A multilevel structural equation modeling analysis of vulnerabilities and resilience resources influencing affective adaptation to chronic pain John A. Sturgeon, M.A., Alex J. Zautra, Ph.D., & Anne Arewasikporn, M.A. Department of Psychology, Arizona State University, Tempe, AZ Introduction Methods Results References  Fibromyalgia (FM) and osteoarthritis (OA) are rheumatic pain disorders that carry high co-morbid rates of psychological dysfunction.  Evidence indicates that adaptation to chronic pain involves both cognitive (pain catastrophizing) and social processes (interpersonal relationships).  Pain flares may cause individuals with pain to withdraw socially (Zautra, Hamilton, & Burke, 1999).  Pain adaptation likely involves processes that foster individual resilience (e.g., positive interpersonal events) and maladaptive processes that increase vulnerability to pain-related dysfunction (e.g., pain catastrophizing, interpersonal conflict).  The current study examined concurrent effects of pain catastrophizing and positive and negative interpersonal events on emotional states using daily diary methodology.  Individual differences and daily fluctuations in predictor variables were estimated simultaneously by utilizing multilevel structural equation modeling (MSEM) techniques.  Effects of daily pain intensity on daily changes in positive affect and negative affect were mediated by changes in daily pain catastrophizing and positive interpersonal events, but not negative interpersonal events (level-1 models).  Relationships between average pain intensity and average levels of positive affect and negative affect were mediated by average levels of pain catastrophizing, but not by the average number of positive or negative interpersonal events reported by participants  Multilevel SEMs showed good model fit (RMSEA =.020, CFI =.995, TLI =.966, SRMR within =.008, SRMR Between =.038) 1.Muthen, L. K., & Muthen, B. O. (2007). Mplus Users’s Guide. Los Angeles: Muthen & Muthen. 4 th Edition. 2.Preacher, K. J., Zyphur, M. J., & Zhang, Z. (2010). A general multilevel SEM framework for assessing multilevel mediation. Psychological Methods, 15, Zautra, A. J., Hamilton, N. A., & Burke, H. M. (1999). Comparison of stress responses in women with two types of chronic pain: Fibromyalgia and osteoarthritis. Cognitive Therapy and Research, 23, Discussion  There are significant and independent contributions of pain catastrophizing and positive interpersonal events to adaptation to pain and pain-related affective dysregulation.  These effects occur both between persons and within a person’s everyday life.  2-factor model of affective dysregulation in chronic pain  Pain catastrophizing and negative interpersonal events worsen negative emotional states  Withdrawal from positive social events due to pain dampen positive emotional states  Disruption of positive social functioning by pain flares appears to be a normative process due to immediate pain intensity, but is unrelated to an individual’s typical pain level  Social withdrawal due to pain is an ineffective coping strategy, as negative interpersonal events appear to be uncorrelated with day-to-day and average pain levels. Participants  Total: 260 patients with fibromyalgia and/or osteoarthritis  Mean Age: years  Gender: 100% female  Ethnicity: 91% Caucasian Measures  FM/OA patients made daily reports of their pain, pain catastrophizing, positive and negative affect, and positive and negative interpersonal events over 30 days of diary measures.  Pain  Numerical Rating Scale (NRS; Zautra, Smith, Affleck, & Tennen, 2001)  Pain Catastrophizing (2-item composite)  Coping Strategies Questionnaire (CSQ; Rosentiel & Keefe, 1983)  Positive & Negative Affect  Positive Affect Negative Affect Schedule-Expanded Form (PANAS-X; Watson & Clark, 1994)  Interpersonal Events  Inventory of Small Life Events (ISLE; Zautra, Guarnaccia, & Dohrenwend, 1986) Negative Interpersonal Events Pain Intensity Pain Catastrophizing Positive Interpersonal Events Negative Affect Positive Affect.025** **.086**.060** ** -.007** -.145** Negative Interpersonal Events Pain Intensity Pain Catastrophizing Positive Interpersonal Events Negative Affect Positive Affect.026** **.081** ** ** Level-1 (Within-Day) Level-2 (Mean Scores) Note: Bolded paths represent significant mediated effects. †p <.10. *p <.05. **p <.01. Figure 1. Model depicting the direct effects of pain intensity and indirect effects of pain intensity through pain catastrophizing and negative and positive interpersonal events on daily positive and negative affect. Analytic Plan  Multilevel structural equation models were estimated using Mplus TYPE = TWOLEVEL command (Muthen & Muthen, 2007).  Estimates models separately for level-1 (time- varying) and stable (level-2) variance  Preferable to OLS regression due to non- independence of observations  Preferable to multilevel regression due to available indices of model fit and ability to simultaneously model linear relationships using both level-1 and level-2 variance (Preacher, Zyphur, & Zhang, 2010).