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Trait Anger Management Style Moderates Effects of Actual ("State") Anger Regulation on Symptom-Specific Reactivity and Recovery Among Chronic Low Back Pain Patients

From the Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (J.W.B., A.H., P.Q., B.W., E.G.); and the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee (S.B.).

Address correspondence and reprint requests to John W. Burns, PhD, Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL 60064. E-mail: john.burns{at}rosalindfranklin.edu

Objectives: We examined whether "state" anger regulation—inhibition or expression—among chronic low back pain (CLBP) patients would affect lower paraspinal (LP) muscle tension following anger-induction, and whether these effects were moderated by trait anger management style.

Method: Eighty-four CLBP patients underwent harassment, then they regulated anger under one of two conditions: half expressed anger by telling stories about people depicted in pictures, whereas half inhibited anger by only describing objects appearing in the same pictures. They completed the anger-out and anger-in subscales (AOS; AIS) of the anger expression inventory.

Results: General Linear Model procedures were used to test anger regulation condition by AOS/AIS by period interactions for physiological indexes. Significant three-way interactions were found such that: a) high trait anger-out patients in the inhibition condition appeared to show the greatest LP reactivity during the inhibition period followed by the slowest recovery; b) high trait anger-out patients in the expression condition appeared to show the greatest systolic blood pressure (SBP) reactivity during the expression period followed by rapid recovery.

Conclusions: Results implicate LP muscle tension as a potential physiological mechanism that links the actual inhibition of anger following provocation to chronic pain severity among CLBP patients. Results also highlight the importance of mismatch situations for patients who typically regulate anger by expressing it. These CLBP patients may be at particular risk for elevated pain severity if circumstances at work or home regularly dictate that they should inhibit anger expression.

Key Words: anger regulation • trait anger-out • trait anger-in • symptom-specific reactivity • chronic pain

Abbreviations: CLBP = chronic low back pain; EMG = electromyography; AOS = anger-out scale; AIS = anger-in scale; LP = lower paraspinal muscles; SBP = systolic blood pressure; DBP = diastolic blood pressure; HR = heart rate; LIWC = linguistic inquiry and word count.

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