Investigating the Mediating Role of Cognitive Emotion Regulation Strategies in the Relationship Between Attachment Styles and Ego Strength With Pain Adjustment in Patients With Rheumatoid Arthritis

Jahangiri, Jahangir; Ranjbari-Pour, Tahere; Pashang, Sara; Tari-Moradi, Arezoo; Bahrami Hidaji, Maryam

Volume 12 - Articles-1401 MEJDS (2022) 12: 158 | Back to browse issues page

Ethics code: IR.IAU.CTB.REC.1400.044

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Jahangiri J, Ranjbari-Pour T, Pashang S, Tari-Moradi A, Bahrami Hidaji M. Investigating the Mediating Role of Cognitive Emotion Regulation Strategies in the Relationship Between Attachment Styles and Ego Strength With Pain Adjustment in Patients With Rheumatoid Arthritis. MEJDS 2022; 12 :158-158
URL: http://jdisabilstud.org/article-1-2650-en.html

Investigating the Mediating Role of Cognitive Emotion Regulation Strategies in the Relationship Between Attachment Styles and Ego Strength With Pain Adjustment in Patients With Rheumatoid Arthritis

Jahangir Jahangiri¹

, Tahere Ranjbari-Pour ^*²

, Sara Pashang²

, Arezoo Tari-Moradi²

, Maryam Bahrami Hidaji²

1- PhD Student in Health Psychology, Islamic Azad University, Karaj Branch
2- Assistant Professor, Department of Psychology, Islamic Azad University, Karaj Branch

Abstract: (882 Views)

Background & Objectives: Rheumatoid arthritis is the most common inflammatory rheumatic disease. Due to its chronic course, this disease is debilitating and its chronic pain brings a lot of emotional and psychological stress that produces or aggravate disability resulting from this disease. Pain causes a serious disturbance and challenge to a person's balance at different levels, especially in cognitive functions. Medical, pharmacological, and surgical treatments are insufficient to cure rheumatoid arthritis and other chronic pain situations and have limited effect at best. Therefore, the study of related psychological variables can help improve the treatment processes and ultimately improve the quality of life of these patients. This study aimed to investigate the mediating role of cognitive emotion regulation strategies in the relationship between attachment styles and ego strength with pain adjustment in patients with rheumatoid arthritis.
Methods: This research was a correlational study based on structural equation modeling. The statistical population was all the patients with rheumatoid arthritis, referred to Imam Hossein Hospital in Tehran City, Iran. Of them, 285 people were selected using the available sampling method based on the physician's diagnosis. The inclusion criteria were as follows: diagnosis of rheumatoid arthritis by a specialist doctor based on medical records, ability to read and write, willingness to participate in research and respond to questionnaires, pain rate above 3 on the Pain Scoring Scale (von Baeyer, 2009). The inability to answer the questionnaires was considered as the exclusion criterion. Participants responded to the Attachment Styles Questionnaire (Hazan & Shaver, 1987), Psychosocial Inventory of Ego Strength (Markstrom & Marshall, 2007), Cognitive Emotion Regulation Questionnaire (Garnefski et al., 2001), and Multidimensional Pain Inventory (Kerns et al., 1985). The data were analyzed using Pearson correlation coefficient and structural equation modeling at a significant level 0.05 in SPSS–23 and AMOS–22 software.
Results: The direct effect of the attachment styles variable on pain adjustment was significant (p<0.001, β=0.61). Also, the direct effect of attachment styles on cognitive emotion regulation was significant (p<0.001, β=0.89). Regression weights of the path of the ego strength on pain adjustment were at the level of significance (p<0.001, β=0.93) and also the path of the ego strength on cognitive emotion regulation was at the level of significance (p<0.001, β=0.76). Indirect effect of attachment styles mediated by cognitive emotion regulation on pain adjustment was significant (p<0.001, β=0.89). The indirect effect of ego strength on cognitive emotion regulation mediation on pain adjustment was significant (p<0.001, β=0.76). The fit indices' results indicated the model's confirmation (p=0.415, CMIN/df=3.821, GFI=0.907, RMR=0.610, TLI=0.902, CFI=0.911, NFI=0.937, and RMSEA=0.076).
Conclusion: Since cognitive emotion regulation strategies have both a direct and mediating effect on pain adjustment, they can be used as an important factor in providing psychological services to patients with rheumatoid arthritis.

Keywords: Rheumatoid arthritis, Ego strength, Cognitive emotion regulation, Chronic pain, Attachment styles

Full-Text [PDF 932 kb] (416 Downloads)

Type of Study: Original Research Article | Subject: Psychology

References

1. Vergne‐Salle P, Pouplin S, Trouvin AP, Bera‐Louville A, Soubrier M, Richez C, et al. The burden of pain in rheumatoid arthritis: impact of disease activity and psychological factors. Eur J Neurosci. 2020;24(10):1979–89. [DOI]

2. Petrovská N, Prajzlerová K, Vencovský J, Šenolt L, Filková M. The pre-clinical phase of rheumatoid arthritis: From risk factors to prevention of arthritis. Autoimmun Rev. 2021;20(5):102797. [DOI]

3. Oguro N, Yajima N, Miwa Y. Age and quality of life in patients with rheumatoid arthritis treated with biologic agents. Mod Rheumatol. 2020;30(1):44–9. [DOI]

4. Salaffi F, Di Carlo M, Carotti M, Sarzi-Puttini P. The effect of neuropathic pain symptoms on remission in patients with early rheumatoid arthritis. Curr Rheumatol Rev. 2019;15(2):154–61. [DOI]

5. Martinec R. Quality of life in patients with rheumatoid arthritis – a preliminary study. Acta Clinica Croatica. 2019;58(1):157–66. [DOI]

6. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain. 2019;160(1):19–27. [DOI]

7. Harvey AM. Classification of chronic pain—descriptions of chronic pain syndromes and definitions of pain terms. Clin J Pain. 1995;11(2):163.

8. Mayer S, Spickschen J, Stein KV, Crevenna R, Dorner TE, Simon J. The societal costs of chronic pain and its determinants: the case of Austria. Plos One. 2019;14(3):e0213889. [DOI]

9. LaCroix-Fralish ML, Mogil JS. Progress in genetic studies of pain and analgesia. Annu Rev Pharmacol Toxicol. 2009;49:97–121. [DOI]

10. Wager J, Brown D, Kupitz A, Rosenthal N, Zernikow B. Prevalence and associated psychosocial and health factors of chronic pain in adolescents: differences by sex and age. Eur J Pain. 2020;24(4):761–72. [DOI]

11. Jacobs MS. Psychological factors influencing chronic pain and the impact of litigation. Curr Phys Med Rehabil Rep. 2013;1(2):135–41. [DOI]

12. McWilliams LA, Cox BJ, Enns MW. Impact of adult attachment styles on pain and disability associated with arthritis in a nationally representative sample. Clin J Pain. 2000;16(4):360–4. [DOI]

13. Cramer P. Psychological maturity and change in adult defense mechanisms. J Res Pers. 2012;46(3):306–16. [DOI]

14. Karantzas GC, Cole SF. Arthritis and support seeking tendencies: the role of attachment. J Soc Clin Psychol. 2011;30(4):404–40. [DOI]

15. Weiner IB, Tennen HA, Suls JM. Handbook of psychology, personality and social psychology. Vol 5. Hoboken, NJ: John Wiley & Sons; 2012.

16. Mahapatra J, Sahoo D, Mishra PK, Kumar R. Evaluating ego-strength in depression on SIS-I indices. SIS J Proj Psy & Ment Health. 2011;18(1):69–76.

17. Block JH, Block J. The role of ego-control and ego-resiliency in the organization of behavior. In: Collins WA; editor. Development of cognition, affect, and social relations. London: Psychology Press; 2014.

18. Hyphantis TN, Christou K, Kontoudaki S, Mantas C, Papamichael G, Goulia P, et al. Disability status, disease parameters, defense styles, and ego strength associated with psychiatric complications of multiple sclerosis. Int J Psychiatry Med. 2008;38(3):307–27. [DOI]

19. Brenning KM, Braet C. The emotion regulation model of attachment: an emotion-specific approach. Personal Relationships. 2013;20(1):107–23. [DOI]

20. Sadava SW, Busseri MA, Molnar DS, Perrier CPK, DeCourville N. Investigating a four-pathway model of adult attachment orientation and health. J Soc Pers Relat. 2009;26(5):604–33. [DOI]

21. Caldwell JG, Shaver PR. Exploring the cognitive-emotional pathways between adult attachment and ego-resiliency. Individual Differences Research. 2012;10(3):141–52.

22. Pellitteri J. Emotional processes in music therapy. Barcelona: Barcelona Publishers; 2009.

23. Tugade MM, Fredrickson BL. Regulation of positive emotions: emotion regulation strategies that promote resilience. J Happiness Stud. 2007;8(3):311–33. [DOI]

24. Barberis N, Cernaro V, Costa S, Montalto G, Lucisano S, Larcan R, et al. The relationship between coping, emotion regulation, and quality of life of patients on dialysis. Int J Psychiatry Med. 2017;52(2):111–23. [DOI]

25. Lutz J, Gross RT, Vargovich AM. Difficulties in emotion regulation and chronic pain-related disability and opioid misuse. Addict Behav. 2018;87:200–5. [DOI]

26. Lewis M, Haviland-Jones JM, Barrett LF. Handbook of emotions. New York: Guilford Press; 2008.

27. Nesse RM, Ellsworth PC. Evolution, emotions, and emotional disorders. Am Psychol. 2009;64(2):129–39. [DOI]

28. Gross JJ. Handbook of emotion regulation. New York: Guilford Press; 2013.

29. Hasenbring M, Hallner D, Klasen B. Psychological mechanisms in the transition from acute to chronic pain: over- or underrated? Pain. 2001;15(6):442–7. [DOI]

30. Boersma K, Linton SJ. Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability. Clin J Pain. 2006;22(2):160–6. [DOI]

31. Newman AK, Van Dyke BP, Torres CA, Baxter JW, Eyer JC, Kapoor S, et al. The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population. Pain. 2017;158(9):1687–96. [DOI]

32. Vickberg SMJ, Deaux K. Measuring the dimensions of women’s sexuality: the Women’s Sexual Self-Concept Scale. Sex Roles. 2005;53(5–6):361–9. [DOI]

33. von Baeyer CL. Numerical rating scale for self-report of pain intensity in children and adolescents: recent progress and further questions. Eur J Pain. 2009;13(10):1005–7. [DOI]

34. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. 1987;52(3):511–24. [DOI]

35. Ghanbari B, Hatami A, Esmaieli M, Farahbakhsh K. On the relationship among parenting styles, attachment styles and marital commitment in arried female students of Allameh Tabatabai university. Quarterly Journal of Woman & Society. 2011;2(7):39–60. [Persian] [Article]

36. Pakdaman S. Barrasiye ertebat beyn delbastegi va jame’e talabi dar nojavani [Investigating the relationship between attachment and socialism in adolescence] [PhD dissertation]. [Tehran, Iran]: University of Tehran; 2000. [Persian]

37. Moazen T, Aghaei A, Golparvar M. Predicted students attachment styles based on parents parenting styles. Journal of Instruction and Evaluation. 2014;7(25):87–99. [Persian] [Article]

38. Arghabaei M, Solimanian AA, Mohammadipoor M, Ghalehnovy F. The role of attachment style in substance use tendency: investigating the mediating role of sense of coherence. Etiadpajohi. 2019;13(53):97–118. [Persian] [Article]

39. Markstrom CA, Marshall SK. The psychosocial inventory of ego strengths: examination of theory and psychometric properties. J Adolesc. 2007;30(1):63-79. [DOI]

40. Altafi Sh. Barrasi va moghayseye estehkame man va vizhegihaye shakhsiyati afrade mo'tad va gheyre mo'tad [Examining and comparing ego strength and personality traits of drug addicts and nonaddicts]. [Thesis for M.A.]. [Tehran, Iran]: Shahed University; 2009. [Persian]

41. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain. 1985;23(4):345–56. [DOI]

42. Asghari-Moghadam M, Naser G. Barrasiye vizhegi haye ravan sanjiye siyahe chand vajhi dard dar miyan jamiyat Irani mobtala be dard mozmen [Reliability and validity of the West-Haven Multidimensional Pain Inventory-Farsi Language Version (MPI-F)]. Journal of Psychology. 2008;12(1):50–72. [Persian]

43. Nunnally JC, Bernstein IH. Psychometric theory. Third edition. New York: McGraw-Hill; 1994.

44. Cox T, Ferguson E. Measurement of the subjective work environment. Work & Stress. 1994;8(2):98–109. [DOI]

45. Campbell DT, Fiske DW. Convergent and discriminant validation by the multitrait-multimethod matrix. Psychol Bull. 1959;56(2):81–105. [DOI]

46. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Dif. 2001;30:1311–27. [DOI]

47. Besharat MA, Shahidi V. Mediating role of cognitive emotion regulation strategies on the relationship between attachment styles and alexithymia. Eur J Psychol. 2014;10(2):352–62. [DOI]

48. Besharat MA, Bazzazian S. Psychometri properties of the Cognitive Emotion Regulation Questionnaire in a sample of Iranian population. Advances in Nursing & Midwifery. 2015;24(84): 61-70. [Article]

49. Hasani J. The psychometric properties of the Cognitive Emotion Regulation Questionnaire (CERQ). Journal of Clinical Psychology. 2011;2(3):73–84. [Persian] [Article]

50. Bentler PM, Yuan KH. Structural equation modeling with small samples: test statistics. Multivariate Behav Res. 1999;34(2):181–97. [DOI]

51. Romeo A, Tesio V, Castelnuovo G, Castelli L. Attachment style and chronic pain: toward an interpersonal model of pain. Front Psychol. 2017;8. [DOI]

52. McWilliams LA. Adult attachment insecurity is positively associated with medically unexplained chronic pain. Eur J Pain. 2017;21(8):1378–83. [DOI]

53. Miniati M, Callari A, Pini S. Adult attachment style and suicidality. Psychiat Danub. 2017;29(3):250–9. [DOI]

54. Craparo G, Magnano P, Zapparrata MV, Gori A, Costanzo G, Pace U, et al. Coping, attachment style and resilience: the mediating role of alexithymia. J Clin Psychol. 2018;6(1):1–30. [DOI]

55. Cheche Hoover R, Jackson JB. Insecure attachment, emotion dysregulation, and psychological aggression in couples. J Interpers Violence. 2021;36(19–20):NP10908–36. [DOI]

56. Mikulincer M, Shaver PR, Horesh N. Attachment bases of emotion regulation and posttraumatic adjustment. In: Snyder DK, Simpson J, Hughes JN; editors. Emotion regulation in couples and families: pathways to dysfunction and health. Washington: American Psychological Association; 2006. [DOI]

57. Meredith PJ. Attachment theory and pain. In: Hunter J, Maunder R; editors. Improving patient treatment with attachment theory. Cham: Springer International Publishing; 2016. [DOI]

58. Calkins SD, Hill A. Caregiver influences on emerging emotion regulation: biological and environmental transactions in early development. In: Gross JJ; editor. Handbook of emotion regulation. New York: The Guilford Press; 2007.

59. Baumeister RF, Vohs KD, Tice DM. The strength model of self-control. Curr Dir Psychol Sci. 2007;16(6):351–5. [DOI]