Children with cancer are repeatedly exposed to aversive stimuli including painful procedures. Therefore, emotional regulation techniques may prove useful during such experiences and contribute to pain resilience. This study aimed to determine whether three different emotional regulation strategies (distraction, reappraisal and reassurance) impacted physiological, self- reported and behavioral pain responses in pediatric patients with cancer ages 6 to 18 years (N = 73). The cold pressor task (CPT), an experimental task in which pain is induced by having participants place their hand in cold water, was used to examine pain responses. Patients placed their hand in 7 degree Celsius water for up to 4 minutes. Saliva samples were collected 15 minutes before, immediately after, and then 15 minutes after the CPT. Saliva samples were assayed for alpha amylase, a proxy for sympathetic nervous system activation. Self-reported pain severity was measured upon hand removal. Pain tolerance was assessed by length of time participants kept their hand in the water. Children in the reassurance condition exhibited salivary alpha amylase levels that continued to rise post completion of the CPT as compared to children in the distraction (Beta = -1.68, SE = 0.73, z = -2.30, p = .021, 95% CI [-3.10, -0.25]) and reappraisal (Beta = -1.24, SE = 0.72, z = -1.73, p = .084, 95% CI [-2.65, 0.17]) conditions. However, when self-reported pain and behavior were examined, no differences in pain severity (Wald Chi-squared (2) = 2.47, p = .292), or pain tolerance (Wald Chi-squared (2) = 1.38, p = 0.502) among the emotional regulation strategies were observed. Thus, significant findings were present for physiological markers of distress, but not for self-reported and behavioral measures. These findings suggest that in terms of physiological measures, specific emotional regulation strategies, such as distraction and reappraisal, may be more beneficial in reducing stress responses to painful medical procedures in pediatric patients with cancer as compared to reassurance. These results also demonstrate the importance of examining physiological outcomes in addition to self-report and behavioral outcomes.
Hikita, Natasha H.; Korth, Christina; Greif, Paige; Jenkins, Brooke N.; Granger, Douglas A.; and Fortier, Michelle, "Emotion Regulation and Positive Affect in the Context of Salivary Alpha-Amylase Response to Pain in Children with Cancer: Physiology, Self-Report, and Behavior" (2018). Student Research Day Abstracts and Posters. 284.