The mediating role of negative affect in the relationship between pain anxiety and pain catastrophizing with symptoms of health anxiety disorder

Subject Areas : Psychology

Mohammad Rasoul Mufasseri ¹ , said asadnia ² , Mansour Agashteh ³ , Hasan Satvat Ghasriki ⁴

1 - PhD in Psychology, Faculty of Educational Sciences and Psychology, Urmia University, Urmia, Iran.
2 - PhD in Psychology, Faculty of Educational Sciences and Psychology, Tabriz University, Tabriz, Iran.
3 - PhD student in clinical Psychology, Faculty of Educational Sciences and Psychology, Tabriz University, Tabriz, Iran
4 - Assisstant professor, Psychology group, Faculty of Educational Sciences and Psychology, Azad University of Urmia, Urmia, Iran.

Received: 2024-12-15 Accepted : 2025-01-13 Published : 2025-01-21

Keywords: Negative affect, health anxiety disorder, pain catastrophizing, pain anxiety.,

Abstract :

Pain catastrophizing, pain anxiety, and negative affect are important variables in pain perception, but there is limited knowledge about their role in the level of health anxiety disorder among patients. Therefore, the aim of this study was to examine the mediating role of negative affect in the relationship between pain anxiety and pain catastrophizing with symptoms of health anxiety disorder. This descriptive-correlational study included all students at Urmia University during the second semester of the 1403-1402 academic year. A total of 200 students were selected using multi-stage cluster sampling and participated in this study. Participants completed the Health Anxiety Inventory (Salkovskis et al., 2002), the Pain Catastrophizing Scale (Sullivan et al., 1995), the Pain Anxiety Symptoms Scale (Kraaken et al., 1992), and the Positive and Negative Affect Schedule (Watson et al., 1988). Data were analyzed using Pearson correlation and structural equation modeling with SPSS version 26 and Amos version 24. The results indicated that there is a significant positive relationship at the 0.01 level between pain anxiety, pain catastrophizing, and negative affect with health anxiety. Given the goodness-of-fit indices, the model predicting health anxiety fits relatively well, and the conceptual model provides an appropriate framework for examining health anxiety from the perspective of model fit indices. The findings of this study provide a suitable framework for understanding the etiology of health anxiety disorder and can be used in designing and implementing therapeutic interventions aimed at reducing negative affect, pain catastrophizing, and pain-related anxiety to improve the symptoms of this disorder.

References:

بخشی پوررودسری، عباس، و دژکام، محمود. (1384). تحلیل عاملی تاییدی مقیاس عاطفه مثبت و منفی. مجله روانشناسی، 9(4 (پیاپی 36))، 351-365. https://sid.ir/paper/54494/fa
داوودی، ایران، زرگر، یداله، مظفری پورسی سخت، الهام، نرگسی، فریده، و مولا، کریم. (1391). رابطه فاجعه سازی درد, اضطراب درد, روان رنجورخویی, حمایت اجتماعی و راهبردهای مقابله با ناتوانی عملکردی در بیماران روماتیسمی. روانشناسی سلامت، 1(1)، 59-73 https://sid.ir/paper/227266/fa
فصلنامه روان پژوهی و مطالعات علوم رفتاری زمستان 1403 2(4): 16- 35------------------------------------------ آگشته 32
رحمتی، نرجس، اصغری مقدم، محمدعلی، شعیری، محمدرضا، پاک نژاد، محسن، رحمتی، زهرا، قسامی، مریم، معروغی، نادر، آقایی، جسین نایب. (1396). بررسی ویژگی¬های روانسنجی مقیاس فاجعه آمیزی درد در بیماران ایرانی مبتلا به درد مزمن. مجله علمی دانشگاه علوم پزشکی ایلام.25(1).64-80 http://sjimu.medilam.ac.ir/article-1-2114-fa.html
A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17(1), 52-64. https://doi.org/10.1097/00002508-200101000-00008
Byllesby, B. M., Charak, R., Durham, T. A., Wang, X., & Elhai, J. D. (2016). The underlying role of negative affect in the association between PTSD, major depressive disorder, and generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 38(4), 655-665. DOI: 10.1007/s10862-016-9551-7
Chaturvedi, S. K. (2020). Health anxiety, health-related life events, and somatization during COVID-19 pandemic can increase chronic pain. Pain, 161(11), 2652. DOI: 10.1097/j.pain.0000000000001969
Chen, J. T. H., & Lovibond, P. F. (2020). Threat appraisal and negative affect under ambiguity in generalized anxiety disorder. Journal of Anxiety Disorders, 76, 102299. DOI: 10.1016/j.janxdis.2020.102299
Ciułkowicz, M., Misiak, B., Szcześniak, D., Grzebieluch, J., Maciaszek, J., & Rymaszewska, J. (2022). Social Support mediates the Association between Health anxiety and quality of life: findings from a cross-sectional study. International Journal of Environmental Research and Public Health, 19(19), 12962. DOI: 10.3390/ijerph191912962
Dugas, M. J., Giguère Marchal, K., Cormier, S., Bouchard, S., Gouin, J. P., & Shafran, R. (2023). Pain catastrophizing and worry about health in generalized anxiety disorder. Clinical Psychology & Psychotherapy, 30(4), 852-861. DOI: 10.1002/cpp.2726
Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2016). Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial. Psychological Medicine, 46(1), 103-115. DOI: 10.1017/S0033291715001889
Ezmeirlly, H. A., & Farahat, F. M. (2019). Illness anxiety disorder and perception of disease and distress among medical students in western Saudi Arabia. Saudi Medical Journal, 40(11), 1144. DOI: 10.15537/smj.2019.11.24682
Fergus, T. A., & Bardeen, J. R. (2013). Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Personality and Individual Differences, 55(6), 640-644. DOI: 10.1016/j.paid.2013.06.002
Fernández-de-Las-Peñas, C., de-la-Llave-Rincón, A. I., Ortega-Santiago, R., Ambite-Quesada, S., Gómez-Mayordomo, V., Cuadrado, M. L., ... & Arendt-Nielsen, L. (2022). Prevalence and risk factors of musculoskeletal pain symptoms as long-term post-COVID sequelae in hospitalized COVID-19 survivors: a multicenter study. Pain, 163(9), e989-e996. DOI: 10.1097/j.pain.0000000000002455
French, J. H., & Hameed, S. (2023). Illness anxiety disorder. In StatPearls [Internet]. StatPearls Publishing. DOI: 10.3936/statpearls.v1
نقش واسطه ای عاطفه منفی در رابطه بین اضطراب درد و فاجعه آفرینی درد با نشانه های اختلال اضطراب بیماری ----------------- آگشته 33
Galvez-Sánchez, C. M., Montoro, C. I., Duschek, S., & Del Paso, G. A. R. (2020). Pain catastrophizing mediates the negative influence of pain and trait-anxiety on health-related quality of life in fibromyalgia. Quality of Life Research, 29(7), 1871-1881. DOI: 10.1007/s11136-020-02554-7
Guinle, M. I. B., & Sinha, R. (2020). The role of stress, trauma, and negative affect in alcohol misuse and alcohol use disorder in women. Alcohol Research: Current Reviews, 40(2). DOI: 10.35946/arcr.v40.2.20-00507
Hallegraeff, J. M., Kan, R., van Trijffel, E., & Reneman, M. F. (2020). State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study. Journal of Physiotherapy, 66(1), 39-44. DOI: 10.1016/j.jphys.2020.01.002
Hoffman, S. N., Rassaby, M. M., Stein, M. B., & Taylor, C. T. (2024). Positive and negative affect change following psychotherapeutic treatment for anxiety-related disorders: A systematic review and meta-analysis. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2024.01.016
Kalfas, M., Chisari, C., & Windgassen, S. (2022). Psychosocial factors associated with pain and health‐related quality of life in Endometriosis: A systematic review. European Journal of Pain, 26(9), 1827-1848. https://doi.org/10.1002/ejp.1838
Kikas, K., Werner-Seidler, A., Upton, E., & Newby, J. (2024). Illness Anxiety Disorder: A Review of the Current Research and Future Directions. Current Psychiatry Reports, 1-9. https://doi.org/10.1007/s11920-024-01378-7
Kline, R. B. (2023). Principles and practice of structural equation modeling. Guilford Publications. https://doi.org/10.1016/j.brainres.2022.148971
Knaster, P., Estlander, A. M., Karlsson, H., Kaprio, J., & Kalso, E. (2012). Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety. PLoS One, 7(10), e45672. https://doi.org/10.1371/journal.pone.0045672
Lebel, S., Mutsaers, B., Tomei, C., Leclair, C. S., Jones, G., Petricone-Westwood, D., ... & Dinkel, A. (2020). Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One, 15(7), e0234124. https://doi.org/10.1371/journal.pone.0234124
Marcus, D. K., Hughes, K. T., & Arnau, R. C. (2008). Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research, 64(5), 495-501. https://doi.org/10.1016/j.jpsychores.2007.12.006
Mataix-Cols, D., Isomura, K., Sidorchuk, A., Rautio, D., Ivanov, V. Z., Rück, C., ... & De La Cruz, L. F. (2024). All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis. JAMA Psychiatry, 81(3), 284-291. https://doi.org/10.1001/jamapsychiatry.2023.4072
McCracken, L. M. & Dhingra, L. (2002). A short version of the Pain Anxiety Symptom Scale (PASS-20): Preliminary development and validity. Pain Research and Management, 7, 45-50. https://doi.org/10.1155/2002/675090
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67–73. https://doi.org/10.1016/0304-3959(92)90145-2
فصلنامه روان پژوهی و مطالعات علوم رفتاری زمستان 1403 2(4): 16- 35------------------------------------------ آگشته 34
Melli, G., Bailey, R., Carraresi, C., & Poli, A. (2018). Metacognitive beliefs as a predictor of health anxiety in a self‐reporting Italian clinical sample. Clinical Psychology & Psychotherapy, 25(2), 263-271. https://doi.org/10.1002/cpp.2137
Mousavi, S. H., Bagherian-Saraoudi, R., Meschi, F., Khalatbari, J., & Tajeri, B. (2020). The role of mediating resilience in the relationship between health literacy and specific quality of life in breast cancer patients. Journal of Health Psychology, 9(1), 79-94. https://doi.org/10.1177/135910
Mufassery, M. R., Asadnia, S., Arabi Divrazmi, S., Rahimi, F., Shahini, S., & Shahini, P. (2023). The comparison of illness anxiety disorder with panic disorder based on meta-diagnostic cognitive structures: Pain catastrophizing and anxiety sensitivity. Journal of Research in Psychopathology, 4(14), 29-36. https://doi.org/10.25088/jrip.2023.14.671
Parr, J. J., Borsa, P. A., Fillingim, R. B., Tillman, M. D., Manini, T. M., Gregory, C. M., & George, S. Z. (2012). Pain-related fear and catastrophizing predict pain intensity and disability independently using an induced muscle injury model. The Journal of Pain, 13(4), 370-378. https://doi.org/10.1016/j.jpain.2012.01.002
Petrini, L., & Arendt-Nielsen, L. (2020). Understanding pain catastrophizing: putting pieces together. Frontiers in Psychology, 11, 603420. https://doi.org/10.3389/fpsyg.2020.603420
Rogers, A. H., & Farris, S. G. (2022). A meta‐analysis of the associations of elements of the fear‐avoidance model of chronic pain with negative affect, depression, anxiety, pain‐related disability and pain intensity. European Journal of Pain, 26(8), 1611-1635. https://doi.org/10.1002/ejp.1959
Saeed, S., Islam, S., & Khawar, R. (2019). Mediating Role of Negative Affect in Relationship between Illness Anxiety and Alexithymia. FWU Journal of Social Sciences, 13(3). https://doi.org/10.51709/jesd2019133
Sajjadian, I., Neshat Dost, H., Molavi, H., & Bagherian-Sararoudi, R. (2012). Cognitive and emotional factors effective on chronic low back pain in women: Explanation of the role of fear-avoidance beliefs, pain catastrophizing, and anxiety. Journal of Research in Behavioural Sciences, 9(5), 0-0.
Salkovskis, P. M., Rimes, K. A., Warwick, H. M., & Clark, D. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843-853. https://doi.org/10.1017/S0033291702005822
Scarella, T. M., Boland, R. J., & Barsky, A. J. (2019). Illness anxiety disorder: psychopathology, epidemiology, clinical characteristics, and treatment. Psychosomatic Medicine, 81(5), 398-407. https://doi.org/10.1097/PSY.0000000000000712
Serbic, D., Ferguson, L., Nichols, G., Smith, M., Thomas, G., & Pincus, T. (2020). The role of observers' fear of pain and health anxiety in empathy for pain: An experimental study. British Journal of Pain, 14(2), 74-81. https://doi.org/10.1177/2049463720920147
Seweryn, P., Orzeszek, S. M., Waliszewska-Prosół, M., Jenča, A., Osiewicz, M., Paradowska-Stolarz, A., ... & Więckiewicz, M. (2023). Relationship between pain severity, satisfaction with life, and the quality of sleep in Polish adults with temporomandibular disorders. Dental and Medical Problems, 60(4), 609-617. https://doi.org/10.17219/dmp/157025

نقش واسطه ای عاطفه منفی در رابطه بین اضطراب درد و فاجعه آفرینی درد با نشانه های اختلال اضطراب بیماری ----------------- آگشته 35
Shanbehzadeh, S., Salavati, M., Tavahomi, M., Khatibi, A., Talebian, S., & Khademi-Kalantari, K. (2017). Reliability and validity of the pain anxiety symptom scale in Persian speaking chronic low back pain patients. Spine, 42(21), E1238-E1244. https://doi.org/10.1097/BRS.0000000000002119
Stringer, D. M. (2020). Negative affect. In Encyclopedia of Behavioral Medicine (pp. 1469-1469). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-17404-4_1214
Sturgeon, J. A., & Zautra, A. J. (2013). State and trait pain catastrophizing and emotional health in rheumatoid arthritis. Annals of Behavioral Medicine, 45(1), 69-77. https://doi.org/10.1007/s12160-012-9382-7
Sullivan, M. J., & Tripp, D. A. (2024). Pain catastrophizing: controversies, misconceptions and future directions. The Journal of Pain, 25(3), 575-587. https://doi.org/10.1016/j.jpain.2023.11.010
Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17(1), 52-64. https://doi.org/10.1097/00002508-200101000-00008
Tait, R. C., & Chibnall, J. T. (2005). Factor structure of the pain disability index in workers’ compensation claimants with low back injuries. Archives of Physical Medicine and Rehabilitation, 86(6), 1141-1146. https://doi.org/10.1016/j.apmr.2004.11.031
Unal, G. O., Demiray, K. E., & Unal, O. (2022). Do patients with major depressive disorder and generalized anxiety disorder experience more somatosensorial amplification, hypochondriasis, and fear of COVID-19? Dusunen Adam, 35(1), 34-42. https://doi.org/10.14744/dajp.2022.60031
Wang, P., Cao, W., Chen, T., Gao, J., Liu, Y., Yang, X., ... & Li, Z. (2021). Mediating role of rumination and negative affect in the effect of mind-wandering on symptoms in patients with obsessive-compulsive disorder. Frontiers in Psychiatry, 12, 755159. https://doi.org/10.3389/fpsyt.2021.755159
Watson, D. (1994). The PANAS-X: Manual for the positive and negative affect schedule-expanded form. The University of Iowa. [No DOI available]
Wong, W. S., Lam, H. M. J., Chen, P. P., Chow, Y. F., Wong, S., Lim, H. S., ... & Fielding, R. (2015). The fear-avoidance model of chronic pain: assessing the role of neuroticism and negative affect in pain catastrophizing using structural equation modeling. International Journal of Behavioral Medicine, 22, 118-131. https://doi.org/10.1007/s12529-014-9415-4
Yalçın, İ., Boysan, M., Eşkisi, M., & Çam, Z. (2024). Health anxiety model of cyberchondria, fears, obsessions, sleep quality, and negative affect during COVID-19. Current Psychology, 43(9), 8502-8519. https://doi.org/10.1007/s12144-021-02080-5
Zambelli, Z., Halstead, E. J., Fidalgo, A. R., & Dimitriou, D. (2021). Good sleep quality improves the relationship between pain and depression among individuals with chronic pain. Frontiers in Psychology, 12, 668930. https://doi.org/10.3389/fpsyg.2021.668930