The role of emotion covariation and psychological flexibility in coping with chronic physical pain: an integrative model

Objective: This study focussed on the mutual role of emotion covariation and psychological flexibility in understanding the reciprocal effects of chronic pain and psychological distress. Design: A longitudinal design was applied with a sample of 177 adults (mean age = 58.3, 57.1% women) suffering from chronic back/neck pain. Main outcome measures: Assessments were conducted at three timepoints: pain and psychological distress upon referral to a pain clinic (T1); emotion covariation (the correlation between daily reports of positive and negative emotions) and psychological flexibility (self-reported ability to withstand unpleasant experiences while acting upon personal values) during the weeks before undergoing an intrusive procedure (T2); pain and psychological distress one day prior to the procedure (T3). Results: T2 psychological flexibility and emotion covariation mediated the effect of T1 pain on T3 psychological distress. However, T2 psychological flexibility and emotion covariation did not mediate the effect of T1 psychological distress on T3 pain. Conclusion: The findings highlight two complimentary mechanisms–emotion covariation and psychological flexibility–that mediate the relationship between pain and psychological distress for people with chronic back/neck pain. The findings inform future research on the effects of intervening on these mechanisms, which may lead to clinical interventions aimed at improving coping with pain.