Dispositional Mindfulness Predicts Reappraisal Efficacy Among Chronic Pain Patients: An Observational Mechanistic Study

Background and Purpose: In addition to its associated physiological sensations, pain is a subjective experience that is impacted by cognitive processes, affective states, and behavioral patterns.  In some cases, chronic pain can result in vulnerability to affective disorders and opioid misuse as a means of self-medicating emotional distress. In contrast to this maladaptive coping strategy, positive reappraisal involves the reinterpretation of a seemingly negative event to give it a positive meaning and subsequently alter one’s emotional response (e.g., individuals who experience trauma may reinterpret victimhood as survivorship and experience feelings of empowerment).  Previous studies have shown when positive reappraisal is coupled with mindfulness practice, chronic pain patients demonstrate decreases in pain and increases in affect regulation.  Trait mindfulness refers to an enduring disposition or tendency to exhibit mindful attitudes and behaviors in everyday life, including nonreactivity to and acceptance of one’s own momentary thoughts, feelings, and perceptions.  In this study, we evaluated chronic pain patients’ ability to effectively reappraise negative stimuli, as well as accompanying correlates such as trait mindfulness and opioid craving.  We hypothesized that trait mindfulness would be positively correlated with reappraisal efficacy and that trait mindfulness would predict reappraisal efficacy after controlling for trait affect.  We also hypothesized reappraisal efficacy would be inversely correlated with opioid craving.

Methods: A sample of 71 opioid-treated chronic pain patents provided demographic and clinical information through questionnaires and the MINI Psychiatric interview before completing a psychophysiological measurement protocol.  These measures assessed trait mindfulness, trait positive and negative affect, opioid craving, and emotional reactivity.  Participants were primarily low-income, white, and African American individuals.  As a part of the psychophysiological protocol, participants completed a validated emotional regulation task during which they were asked to: (1) look at negative photos and notice whatever feelings naturally arise for them, and (2) reappraise negative photos by reinterpreting the meaning of the images.  Participants were then asked to rate their positive and negative affect, level of pain, and level of opioid craving on visual analogue scales.

Results: We found that trait mindfulness is correlated with reappraisal efficacy (r = .28, p = .04).  Concomitantly, trait mindfulness significantly predicted reappraisal efficacy after controlling for trait positive and negative affect (p = .02).  We also found that reappraisal efficacy is significantly inversely correlated with opioid craving (r = .26, p = .05).

Conclusions and Implications: Our study provides the first evidence of the effect of trait mindfulness on a performance-based measure of reappraisal efficacy.  Findings indicate that trait mindfulness may buffer opioid craving through the mechanism of increased reappraisal efficacy.  The Mindfulness to Meaning Theory (MMT) asserts that mindfulness allows individuals to broaden attention to new information that supports positive reappraisal of life circumstances, which in turn motivates values-driven behavior and leads to an increased sense of meaning in life.  Our findings align with the MMT given that chronic pain patients who are able to manage their opioid cravings through reappraisal may experience an accompanying ability to see beyond their desire for opioids.