title: Anger arousal and behavioral anger regulation in everyday life among people with chronic low back pain: Relationships with spouse responses and negative affect.
abstract: OBJECTIVE
  To determine the degree to which anger arousal and anger regulation (expression, inhibition) in the daily lives of people with chronic pain were related to spouse support, criticism, and hostility as perceived by patients and as reported by spouses.
  
  
  METHODS
  Married couples (N = 105, 1 spouse with chronic low back pain) completed electronic daily diaries, with assessments 5 times/day for 14 days. On these diaries, patients completed items on their own anger arousal, anger expression, and inhibition, and on perceived spouse support, criticism, and hostility. Spouses reported on their responses toward patients and their negative affect. Hierarchical linear modeling tested concurrent and lagged relationships.
  
  
  RESULTS
  Patient-reported increases in anger arousal and anger expression were predominantly related to concurrent decreases in patient-perceived and spouse-reported spouse support, concurrent increases in patient-perceived and spouse-reported spouse criticism and hostility, and increases in spouse-reported negative affect. Relationships for anger expression remained significant with anger arousal controlled. These effects were especially strong for male patients. Spouses reported greater negative affect when patients were present than when they were not.
  
  
  CONCLUSIONS
  Social support may facilitate adjustment to chronic pain, with declining support and overt criticism and hostility possibly adversely impacting pain and function. Results suggest that patient anger arousal and expression may be related to a negative interpersonal environment for married couples coping with chronic low back pain.
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: James I
authors.initials: JI
authors.lastname: Gerhart
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bruehl
authors.affiliation: Department of Psychology, University of La Verne.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Post
authors.affiliation: Department of Psychology, University of Notre Dame.
authors.forename: David A
authors.initials: DA
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Porter
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: Erik
authors.initials: E
authors.lastname: Schuster
authors.affiliation: Department of Anesthesiology, Rush University Medical Center.
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Fras
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D000786:Anger; D001143:Arousal; D059350:Chronic Pain / Q000523:psychology*; D005260:Female; D006791:Hostility; D006801:Humans; D007266:Inhibition, Psychological; D007398:Interpersonal Relations; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012944:Social Support; D018454:Spouses / Q000523:psychology* / Q000706:statistics & numerical data