Table_2_Euthymic despite pain: the role of cognitive reappraisal and experiential avoidance in autoimmune inflammatory rheumatic diseases—a cross-sectional study.docx

Pain is a central feature of inflammatory rheumatic diseases and is associated with psychological distress. Pain is widely recognized not as a mere physical sensation, but as a complex, multidimensional phenomenon with an affective component. A plethora of research has conceptualized adaptation to pain by focusing on minimizing the pain experience. However, pain in autoimmune inflammatory rheumatic diseases is often neither avoidable nor curable. This cross-sectional study aimed to investigate the processes explaining how pain intensity may be associated with low well-being and why some patients may live well despite pain. Drawing upon the psychological (in)flexibility model and the process model of emotion regulation, we propose that cognitive reappraisal moderates the association between pain and euthymia through experiential avoidance. Ninety-seven patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were included for analyses (mean age = 53.4; mean time since diagnosis = 9.2 years). Most patients were women (75%), married/cohabitant (71%), and attended high school (47%). Results indicate that experiential avoidance may explain how severe pain is associated with lowered euthymia. This indirect negative effect of pain intensity on euthymia became non-significant at high levels of cognitive reappraisal, suggesting that cognitive reappraisal may serve as a protective factor for patients with autoimmune inflammatory rheumatic diseases. This study paves the way for future research in this promising context by providing an initial step towards integrating emotion regulation and psychological inflexibility in pain conditions.

疼痛是炎症性风湿性疾病（inflammatory rheumatic diseases）的核心特征，且与心理痛苦（psychological distress）密切相关。目前学界普遍认为，疼痛并非单纯的躯体感觉，而是一种兼具情感成分的复杂多维现象。既往大量研究均通过聚焦于减轻疼痛体验，来构建疼痛适应的概念模型。然而，自身免疫性炎症性风湿性疾病（autoimmune inflammatory rheumatic diseases）患者的疼痛往往既无法规避，也难以治愈。本项横断面研究（cross-sectional study）旨在阐明疼痛强度（pain intensity）与低幸福感（well-being）之间的关联机制，以及为何部分患者即便遭受疼痛仍能拥有良好的幸福感。本研究基于心理（不）灵活性模型（psychological (in)flexibility model）与情绪调节过程模型（process model of emotion regulation），提出认知重评（cognitive reappraisal）可通过经验性回避（experiential avoidance），调节疼痛与积极心境（euthymia）之间的关联。本研究共纳入97例类风湿关节炎、银屑病关节炎或轴性脊柱关节炎患者进行分析，受试者平均年龄为53.4岁，确诊后的平均病程为9.2年。其中多数受试者为女性（75%），已婚或处于同居状态（71%），47%的受试者受教育程度为高中阶段。研究结果显示，经验性回避可阐释重度疼痛与积极心境降低之间的关联机制。当认知重评水平较高时，疼痛强度对积极心境的间接负向影响不再显著，这表明认知重评可作为自身免疫性炎症性风湿性疾病患者的保护性因素。本研究通过首次将情绪调节与心理（不）灵活性理论整合应用于疼痛领域，为该方向的后续研究奠定了初步基础，也为这一极具潜力的研究场景开辟了新路径。