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Forgiveness, anger and stress in patients with Fibromyalgia syndrome and controls
Forgiveness, anger and stress in patients with Fibromyalgia syndrome and controls
Background Fibromyalgia syndrome (FMS) is a highly prevalent disease which causes chronic multifocal musculoskeletal pain and sensitivity to touch, along with other symptoms like fatigue and sleep problems. Causal treatment is not available. Methods This cross-sectional study focuses on the associations of symptom burden and life quality with forgiveness, anger and anger rumination in FMS patients. 173 FMS patients and 81 healthy individuals completed questionnaires inquiring about general socioeconomic data, pain scales as well as the Fibromyalgia impact questionnaire (FIQ), the quality of life scale (QOLS), the short form health survey 12 (SF-12 with physical component summary (PCS) and mental component summary (MCS)), hospital anxiety and depression scale (HADS with subscales anxiety and depression), Mauger forgiveness of self and others, state trait anger expression inventory (STAXI) and the anger rumination scale (ARS). Results The results show significant differences regarding pain, symptom burden and quality of life (pain duration FMS patients (FMS) 18.07 years, controls (CTRL) 1,05 years; pain today FMS 6,18, CTRL 0,49; pain severity last three months FMS 6,76, CTRL 0,95; QOLS FMS 66,27, CTRL 88,47; FIQ FMS 50,22, CTRL 11,98; HADS subscale anxiety FMS 10,59, CTRL 4,77; HADS depression, FMS 9,42; CTRL 2,7; SF-12 12 PCS FMS 30,24, CTRL 50,48; SF-12 MCS FMS 35,62, CTRL 50,34). FMS patients reported significantly lower levels of forgiveness of self (FMS 38,43, CTRL 30,51); no significant difference regarding forgiveness of others was detected between (FMS 36,59, CTRL 33,61). FMS patients were scoring significantly higher on most STAXI subscales (state anger FMS 15,36, CTRL 11,59; trait anger FMS 21,75, CTRL 19,16; anger-in FMS 20,35, CTRL 15,51). Significant differences on all subscales of the ARS were found (angry afterthoughts FMS 2,44, CTRL 1,83, thoughts of revenge FMS 1,60, CTRL 1,45; angry memories FMS 2,50, CTRL 1,80; understanding causes FMS 2,50, CTRL 2,10; anger rumination scale total FMS 2,26, CTRL 1,80). In FMS patients Self-forgiveness showed several significant Pearson correlation coefficients r with quality of life and symptom burden indices (FIQ: r=0,30; HADS anxiety r=0,58; HADS depression r=0,45; SF-12 PCS r=0,07; SF-12 MCS r=-0,41, QOLS r=-0,43). Forgiveness of others also showed significant correlations (FIQ: r=0,07; HADS-anxiety r=0,23; HADS depression r=0,22; SF-12 PCS r=-0,02, SF-12 MCS r=-0,09; QOLS r=-0,29). Of all STAXI anger subscales, state anger correlated most with high symptom expression, poor mental health and low quality of life (FIQ r=0,31; HADS anxiety r=0,33; HADS depression r=0,37; SF-12 PCS r=-0,10; SF-12 MCS r=-0,30; QOLS r=-0,40), followed by trait anger, anger in and anger out. Of all ARS subscales, angry afterthoughts correlated most with high FMS symptom expression, low mental health and low quality of life life (FIQ r=0,24; HADS anxiety r=0,46; HADS depression r=0,43; SF-12 PCS r=0,05; SF-12 MCS r=-0,23; QOLS r=-0,31). Discussion Forgiving themselves is difficult for FMS patients. Behavioral patterns centered around exceptionally high self-expectations and self-criticism have been reported. Prior studies link high levels of self-criticism to grave symptom severity in chronic pain patients. Therefore, it seems likely that FMS patients could decrease their disease burden by increasing their self-forgiveness. Anger, especially anger, which is directed inward, has been demonstrated to amplify the level of preexisting pain and worsen depressive symptoms. Forgiveness has shown to have a diminishing effect on anger expression while boosting anger control. Hence, it seems likely that a forgiveness-based intervention focused on reducing the internalization of anger and education on how to express anger healthily would be promising for FMS patients. As with anger, prior research suggests a similar connection of anger rumination to symptom burden. It seems likely that angry rumination could be decreased by an intervention centered around forgiveness, which could benefit FMS patients.
Fibromyalgia syndrome, forgiveness, anger rumination, stress
King, Felix
2021
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
King, Felix (2021): Forgiveness, anger and stress in patients with Fibromyalgia syndrome and controls. Dissertation, LMU München: Faculty of Medicine
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Abstract

Background Fibromyalgia syndrome (FMS) is a highly prevalent disease which causes chronic multifocal musculoskeletal pain and sensitivity to touch, along with other symptoms like fatigue and sleep problems. Causal treatment is not available. Methods This cross-sectional study focuses on the associations of symptom burden and life quality with forgiveness, anger and anger rumination in FMS patients. 173 FMS patients and 81 healthy individuals completed questionnaires inquiring about general socioeconomic data, pain scales as well as the Fibromyalgia impact questionnaire (FIQ), the quality of life scale (QOLS), the short form health survey 12 (SF-12 with physical component summary (PCS) and mental component summary (MCS)), hospital anxiety and depression scale (HADS with subscales anxiety and depression), Mauger forgiveness of self and others, state trait anger expression inventory (STAXI) and the anger rumination scale (ARS). Results The results show significant differences regarding pain, symptom burden and quality of life (pain duration FMS patients (FMS) 18.07 years, controls (CTRL) 1,05 years; pain today FMS 6,18, CTRL 0,49; pain severity last three months FMS 6,76, CTRL 0,95; QOLS FMS 66,27, CTRL 88,47; FIQ FMS 50,22, CTRL 11,98; HADS subscale anxiety FMS 10,59, CTRL 4,77; HADS depression, FMS 9,42; CTRL 2,7; SF-12 12 PCS FMS 30,24, CTRL 50,48; SF-12 MCS FMS 35,62, CTRL 50,34). FMS patients reported significantly lower levels of forgiveness of self (FMS 38,43, CTRL 30,51); no significant difference regarding forgiveness of others was detected between (FMS 36,59, CTRL 33,61). FMS patients were scoring significantly higher on most STAXI subscales (state anger FMS 15,36, CTRL 11,59; trait anger FMS 21,75, CTRL 19,16; anger-in FMS 20,35, CTRL 15,51). Significant differences on all subscales of the ARS were found (angry afterthoughts FMS 2,44, CTRL 1,83, thoughts of revenge FMS 1,60, CTRL 1,45; angry memories FMS 2,50, CTRL 1,80; understanding causes FMS 2,50, CTRL 2,10; anger rumination scale total FMS 2,26, CTRL 1,80). In FMS patients Self-forgiveness showed several significant Pearson correlation coefficients r with quality of life and symptom burden indices (FIQ: r=0,30; HADS anxiety r=0,58; HADS depression r=0,45; SF-12 PCS r=0,07; SF-12 MCS r=-0,41, QOLS r=-0,43). Forgiveness of others also showed significant correlations (FIQ: r=0,07; HADS-anxiety r=0,23; HADS depression r=0,22; SF-12 PCS r=-0,02, SF-12 MCS r=-0,09; QOLS r=-0,29). Of all STAXI anger subscales, state anger correlated most with high symptom expression, poor mental health and low quality of life (FIQ r=0,31; HADS anxiety r=0,33; HADS depression r=0,37; SF-12 PCS r=-0,10; SF-12 MCS r=-0,30; QOLS r=-0,40), followed by trait anger, anger in and anger out. Of all ARS subscales, angry afterthoughts correlated most with high FMS symptom expression, low mental health and low quality of life life (FIQ r=0,24; HADS anxiety r=0,46; HADS depression r=0,43; SF-12 PCS r=0,05; SF-12 MCS r=-0,23; QOLS r=-0,31). Discussion Forgiving themselves is difficult for FMS patients. Behavioral patterns centered around exceptionally high self-expectations and self-criticism have been reported. Prior studies link high levels of self-criticism to grave symptom severity in chronic pain patients. Therefore, it seems likely that FMS patients could decrease their disease burden by increasing their self-forgiveness. Anger, especially anger, which is directed inward, has been demonstrated to amplify the level of preexisting pain and worsen depressive symptoms. Forgiveness has shown to have a diminishing effect on anger expression while boosting anger control. Hence, it seems likely that a forgiveness-based intervention focused on reducing the internalization of anger and education on how to express anger healthily would be promising for FMS patients. As with anger, prior research suggests a similar connection of anger rumination to symptom burden. It seems likely that angry rumination could be decreased by an intervention centered around forgiveness, which could benefit FMS patients.