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Psychiatry Newsletter - Through Clenched Teeth

Hopkins BrainWise Winter 2010

Through Clenched Teeth

By: Marjorie Centofanti
Date: February 1, 2010

Anger’s natural, but squelching it can be a real pain.

Phil Quartana
“The cold pressor test is safe,” says Phil Quartana, here with a volunteer, “and it quickly tells us about someone’s level of pain and emotional state.”

Anyone who has ever stubbed a toe knows firsthand the connection between anger and pain. That’s the example Phillip Quartana, Ph.D., uses when discussing his novel research. “It’s not enough to respond to your sore toe,” says the clinical psychologist. “We also want to yell at the object that caused pain. We want to hurt it back. There’s an anger component that underlies the experience of pain.”

Quartana is one of a close-knit group of pain researchers looking into patients’ emotional responses to stressors. By cataloguing anger’s effects and explaining what’s going on cognitively, he hopes to discover tactics to reduce the misery of chronic pain.

The connection between anger and pain harkens back to Freudian thought, the idea that suppressed motives and impulses convert into physical symptoms. Newer research also leans that way but remains mostly anecdotal. Quartana’s team, however, has tested the theory—first on healthy subjects by provoking anger, encouraging them to suppress it and then inducing pain by soaking hands in ice water. The anger-suppressors rated their experience as more painful than those free to react any way they wished.

Quartana’s team has dubbed their findings the “ironic process model of pain suppression.” It’s an offshoot of an existing theory that says instructing the mind not to think of a concept calls it forth more often. It’s like the teaser, “Don’t think of a pink elephant.” Thus, trying to ignore pain and suppressing its sidekick, anger, Quartana argues, should cause more pain and anger over time.

The underlying rationale is fascinating: When you suppress anything, he says, you activate an unconscious “monitor”—a cognitive search engine that targets failure of suppression. When the monitor uncovers anger, it tells the mind eliminate it. Doing that, though, requires cognitive resources and energy. “When you’re under stress,” Quartana says, “that’s an added cognitive load. The complying mind has fewer resources to maintain control.” Meanwhile, the automatic monitor, needing no resources, just keeps chalking up anger.

 And in stressed people, he explains, the mounting anger breaks through, becoming “hyper-accessible” to consciousness. Quartana later supported the hyperaccessibility idea with other research.

Now he and his team are discovering similar results in patients with chronic low back pain. Not only do patients told to suppress anger exhibit more pain behavior, like grimacing, but testing shows exaggerated tension in their lower back muscles.

Quartana hopes that drawing the physical connection between pain and emotional suppression will widely improve treatment. “If we can identify what processes are at work,” he says, “that should help us refine therapy. Spotting people who need to express their emotions, for example, and finding the optimal way for them to do that would likely lessen pain.” 

For information: 410-550-7984

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