), however, is a type of emotion-focused coping that appears to be adaptive in some nonpain populations but has not yet been examined in a chronic pain population. In a sample of 80 patients (75% women, M = 48.67 years of age) with chronic myofascial pain, we contrasted how EAC (assessed with the Emotional Approach Coping Scale) and 5 passive pain-coping strategies (assessed with the Vanderbilt Multidimensional Pain Coping Inventory (VMPCI)) were related to sensory and affective pain, physical impairment, and depression. Passive coping strategies were positively correlated with one another, but EAC was inversely correlated with most of them. The VMPCI passive strategies were substantially positively related to negative affect, whereas EAC was inversely related to negative affect. Controlling for potentially confounding demographics, higher EAC was related to less affective pain and depression, even after controlling for negative affect. Using passive coping strategies, in contrast, was associated with more pain, impairment, and depression, although these relations were greatly attenuated after controlling for negative affect. When considered simultaneously, EAC, but not passive coping, was related to affective pain, and both EAC and passive coping were significant correlates of depression, although in opposite directions. In secondary analyses, we found that EAC was related to less pain (particularly sensory) among men and to less depression among women. Unlike the use of passive pain-coping strategies, which are associated with worse pain and adjustment, the use of EAC (emotional processing and emotional expression) with chronic pain is associated with less pain and depression. This suggests that some emotion-focused types of pain coping may be adaptive, and it highlights the need to assess emotional coping processes that are not confounded with distress or dysfunction.


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  1. (1).
    Hagglund KJ, Haley WE, Reveille JD, Alarcon GS: Predicting individual differences in pain and functional impairment among patients with rheumatoid arthritis.Arthritis & Rheumatism. 1989,32:851–858.Google Scholar
  2. (2).
    Lumley MA, Kelley JE, Leisen JCC: Predicting pain and adjustment in rheumatoid arthritis: The role of stressful life events and emotional processing.Journal of Health Psychology. 1997,2:255–264.CrossRefGoogle Scholar
  3. (3).
    Brown GK, Nicassio PM, Wallston KA: Pain coping strategies and depression in rheumatoid arthritis.Journal of Consulting and Clinical Psychology. 1989,57:652–657.PubMedCrossRefGoogle Scholar
  4. (4).
    Evers AW, Kraaimaat FW, Geenen R, Bijlsma JW: Psychosocial predictors of functional change in recently diagnosed rheumatoid arthritis patients.Behavior Research and Therapy. 1998,36:179–193.CrossRefGoogle Scholar
  5. (5).
    Gil KM, Abrams MR, Phillips G, Keefe FJ: Sickle cell disease pain: Relation of coping strategies to adjustment.Journal of Consulting and Clinical Psychology. 1989,57:725–731.PubMedCrossRefGoogle Scholar
  6. (6).
    Jensen MP, Turner JA, Romano JM, Karoly P: Coping with chronic pain: A critical review of the literature.Pain. 1991,47:249–283.PubMedCrossRefGoogle Scholar
  7. (7).
    Sullivan M, D’Eon J: Relation between catastrophizing and depression in chronic pain patients.Journal of Abnormal Psychology. 1990,99:260–263.PubMedCrossRefGoogle Scholar
  8. (8).
    Keefe FJ, Caldwell DS: Cognitive behavioral control of arthritis pain.Medical Clinics of North America. 1997,81:277–290.PubMedCrossRefGoogle Scholar
  9. (9).
    Potter PT, Zautra AJ: Stressful life events’ effects on rheumatoid arthritis disease activity.Journal of Consulting and Clinical Psychology. 1997,65:319–323.PubMedCrossRefGoogle Scholar
  10. (10).
    Thomason BT, Brantley PJ, Jones GN, Dyer HR, Morris JL: The relation between stress and disease activity in rheumatoid arthritis.Journal of Behavioral Medicine. 1992,15:215–220.PubMedCrossRefGoogle Scholar
  11. (11).
    Urrows S, Affleck G, Tennen H, Higgins P: Unique clinical and psychological correlates of fibromyalgia tender points and joint tenderness in rheumatoid arthritis.Arthritis & Rheumatism 1994,37:1513–1520.CrossRefGoogle Scholar
  12. (12).
    Zautra AJ, Okun MA, Robinson SE, et al.: Life stress and lymphocyte alterations among patients with rheumatoid arthritis.Health Psychology. 1989,8:1–14.PubMedCrossRefGoogle Scholar
  13. (13).
    Borkovec TD, Roemer L, Kinyon J: Disclosure and worry: Opposite sides of the emotional processing coin. In Pennebaker JW (ed),Emotion, Disclosure and Health. Washington, DC: American Psychological Association, 1995, 47–70.CrossRefGoogle Scholar
  14. (14).
    Pennebaker JW: Putting stress into words: Health, linguistic, and therapeutic implications.Behaviour Research and Therapy. 1993,31:539–548.PubMedCrossRefGoogle Scholar
  15. (15).
    Horowitz MJ:Stress response syndromes (2nd Ed.). Northvale, NJ: Aronson, 1986.Google Scholar
  16. (16).
    Pennebaker JW, O’Heeron RC: Confiding in others and illness rates among spouses of suicide and accidental-death victims.Journal of Abnormal Psychology. 1984,93:473–476.PubMedCrossRefGoogle Scholar
  17. (17).
    Paez D, Basabe N, Valdoseda M, Velasco C, Iraurgi I: Confrontation: Inhibition, alexithymia, and health. In Pennebaker JW (ed),Emotion, Disclosure and Health. Washington, DC: American Psychological Association, 1995, 195–222.CrossRefGoogle Scholar
  18. (18).
    Pennebaker JW, Barger SD, Tiebout J: Disclosure of traumas and health among Holocaust survivors.Psychosomatic Medicine. 1989,51:577–589.PubMedGoogle Scholar
  19. (19).
    Esterling BA, Antoni MH, Fletcher MA, Margulies S, Schnie-derman N: Emotional disclosure through writing or speaking modulates latent Epstein-Barr Virus antibody titers.Journal of Consulting and Clinical Psychology. 1994,62:130–140.PubMedCrossRefGoogle Scholar
  20. (20).
    Francis ME, Pennebaker JW: Putting stress into words: The impact of writing on psychological, absentee and self-reported emotional well-being measures.American Journal of Health Promotion. 1992,6:280–287.PubMedGoogle Scholar
  21. (21).
    Greenberg MA, Stone AA: Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity.Journal of Personality and Social Psychology. 1992,63:75–84.PubMedCrossRefGoogle Scholar
  22. (22).
    Pennebaker JW, Colder M, Sharp LK: Accelerating the coping process.Journal of Personality and Social Psychology. 1990,58:528–537.PubMedCrossRefGoogle Scholar
  23. (23).
    Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG: Disclosure of trauma and immune response to a hepatitis B vaccination program.Journal of Consulting and Clinical Psychology. 1995,63:787–792.PubMedCrossRefGoogle Scholar
  24. (24).
    Kelley JE, Lumley MA, Leisen JCC: The health effects of emotional disclosure in rheumatoid arthritis.Health Psychology 1997,16:331–340.PubMedCrossRefGoogle Scholar
  25. (25).
    Smyth JM, Stone AA, Hurewitz A, Kaell A: Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis.Journal of the American Medical Association. 1999,281:1304–1309.PubMedCrossRefGoogle Scholar
  26. (26).
    Stanton AL, Danoff-Burg S, Cameron CL, Ellis AP: Coping through emotional approach: Problems of conceptualization and confounding.Journal of Personality and Social Psychology. 1994,66:350–362.PubMedCrossRefGoogle Scholar
  27. (27).
    Stanton AL, Kirk SB, Cameron CL, Danoff-Burg S: Coping through emotional approach: Scale construction and validation.Journal of Personality and Social Psychology. 2000,78:1150–1169.PubMedCrossRefGoogle Scholar
  28. (28).
    Stanton AL, Danoff-Burg S, Cameron CL, et al.: Emotionally expressive coping predicts psychological and physical adjustment to breast cancer.Journal of Consulting and Clinical Psychology. 2000,68:875–882.PubMedCrossRefGoogle Scholar
  29. (29).
    Smith CA, Wallston KA, Dwyer KA, Dowdy SW: Beyond good and bad coping: A multidimensional examination of coping and pain in persons with rheumatoid arthritis.Annals of Behavioral Medicine. 1997,19:11–21.PubMedCrossRefGoogle Scholar
  30. (30).
    Melzack R, Katz J: The McGill Pain Questionnaire: Appraisal and current status. In Turk DC, Melzack R (eds),Handbook of Pain Assessment. New York: Guilford, 1992, 152–168.Google Scholar
  31. (31).
    Watson D, Clark LA: Negative affectivity: The disposition to experience aversive emotional states.Psychological Bulletin. 1984,96:465–490.PubMedCrossRefGoogle Scholar
  32. (32).
    Watson D, Pennebaker JW: Health complaints, stress, and distress: Exploring the central role of negative affectivity.Psychological Review. 1989,96:234–254.PubMedCrossRefGoogle Scholar
  33. (33).
    Sola AE, Bonica JJ: Myofascial pain syndrome. In Bonica JJ (ed),The Management of Pain (2nd Ed., Vol. 1). Philadelphia: Lea & Febiger, 1990, 352–367.Google Scholar
  34. (34).
    Melzack R: The McGill Pain Questionnaire: Major properties and scoring methods.Pain. 1975,1:277–299.PubMedCrossRefGoogle Scholar
  35. (35).
    Kerns R, Haythornewaite J: Depression among chronic pain patients: Cognitive-behavioral analysis and effects on rehabilitation outcome.Journal of Consulting and Clinical Psychology. 1988,56:870–876.PubMedCrossRefGoogle Scholar
  36. (36).
    Wilkie DJ, Savedra MC, Holzemer WL, Tesler MD, Paul SM: Use of the McGill Pain Questionnaire to measure pain: A meta-analysis.Nursing Research. 1990,39:36–41.PubMedCrossRefGoogle Scholar
  37. (37).
    Kerns RD, Turk DC, Rudy TE: The West Haven-Yale Multidimensional Pain Inventory(WHYMPI).Pain.1985,23:345–356.PubMedCrossRefGoogle Scholar
  38. (38).
    Radloff LS: The CES-D scale: A self-report depression scale for research in general populations.Applied Psychological Measurement. 1977,1:385–401.CrossRefGoogle Scholar
  39. (39).
    Blalock SJ, DeVellis BM, Brown GK, Wallston KA: Validity of the Center for Epidemiological Studies Depression Scale in arthritis populations.Arthritis Care and Rheumatism. 1989,32:991–997.CrossRefGoogle Scholar
  40. (40).
    Watson D, Clark LA:The PANAS-X: Manual for the Positive and Negative Affect Schedule-Expanded Form. Unpublished manuscript, University of Iowa, 1994.Google Scholar
  41. (41).
    Watson D, Clark LA, Tellegen A: Development and validation of brief measures of positive and negative affect: The PANAS scales.Journal of Personality and Social Psychology. 1988,54:1063–1070.PubMedCrossRefGoogle Scholar
  42. (42).
    Stanton AL, Parsa A, Austenfeld JL: The adaptive potential of coping through emotional approach. In Snyder CR, Lopez SJ (eds),Handbook of Positive Psychology. New York: Oxford University Press, 2002, 148–158.Google Scholar
  43. (43).
    Schut HAW, Stroebe MS, van der Bout J, de Keijser J: Intervention for the bereaved: Gender differences in the efficacy of two counseling programmes.British Journal of Clinical Psychology. 1997,36:63–72.PubMedGoogle Scholar
  44. (44).
    Smyth JM: Written emotional expression: Effect sizes, outcome types, and moderating variables.Journal of Consulting and Clinical Psychology. 1998,66:174–184.PubMedCrossRefGoogle Scholar
  45. (45).
    Freyberger H: Supportive psychotherapeutic techniques in primary and secondary alexithymia.Psychotherapy and Psycho-somatics. 1977,28:337–342.Google Scholar
  46. (46).
    Lumley MA, Stettner L, Wehmer F: How are alexithymia and physical illness linked? A review and critique of pathways.Journal of Psychosomatic Research. 1996,41:505–518.PubMedCrossRefGoogle Scholar
  47. (47).
    Bellamy N, Bradley LA: Workshop on chronic pain, pain control, and patient outcomes in rheumatoid arthritis and osteo-arthritis.Arthritis & Rheumatism. 1996,39:357–362.CrossRefGoogle Scholar
  48. (48).
    NIH Technology Assessment Panel: Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.Journal of the American Medical Association. 1996,276:313–318.CrossRefGoogle Scholar
  49. (49).
    Tota-Faucette ME, Gil KM, Williams DA, Keefe FJ, Goli V: Predictors of response to pain management treatment. The role of family environment and changes in cognitive processes.Clinical Journal of Pain. 1993,9:115–123.PubMedCrossRefGoogle Scholar
  50. (50).
    Dominguez B, Valderrama P, Meza MA, et al.: The roles of disclosure and emotional reversal in clinical practice. In Pennebaker JW (ed),Emotion, Disclosure and Health. Washington, DC: American Psychological Association, 1995, 255–270.CrossRefGoogle Scholar
  51. (51).
    Lane RD, Quinlan DM, Schwartz GE, Walker PA, Zeitlin SB: The Levels of Emotional Awareness Scale: A cognitive-developmental measure of emotion.Journal of Personality Assessment. 1990,55:124–134.PubMedCrossRefGoogle Scholar
  52. (52).
    Mayer JD, Caruso DR, Salovey P: Emotional intelligence meets traditional standards for an intelligence.Intelligence. 2000,27:267–298.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2002

Authors and Affiliations

  • Julie A. Smith
    • 1
  • Mark A. Lumley
    • 1
  • David J. Longo
    • 2
  1. 1.Department of PsychologyWayne State UniversityDetroit
  2. 2.Geisinger Medical CenterDanville

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