Emotion regulation strategies mediate the associations of positive and negative affect to upper extremity physical function.
The Gross process model of emotion regulation holds that emotion-eliciting situations (e.g. musculoskeletal illness) can be strategically regulated to determine the final emotional and behavioral response. Also, there is some evidence that innate emotional traits may predispose an individual to a particular regulating coping style.



We enrolled 107 patients with upper extremity musculoskeletal illness in this cross-sectional study. They completed self-report measures of positive and negative affect, emotion regulation strategies (cognitive reappraisal and expressive suppression), upper extremity physical function, pain intensity, and demographics. We used Preacher and Hayes' bootstrapping approach to process analysis to infer the direct effect of positive and negative affect on physical function as well as their indirect effects through activation of emotion regulation strategies.



Negative affect was associated with decreased physical function. The association was partly mediated by expressive suppression (b (SE)=-.10 (.05), 95% BCa CI [-.21, -.02]). Positive affect was associated with increased physical function. Cognitive reappraisal partially mediated this association (b (SE)=.11 (.05), 95% BCa CI [.03, .24]). After controlling for pain intensity, the ratio of the mediated effect to total effect grew even larger in controlled model comparing to uncontrolled model (33% vs. 26% for expressive suppression and 32% vs. 30% for cognitive reappraisal).



The relationships between affect, emotion regulation strategies and physical function appear to be more dependent on the emotional response to an orthopedic condition rather than the intensity of the nociceptive stimulation of the pain. Findings support integration of emotion regulation training in skill-based psychotherapy in this population to mitigate the effect of negative affect and enhance the influence of positive affect on physical function.
Department of Orthopedics, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mtalaeikhoei@mgh.harvard.edu.
Mojtaba
M
Talaei-Khoei
Department of Orthopedics, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: hnematirezvani@mgh.harvard.edu.
Hora
H
Nemati-Rezvani
Department of Orthopedics, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedics and Traumatology, University Hospital Graz, Medical University of Graz, Graz, Austria. Electronic address: stefan.fischerauer@medunigraz.at.
Stefan F
SF
Fischerauer
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, TX, USA. Electronic address: david.ring@austin.utexas.edu.
David
D
Ring
Department of Orthopedics, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: nchen1@mgh.harvard.edu.
Neal
N
Chen
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: avranceanu@mgh.harvard.edu.
Ana-Maria
AM
Vranceanu
D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D003430:Cross-Sectional Studies; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000503:physiopathology* / Q000523:psychology*; D057566:Self Report; D034941:Upper Extremity / Q000503:physiopathology*