by Michael D. Anestis, M.S.
In today's article, I want to build off some of what I wrote about in late December regarding emotions and suicide risk. To do so, I want to discuss an article by Konrad Bresin, PBB guest author Katie Gordon, Ted Bender, Linda Gordon, and Thomas Joiner that is currently in press at Motivation and Emotion. In this paper, the authors discussed two studies they conducted that examined the impact of physical pain on momentary emotional experiences.
The rationale for this study was very clear. A large number of people voluntarily engage in experiences that involve physical damage to their bodies and, oftentimes, substantial amounts of physiological pain (e.g., non-suicidal self-injury [NSSI]). Psychologists are understandably curious as to why individuals would choose to engage in such behavior and one common theory, supported by increasing amounts of research (e.g., Nock & Prinstein 2004) is that individuals engage in these types of behaviors in an effort to regulate their own emotions. In other words, the behavior serves the function of helping an individual diminish an unwanted emotional experience or increasing the intensity of a desired emotional state (e.g., Haines et al., 1995, Welch et al., 2008). In one particularly compelling study using ecological momentary assessment (EMA), Jennifer Muehlenkamp and her colleagues (2009) found that, after engaging in NSSI, women diagnosed with bulimia nervosa (BN) experienced immediate and significant increases in positive affect.
In the studies reported on here, Bresin and colleagues (in press) wanted to expand upon these findings in a nonclinical population. In their first study, 167 undergraduates were recruited and filled out measures of positive and negative affect immediately prior to and following a physiological pain tolerance task. In this case, the pain tolerance task was a pressure algometer, which we have written about on PBB previously. What the authors found was that, after the experience of pain, mean levels of both positive and negative affect decreased. In other words, participants reported feeling less positive and negative emotions after they felt physiological pain. This effect was particularly pronounced for females, although it was significant for both men and women.
A couple of important points can be taken out of study 1. First of all, the data provide support for the emotion regulation model of NSSI, as they indicate that experiencing pain can, in fact, reduce feelings of negative emotions. Second of all, the positive affect findings ran counter to those of Muehlenkamp et al (2009), meaning that either something was unique about one or both of the samples, or positive affect and pain relate differently to one another in clinical versus nonclinical populations.
Bresin and colleagues (in press) built further upon these findings in study 2. In this study, 184 undergraduates took part in a similar experiment, with the only notable differences being a different pain tolerance task (Thermal Sensory Analyzer - measures tolerance of heat based pain tolerance rather than pressure) and the use of a measure of emotional reactivity. This second difference was the key in this case. The authors were particularly interested in examining whether certain individuals demonstrated particularly strong reductions in negative affect in response to pain, as this would indicate that those individuals may be more motivated to engage in painful behaviors. More specifically, they were interested in whether individuals who experience greater levels of emotional reactivity - a population previously shown to engage in higher rates of NSSI (e.g., Anestis et al., 2009; Linehan, 1993) - experienced greater reductions in negative affect than did individuals with lower levels of emotional intensity. If this is the case, it would support the notion that these individuals demonstrate higher rates of painful behaviors due to capacity of such behaviors to provide them with relief from their intense emotions.
The findings in this second study were particularly interesting. First of all, they replicated the findings from study 1. Specifically, individuals demonstrated significantly lower levels of both positive and negative affect immediately following the pain tolerance task and the negative affect finding was particularly strong in women. Secondly, individuals with high levels of emotional reactivity demonstrated greater decreases in negative affect following the pain tolerance task than did individuals with lowel levels of emotional reactivity.
Taking all of these findings into consideration, Bresin and colleagues (in press) provided a strong empirical case for the emotion regulation properties of physiological pain. This does not mean that all people experience relief after experiencing pain or that the answer to a bad mood is a swift punch to the face. Instead, what this means is that, when we see individuals chronically engaging in behaviors that, to many, are difficult to understand (NSSI) there may, in fact, be fundamentally rewarding processes driving those behaviors that, when we think about it, make a lot of sense. For individuals who experience frequently strong emotions, the motivation to find ways to quickly reduce such sensations is going to be strong. NSSI may be one path towards such immediate relief. Unfortunately - and quite obviously - the long term costs of such behavior are too high to justify its use, even when considering the short term benefits; however, for individuals highly motivated to immediately stop feeling an unacceptable emotional experience, such cost-benefit analyses are unlikely and the immediate reward is likely to win out. The trick then is to help such individuals develop new methods for regulating, accepting, or simply tolerating their emotions, key aspects of treatments like dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT).
This study - like all studies - was not without its flaws and, given than I am colleagues with most of these authors, I certainly can not look at the results with a completely unbiased eye (although data are data, so any bias can be rooted out by a discussion of my interpretation of the results). That being said, I am curious what you think about these results and their implications.
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Mike Anestis is a psychology resident at the University of Mississippi Medical Center and a doctoral candidate in the clinical psychology department at Florida State University.
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