Abstract
Background and aims
Affect balance reflects relative levels of negative affect (NA) and positive affect (PA) and includes four styles: Healthy (low NA/high PA), Depressive (high NA/low PA), Reactive (high NA/high PA) and Low (low NA/low PA). These affect balance styles may have important associations with clinical outcomes in patients with fibromyalgia. Herein, we evaluated the severity of core fibromyalgia symptom domains as described by the Outcomes Research in Rheumatology-Fibromyalgia working group in the context of the four affect balance styles.
Methods
Data from 735 patients with fibromyalgia who completed the Brief Pain Inventory, Multidimensional Fatigue Inventory, Profile of Mood States, Medical Outcomes Sleep Scale, Multiple Ability Self-Report Questionnaire, Fibromyalgia Impact Questionnaire-Revised, Medical Outcomes Study Short Form-36, and Positive and Negative Affect Schedule were included in this analysis.
Results
The majority (51.8%) of patients in our sample had a Depressive affect balance style; compared to patients with a Healthy affect balance style, they scored significantly worse in all fibromyalgia symptom domains including pain, fatigue, sleep disturbance, dyscognition, depression, anxiety, stiffness, and functional status (P = <.001 to .004). Overall, patients with a Healthy affect balance style had the lowest level of symptoms, while symptom levels of those with Reactive and Low affect balance styles were distributed in between those of the Depressive and Healthy groups.
Conclusions and implications
The results of our cross-sectional study suggest that having a Healthy affect balance style is associated with better physical and psychological symptom profiles in fibromyalgia. Futures studies evaluating these associations longitudinally could provide rationale for evaluating the effect of psychological interventions on affect balance and clinical outcomes in fibromyalgia.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2014.05.009.
Conflict of interest: All authors of this manuscript declare no conflicts of interest.
Acknowledgments
Study data were collected and managed using REDCap electronic data capture tools hosted at Mayo Clinic. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.
References
[1] Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54:1063–70.10.1037/0022-3514.54.6.1063Search in Google Scholar PubMed
[2] Finan PH, Okun MA, Kruszewski D, Davis MC, Zautra AJ, Tennen H. Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients. Health Psychol 2010;29:429–37 [Research Support, N.I.H., Extramural].10.1037/a0020230Search in Google Scholar PubMed PubMed Central
[3] Strand EB, Zautra AJ, Thoresen M, Odegard S, Uhlig T, Finset A. Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. J Psychosom Res 2006;60:477–84 [Research Support, Non-U.S. Gov’t].10.1016/j.jpsychores.2005.08.010Search in Google Scholar PubMed
[4] Hassett AL, Simonelli LE, Radvanski DC, Buyske S, Savage SV, Sigal LH. The relationship between affect balance style and clinical outcomes in fibromyalgia. Arthritis Rheum 2008;59:833–40 [Research Support, N.I.H., Extramural].10.1002/art.23708Search in Google Scholar PubMed
[5] Zautra AJ, Fasman R, Reich JW, Harakas P, Johnson LM, Olmsted ME, Davis MC. Fibromyalgia: evidence for deficits in positive affect regulation. Psychosom Med 2005;67:147–55.10.1097/01.psy.0000146328.52009.23Search in Google Scholar PubMed PubMed Central
[6] Hamilton NA, Zautra AJ, Reich JW. Affect and pain in rheumatoid arthritis: do individual differences in affective regulation and affective intensity predict emotional recovery from pain? Ann Behav Med 2005;29:216–24.10.1207/s15324796abm2903_8Search in Google Scholar PubMed
[7] Finan PH, Quartana PJ, Smith MT. Positive and negative affect dimensions in chronic knee osteoarthritis: effects on clinical and laboratory pain. Psychosom Med 2013;75:463–70 [Research Support, N.I.H., Extramural].10.1097/PSY.0b013e31828ef1d6Search in Google Scholar PubMed PubMed Central
[8] Finan PH, Zautra AJ, Davis MC. Daily affect relations in fibromyalgia patients reveal positive affective disturbance. Psychosom Med 2009;71:474–82 [Comparative Study Research Support, N.I.H., Extramural].10.1097/PSY.0b013e31819e0a8bSearch in Google Scholar PubMed
[9] Parrish BP, Zautra AJ, Davis MC. The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis. Health Psychol 2008;27:694–702 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.1037/0278-6133.27.6.694Search in Google Scholar PubMed PubMed Central
[10] Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry 2006;67:1219–25 [Comparative Study Research Support, N.I.H., Extramural].10.4088/JCP.v67n0807Search in Google Scholar PubMed
[11] Hassett AL, Radvanski DC, Buyske S, Savage SV, Sigal LH. Psychiatric comorbidity and other psychological factors in patients with “chronic Lyme disease”. Am J Med 2009;122:843–50 [Research Support, N.I.H., Extramural].10.1016/j.amjmed.2009.02.022Search in Google Scholar PubMed
[12] Epstein SA, Kay G, Clauw D, Heaton R, Klein D, Krupp L, Kuck J, Leslie V, Masur D, Wagner M, Waid R, Zisook S. Psychiatric disorders in patients with fibromyalgia. A multicenter investigation. Psychosomatics 1999;40:57–63 [Multicenter StudyResearch Support, Non-U.S. Gov’t].10.1016/S0033-3182(99)71272-7Search in Google Scholar PubMed
[13] Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clauw DJ. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum 2003;48:2916–22 [Research Support, U.S. Gov’t, Non-P.H.S. Research Support, U.S. Gov’t, P.H.S.].10.1002/art.11272Search in Google Scholar PubMed
[14] Hassett AL, Cone JD, Patella SJ, Sigal LH. The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. Arthritis Rheum 2000;43:2493–500 [Comparative Study].10.1002/1529-0131(200011)43:11<2493::AID-ANR17>3.0.CO;2-WSearch in Google Scholar PubMed
[15] Staud R, Robinson ME, Vierck Jr CJ, Cannon RC, Mauderli AP, Price DD. Ratings of experimental pain and pain-related negative affect predict clinical pain in patients with fibromyalgia syndrome. Pain 2003;105:215–22 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].10.1016/S0304-3959(03)00208-2Search in Google Scholar PubMed
[16] Staud R, Price DD, Robinson ME, Vierck Jr CJ. Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia. J Pain 2004;5:338–43 [Comparative Study Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].10.1016/j.jpain.2004.05.007Search in Google Scholar PubMed
[17] Staud R, Vierck CJ, Robinson ME, Price DD. Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect – possible role of peripheral tissues. Rheumatology 2006;45:1409–15 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.1093/rheumatology/kel121Search in Google Scholar
[18] Furlong LV, Zautra A, Puente CP, Lopez-Lopez A, Valero PB. Cognitive-affective assets and vulnerabilities: two factors influencing adaptation to fibromyalgia. Psychol Health 2010;25:197–212.10.1080/08870440802074656Search in Google Scholar PubMed
[19] Zautra AJ, Johnson LM, Davis MC. Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol 2005;73:212–20 [Research Support, Non-U.S. Gov’t].10.1037/0022-006X.73.2.212Search in Google Scholar PubMed
[20] McAllister SJ, Vincent A, Hassett AL, Whipple MO, Oh TH, Benzo RP, Toussaint LL. Psychological resilience, affective mechanisms and symptom burden in a tertiary-care sample of patients with fibromyalgia. Stress Health 2013.10.1002/smi.2555Search in Google Scholar
[21] Kersh BC, Bradley LA, Alarcon GS, Alberts KR, Sotolongo A, Martin MY, Aaron LA, Dewaal DF, Domino ML, Chaplin WF, Palardy NR, Cianfrini LR, Triana-Alexander M. Psychosocial and health status variables independently predict health care seeking in fibromyalgia. Arthritis Rheum 2001;45:362–71 [Research Support, U.S. Gov’t, P.H.S.].10.1002/1529-0131(200108)45:4<362::AID-ART349>3.0.CO;2-PSearch in Google Scholar PubMed
[22] Zautra AJ, Fasman R, Parish BP, Davis MC. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain 2007;128:128–35 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.1016/j.pain.2006.09.004Search in Google Scholar PubMed
[23] Sibille KT, Kindler LL, Glover TL, Staud R, Riley 3rd JL, Fillingim RB. Affect balance style, experimental pain sensitivity, and pain-related responses. Clin J Pain 2012;28:410–7 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.1097/AJP.0b013e3182324799Search in Google Scholar PubMed
[24] Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38:19–28 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].10.1002/art.1780380104Search in Google Scholar PubMed
[25] Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, Martin SA, Morea J, Simon L, Strand CV, Williams DA. Fibromyalgia syndrome module at OMERACT 9: domain construct. J Rheumatol 2009;36:2318–29 [Consensus Development Conference Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.3899/jrheum.090367Search in Google Scholar PubMed
[26] Alok R, Das SK, Agarwal GG, Salwahan L, Srivastava R. Relationship of severity of depression, anxiety and stress with severity of fibromyalgia. Clin Exp Rheumatol 2011;29:S70–2 [Research Support, Non-U.S. Gov’t].Search in Google Scholar PubMed
[27] Suhr JA. Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain. J Psychosom Res 2003;55:321–9.10.1016/S0022-3999(02)00628-1Search in Google Scholar PubMed
[28] Whipple M, McAllister S, Oh TH, Luedtke CA, Toussaint LL, Vincent A. Construction of a US Fibromyalgia Registry using the Fibromyalgia Research Survey criteria. Clin Trans Sci 2013;6:398–9.10.1111/cts.12056Search in Google Scholar
[29] Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, Hauser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011;38:1113–22.10.3899/jrheum.100594Search in Google Scholar PubMed
[30] Cleeland CS, Ryan KM. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singapore 1994;23:129–38 [Review].Search in Google Scholar PubMed
[31] Williams DA, Arnold LM. Measures of fibromyalgia: Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), Multidimensional Fatigue Inventory (MFI-20), Medical Outcomes Study (MOS) Sleep Scale, and Multiple Ability Self-Report Questionnaire (MASQ). Arthritis Care Res 2011;63:S86–97 [Research Support, N.I.H., Extramural Review].10.1002/acr.20531Search in Google Scholar
[32] Smets EM, Garssen B, Bonke B, De Haes JC. The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995;39:315–25.10.1016/0022-3999(94)00125-OSearch in Google Scholar PubMed
[33] McNair DM, Lorr M, Droppleman LF. Edits manual for the profile of mood states. San Diego: Educational Testing Services; 1992.Search in Google Scholar
[34] Cappelleri JC, Bushmakin AG, McDermott AM, Dukes E, Sadosky A, Petrie CD, Martin S. Measurement properties of the medical outcomes study sleep scale in patients with fibromyalgia. Sleep Med 2009;10:766–70 [Research Support, Non-U.S. Gov’t].10.1016/j.sleep.2008.09.004Search in Google Scholar PubMed
[35] Seidenberg M, Haltiner A, Taylor MA, Hermann BB, Wyler A. Development and validation of a multiple ability self-report questionnaire. Clin Exp Neuropsychol 1994;16:93–104 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t Non-P.H.S.].10.1080/01688639408402620Search in Google Scholar PubMed
[36] Bennett RM, Friend R, Jones KD, Ward R, Han BK, Ross RL. The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther 2009;11:415.10.1186/ar2830Search in Google Scholar
[37] Ware Jr JE. SF-36 health survey update. Spine 2000;25:3130–9.10.1097/00007632-200012150-00008Search in Google Scholar PubMed
[38] Da Costa D, Dobkin PL, Fitzcharles MA, Fortin PR, Beaulieu A, Zummer M, Senecal JL, Goulet JR, Rich E, Choquette D, Clarke AE. Determinants of health status in fibromyalgia: a comparative study with systemic lupus erythematosus. J Rheumatol 2000;27:365–72 [Comparative Study Research Support, Non-U.S. Gov’t].Search in Google Scholar PubMed
[39] Crawford JR, Henry JD. The Positive and Negative Affect Schedule (PANAS): construct validity, measurement properties and normative data in a large nonclinical sample. Br J Clin Psychol 2004;43:245–65.10.1348/0144665031752934Search in Google Scholar PubMed
[40] IBM Corp. Released. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.; 2010.Search in Google Scholar
[41] SAS Institute Inc. Base SAS® 9.3 Procedures Guide. Cary, NC: SAS Institute Inc.; 2011.Search in Google Scholar
[42] Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and positive emotional granularity: examining the benefits of positive emotions on coping and health. J Pers 2004;72:1161–90 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, Non-P.H.S. Research Support, U.S. Gov’t, P.H.S. Review].10.1111/j.1467-6494.2004.00294.xSearch in Google Scholar PubMed PubMed Central
[43] Brummett BH, Boyle SH, Kuhn CM, Siegler IC, Williams RB. Socioeconomic status moderates associations between CNS serotonin and expression of beta2-integrins CD11b and CD11c. J Psychiatr Res 2010;44:373–7 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].10.1016/j.jpsychires.2009.09.004Search in Google Scholar PubMed PubMed Central
[44] Ong AD, Allaire JC. Cardiovascular intraindividual variability in later life: the influence of social connectedness and positive emotions. Psychol Aging 2005;20:476–85 [Research Support, Non-U.S. Gov’t].10.1037/0882-7974.20.3.476Search in Google Scholar PubMed
[45] Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol 2004;86:320–33 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].10.1037/0022-3514.86.2.320Search in Google Scholar PubMed PubMed Central
[46] Ljotsson B, Atterlof E, Lagerlof M, Andersson E, Jernelov S, Hedman E, Kemani M, Wicksell RK. Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn Behav Ther 2014;43:93–104.10.1080/16506073.2013.846401Search in Google Scholar PubMed
[47] Wicksell RK, Kemani M, Jensen K, Kosek E, Kadetoff D, Sorjonen K, Ingvar M, Olsson GL. Acceptance and commitment therapy for fibromyalgia: a randomized controlled trial. Eur J Pain 2013;17:599–611 [Randomized Controlled Trial Research Support, Non-U.S. Gov’t].10.1002/j.1532-2149.2012.00224.xSearch in Google Scholar PubMed
[48] Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol 2005;60:410–21 [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t].10.1037/0003-066X.60.5.410Search in Google Scholar PubMed
[49] Davis MC, Zautra AJ. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Ann Behav Med 2013;46:273–84 [Research Support, Non-U.S. Gov’t].10.1007/s12160-013-9513-7Search in Google Scholar PubMed
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