Emotion dysregulation is thought to be a core mechanism underlying many medical and psychiatric disorders. In particular, emotion dysregulation is believed to play a crucial role in physical and emotional responses to pain. A growing body of basic research is beginning to illuminate the neural correlates and behavioral sequelae of emotion dysregulation and perception of pain. Concurrently, a growing body of clinical research supports the efficacy of selected psychosocial interventions for pain. However, little is known about how these treatments modulate emotional reactivity to pain. The proposed study will directly address this knowledge gap by examining how two, distinct psychosocial treatment modalities-Cognitive- Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR)-impact two specific forms of emotion regulation-cognitive regulation (CR) and attention regulation (AR)-in patients with CLBP. Back pain affects up to 85% of people over their lives;up to 5% of all adults experience severe and debilitating effects of CLBP. CLBP is associated with a huge disease burden: it has a high rate of recurrence and is highly comorbid with psychiatric disorders, including major depression (MOD), substance abuse, and anxiety disorders. Although CLBP is a major cause of functional disability and suffering, how psychosocial treatments reduce that suffering is not well understood. Our overall approach is to use behavioral and neural measures of emotion regulation in the context of an RCT to examine the differential impacts of CBT versus MBSR on pain symptoms and well-being in patients with CLBP (Aim 1), to differential changes in CR and AR related to CBT versus MBSR (Aim 2), and to determine whether CR and AR mediate treatment outcome (Aim 3). The broad, long-term objective of this translational research program is to provide an empirical basis for refining and/or integrating specific components of CBT and MBSR for CLBP and strengthen our understanding of the role specific emotion regulation processes play in CLBP, as well as other medical and psychiatric disorders.

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The goal of this proposal is to elucidate the efficacy and neural bases of two forms of emotion regulation -- cognitive regulation and attention regulation- in the context of chronic lower back pain (CLBP). We propose to study how two different psychosocial treatments - Cognitive-Behavioral Therapy and Mindfulness-Based Stress Reduction ~ differentially impact emotion regulation in CLBP. The long-term objective of this research is to understand how psychosocial interventions address emotion dysregulation difficulties.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Program Projects (P01)
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Special Emphasis Panel (ZAT1-SM)
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Stanford University
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Sturgeon, John A; Carriere, Junie S; Kao, Ming-Chih J et al. (2016) Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study. Ann Behav Med 50:802-812
Darnall, Beth D (2016) Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand Clin 32:33-9
Darnall, Beth D; Scheman, Judith; Davin, Sara et al. (2016) Pain Psychology: A Global Needs Assessment and National Call to Action. Pain Med 17:250-63
Darnall, Beth D; Schatman, Michael E (2015) The Relationship Between Industry and Pain Societies, Part 1: Demystification and Legitimization of Continuing Medical Education. Pain Med 16:1251
Darnall, Beth D; Schatman, Michael E (2015) Opioid use and lactation: protecting the child in the context of maternal pain care. Pain Med 16:628
Sturgeon, John A; Dixon, Eric A; Darnall, Beth D et al. (2015) Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain 156:2627-33
Darnall, Beth D (2015) "Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary". Health Care Curr Rev 3:
Chapin, Heather L; Darnall, Beth D; Seppala, Emma M et al. (2014) Pilot study of a compassion meditation intervention in chronic pain. J Compassionate Health Care 1:
Darnall, Beth D (2014) Minimize opioids by optimizing pain psychology. Pain Manag 4:251-3
Darnall, Beth D; Sturgeon, John A; Kao, Ming-Chih et al. (2014) From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing. J Pain Res 7:219-26

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