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Dissertation Docteur De L'université Du Luxembourg

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Dissertation Docteur De L'université Du Luxembourg PhD-FLSHASE-2016-23 The Faculty of Language and Literature, Faculty of Psychology and Educational Humanities, Arts and Education Sciences DISSERTATION Defence held on 13/10/2016 in Luxembourg to obtain the degree of DOCTEUR DE L’UNIVERSITÉ DU LUXEMBOURG EN PSYCHOLOGIE AND DOCTOR IN DE PSYCHOLOGIE by Silke ROST Born on 30 March 1985 in Luxembourg (Luxembourg) THE ROLE OF SELF-REGULATORY CAPACITY IN THE ADAPTATION TO PAIN Dissertation defence committee Dr. Claus Vögele, dissertation supervisor Professor, University of Luxembourg Dr. Geert Crombez, dissertation supervisor Professor, Ghent University Dr. Christine Schiltz, Chairman Professor, University of Luxembourg Dr. Micheal Witthöft, Professor, Johannes Gutenberg University Mainz Dr. Andrea Evers, Professor, Leiden University Dr. Stefaan Van Damme, Vice Chairman Associate-Professor, Ghent University Science is organized knowledge. Wisdom is organized life. Immanuel Kant (1724 – 1804) Acknowledgements Many great people accompanied me through my PhD and I would like to thank all of them. But I want to start with the one person who left me much too early and whom I could not share this important part of my life with, my Dad. You raised me to be curious and explore the world and you taught me to belief in myself. You are the primary reason that I actually got here. It would make you incredibly proud to see where I stand right now and if there is one thing I regret about getting to the point of finishing my PhD is the fact that you simply cannot be part of it. Thank you for having been the greatest Dad and for having guided me to be who I am. Then of course I am in deep gratitude to my supervisors Claus Vögele and Geert Crombez. Administration not always made it easy for us, but I would like to thank you for having gone this whole way of a joint doctorate which I benefitted so much of. Thank you Claus that you put so much faith in me and that you trusted me. Thank you for having offered me your precious help and advice whenever I needed it and thank you for always having had my back. Thank you Geert that you believed in me and my ideas. I still remember my first presentation in Ghent, oh God… Thank you that you always found time for me when I visited. I highly appreciate your invaluable support and help and want to thank you that, despite the distance, you’ve always been “there”. I’ve also been guided by great people from whom I’ve learnt enormously and who have gained a special place, not only as mentors but also as friends. Dimitri, I don’t even know where to start. Thank you for your scientific guidance and your patience, for your countless hours invested in my PhD, for inspiring discussions, for always being reachable and always offering help, for believing in my work as a researcher and for having supported me in every moment of the last four years! But also thank you for the fun we had and for sharing personal commonalities. Stefan, thank you for having created the opportunity for “this” in the first place. You have been so essential for me in the last years and I want to thank you for your scientific and moral support. Thank you for never doubting me and for always having turned my perspective from the problems to the achievements. And a special thanks for having pulled me out of my deep hole 10 days ago and motivated me to finish my PhD. André, thank you for your support, for your interest and your belief in me. Thank you also to the members of my dissertation defence committee for having agreed to be part of this. Thank you to Dieter Ferring for having accompanied me too. I THANK YOU also to all my colleagues in Luxembourg and in Ghent. Thank you to the Self-Regulation and Health team and the Health Psychology Lab. It was such a great pleasure working with all of you. A special thanks to Yacine, Zoé and Gunnthora for having been there to support me even in the hardest times, for never giving up the optimism and for having become great friends. Thank you Nele for the great ASEF-I-time. Thank you Wouter, Annick, Charlotte, Sophie and Lien for the exciting conferences we spent together. Thank you also to Raymonde who has been supporting me throughout these last four years. I would also like to thank all the great participants who have supported my research! And a very warm THANKS goes of course to my family and friends who have backed me where they could, who have not stopped believing in me, who have helped me to see the bright side of life, who have been patient with me and spent comfort during hard times. Thank you Mum, my siblings Kai and Frauke, thank you my parents-in-law for your interest in my work, for your esteem and for your unconditional support. Thank you Romy, Martine, Patty, Yasmine, Anne and all my other great friends, I couldn’t wish for better friends. Thank you to all my wonderful friends in Berlin who have, despite the distance, always been very close and whom I’d never want to miss again. Thank you also to my friends from the “Leidelenger Musek”, you have helped me to unwind and find new energy in music. And finally I want to thank the two most important persons in my life. Sebastian, for being the greatest partner I could imagine. Thank you for having come with me to Luxembourg, for having supported my stay in Ghent, for having supported me with much care in the most difficult moments and for always having been on my side. You made me smile in the moments I was about to forget what smiling is and you always made me feel valued as your partner, as a psychologist, as a scientist and as a mum. Loki, today you may not really understand what I say, but I would like to thank you too. I cannot hide that you made me go through very hard times with your very special sleep-pattern for weeks and months. But the truth is that you have opened a door to another life for me and I would never want to go back. You are the best thing that happened to me and I will always be grateful that you unremittingly kept spoiling me with the most amazing moments of my life, no matter how hard I was fighting to reach the end of my PhD. With the last words of my PhD, I feel completely exhausted and amazingly light and happy to reach the end. Thank you to every other amazing person who has shared my life and this special part of it, who has been indulgent, motivating and caring! THANK YOU. II Abstract Pain is an everyday experience and serves an important evolutionary function. It attracts attention and interrupts ongoing activity to assure survival. Chronic pain, however, loses its warning signal function and constitutes a common problem in healthcare. It is associated with important personal and social impairments as well as considerable costs which are mostly due to work absenteeism. The gate control theory has opened a new window and allowed the field of pain research to move from a biomedical to a biopsychosocial perspective which considers medical, social, and psychological factors as potentially influencing the experience of pain. Popular contemporary explanations of chronic pain conditions are based on the idea of dysfunctional attentional processes. One can distinguish between two modes of attentional selection. The bottom-up, involuntary, capture of attention by pain is a critical feature of its alarm function. It interrupts ongoing behaviour and thereby allows an individual to prevent further injury. Top-down factors can modulate this unintentional capture of attention. Clinical observations have argued for chronic pain patients, particularly fibromyalgia (FM) patients, to be hypervigilant, i.e. excessively attend to threat-related information, and thereby report amplified pain experience. Distraction, on the other hand, can be defined as an attentional strategy to cope with pain by directing one’s attention away from pain, thereby decreasing pain experience. Moreover, pain, by definition, is a sensory and emotional experience and the disentanglement of both pain and emotion is a challenge for research. To gain a better understanding of the dynamic interplay between emotions and pain, it may be necessary to switch from a categorical to a more flexible and dynamic perspective. Emotions are shaped not only by intensity, but also by time features. Temporal patterns rely on regulation processes and provide unique information that is relevant for psychological well-being. Emotion regulation can be integrated in the more general notion of self- regulation which refers to the capacity to control one’s thoughts, emotions, and behaviour in order to pursue a goal. Thereby, self-regulation refers to a higher-order process which controls lower-order processes to guide behaviour, primarily operating by inhibitory control. According to the model of neurovisceral integration, self-regulatory capacity reflects the adaptability of an organism to respond to changing environmental demands and can be operationalized by heart rate variability (HRV). Self-regulatory processes involve attention which is either directed towards environmental or towards internal sources. One of the most important internal targets of regulation certainly refers to an emotion. Numerous studies have revealed a close association between dysregulated affect, III such as affective instability which is defined as large and frequent mood shifts over time, and psychopathology. Besides its importance for mental well-being, emotion regulation was also suggested as a key factor in the adaptation to chronic pain.
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