Emotional suppression and distress mediate the relationship between beliefs about emotions and outcomes in fibromyalgia

Abstract

Background: Beliefs about the unacceptability of experiencing and expressing emotions have been found to be related to worse outcomes in medically unexplained symptoms. A model exploring potential mechanisms of this relationship was tested in people with fibromyalgia. Methods: 176 participants took part in an online questionnaire. Data were analysed using mediation analysis. The mediation model tested emotional suppression and affective distress as serial mediators of the relationship between beliefs about emotions and global impact. In parallel paths, two forms of support-seeking were tested (personal/emotional and symptom-related support-seeking) as mediators. Results: Emotional suppression and affective distress significantly serially mediated the relationship between beliefs about emotions and global impact. Alternate model testing supported the direction of this indirect effect. Neither support-seeking variable significantly mediated this relationship. There was no direct relationship between beliefs about emotions and global impact indicating inconsistent mediation. Post-hoc cluster analysis revealed three distinct subgroups in the sample, two of which showed a positive relationship between beliefs about emotions and global impact, and one group which showed a negative relationship, whereby more beliefs about emotions are related to better outcomes. For this particular subgroup, global impact and affective distress scores were significantly higher than the other two subgroups. Discussion: Results indicate a potential mechanism through which beliefs about emotions and global impact might relate. The differential relationships between beliefs about emotions and global impact suggest studying subgroups of fibromyalgia might be beneficial as the same beliefs might be helpful to some and detrimental to others.