Zautra Alex J, Fasman Robert, Reich John W, Harakas Peter, Johnson Lisa M, Olmsted Maureen E, Davis Mary C
Department of Psychology, Arizona State University, Tempe, Arizona, USA.
Psychosom Med. 2005 Jan-Feb;67(1):147-55. doi: 10.1097/01.psy.0000146328.52009.23.
Fibromyalgia (FMS) is characterized by chronic pain, high psychiatric comorbidity, and the absence of observable pathology. Our objective was to examine positive and negative affective indices, both at the trait and contextual levels, in FMS compared with a chronic pain control group, osteoarthritis (OA).
The sample consisted of 126 female FMS (87) and OA (39) patients from the community. Participants answered a self-report questionnaire assessing demographic and personality variables and were interviewed regarding average pain, affect, anxiety, and depression. Participants were then interviewed weekly for up to 12 weeks regarding pain, affect, fatigue, perceived interpersonal stress (IS), and positive interpersonal events (PE).
FMS participants reported lower levels of positive affect (p < .01) and extraversion (p < .01) than OA participants. There were no significant differences between groups in negative affect, depression, anxiety, or neuroticism after controlling for age and average pain. At the weekly level, FMS participants reported lower levels of positive affect (p < .01), but not negative affect. Furthermore, during weeks of elevated IS, FMS participants evidenced steeper declines in positive affect than OA participants (p < .01).
Despite the predominance of literature focusing on psychologic disturbance in FMS, these analyses identified dysfunctional positive affect regulation as a key feature of FMS. FMS status was uniquely characterized by lower levels of positive affect, especially during stressful weeks. These findings challenge current conceptualizations of FMS and point to new directions for interventions that focus on improving positive affective resources, especially during times of stress.
纤维肌痛(FMS)的特征为慢性疼痛、高精神共病率以及无明显病理表现。我们的目的是在FMS患者与慢性疼痛对照组骨关节炎(OA)患者中,从特质和情境层面检查积极和消极情感指标。
样本包括126名来自社区的女性FMS患者(87例)和OA患者(39例)。参与者回答了一份评估人口统计学和人格变量的自我报告问卷,并接受了关于平均疼痛、情感、焦虑和抑郁的访谈。然后,每周对参与者进行一次访谈,持续12周,内容涉及疼痛、情感、疲劳、感知到的人际压力(IS)和积极人际事件(PE)。
与OA参与者相比,FMS参与者报告的积极情感水平较低(p <.01),外向性较低(p <.01)。在控制年龄和平均疼痛后,两组在消极情感、抑郁、焦虑或神经质方面没有显著差异。在每周层面,FMS参与者报告的积极情感水平较低(p <.01),但消极情感水平没有差异。此外,在IS升高的几周内,FMS参与者的积极情感下降幅度比OA参与者更大(p <.01)。
尽管大量文献关注FMS中的心理障碍,但这些分析确定功能失调的积极情感调节是FMS的一个关键特征。FMS状态的独特之处在于积极情感水平较低,尤其是在压力较大的几周。这些发现挑战了当前对FMS的概念化,并指出了干预的新方向,即专注于改善积极情感资源,尤其是在压力时期。