Structural Pattern of Perceived Pain Based on Brain/ Behavioral Systems and Social Support Mediated by Distress Tolerance

Document Type : Original Article


1 Department of Health psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran.

2 Assistant Professor, Department of Psychology, Faculty of Psychology, Payame Noor University, Tehran, Iran

3 Associate Professor, Department of Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.

4 Assistant Professor, Department of Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.

5 Assistant Professor, Department of Neurology , Tehran Medical Branch, Islamic Azad University, Tehran, Iran.


Aim: The aim of this study was to determine the structural pattern of perceived pain based on brain/ behavioral systems and social support mediated by distress tolerance. Method: The research method was descriptive-correlational and the statistical population of the present study included all migraine patients referred to Bouali Hospital and two neurology clinics in Tehran in 2020, from which 374 patients were selected by convenience sampling method. Research tools include Behavioral Inhibition/ Activation Systems Scales by Carver & White (1994); Multidimensional Scale of Perceived Social Support by Zimet et al. (1988); Distress Tolerance Scale by Simons, & Gaher (2005) and Chronic Pain Questionnaire by Mohammadian (1995). The data of the present study were analyzed using structural equation modeling and Amos software. Results: The results indicated that the structural model of the research fit with the collected data. Indirect path coefficient between behavioral activation system and perceived pain was negative (P=0.001, β=-0.109). The indirect path coefficient between perceived social support and perceived pain was negative (P=0.001, β=0.145). Conclusion: It seems that perceived social support and behavioral activation system motivate the individual to endure pain-related distress in order to reduce it. Based on the results of the present study, interventions that modulate the manifestations of brain / behavioral systems and provide support groups to provide social support to patients with migraine pain are suggested.


Anestis, M. D., Selby, E. A., Fink, E. L., & Joiner, T. E. (2007). The multifaceted role of distress tolerance in dysregulated eating behaviors. The International journal of eating disorders40(8), 718–726. [Link]
Azizi A. R. (2010). Reliability and validity of the Persian version of distress tolerance scale. Iranian journal of psychiatry5(4), 154-158. [Link]
Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales. Journal of Personality and Social Psychology, 67(2), 319-333. [Link]
Charney, D. S. (2003). The psychobiology of resilience and vulnerability to anxiety disorders: implications for prevention and treatment. Dialogues in clinical neuroscience, 5(3), 207-221. [Link]
Che, X., Cash, R., Ng, S. K., Fitzgerald, P., & Fitzgibbon, B. M. (2018). A Systematic Review of the Processes Underlying the Main and the Buffering Effect of Social Support on the Experience of Pain. The Clinical journal of pain34(11), 1061–1076. [Link]
Cohen, J. R., Danielson, C. K., Adams, Z. W., & Ruggiero, K. J. (2016). Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster. Journal of psychopathology and behavioral assessment38(4), 538–546. [Link]
Gable, S. L., Reis, H. T., & Elliot, A. J. (2000). Behavioral activation and inhibition in everyday life. Journal of personality and social psychology78(6), 1135–1149. [Link]
Galvez-Sánchez, C. M., Reyes Del Paso, G. A., & Duschek, S. (2018). Cognitive impairments in fibromyalgia syndrome: Associations with positive and negative affect, alexithymia, pain catastrophizing and self-esteem. Frontiers in Psychology, 22(9), 377. [Link]
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews, 97(2), 553-622. [Link]
Gray J. A. (1991) The Neuropsychology of Temperament. In: Strelau J., Angleitner A. (eds) Explorations in Temperament. Perspectives on Individual Differences. Springer, Boston, MA. [Link]
Jangi Ghoojeh Beigloo, S., Narimani, M., Jani, S., & Pouresmali, A. (2014). The role of brain/behavioural systems in prediction of quality of life and coping strategies in cancer patients [Research Article]. Journal of Kermanshah University of Medical Sciences, 17(12), e74282. [Link]
Kilpatrick, Q. K. (2018). The role of the behavioral inhibition and activation systems in the stress process. A Dissertation submitted to the Department of Sociology in partial fulfilment of the requirements for the degree of Doctor of Philosophy. [Link]
Koenig, A., Kupper, A., Skidmore, J., & Murph, K. (2015). Pain self-efficacy mediates the relationship between depressive symptoms and pain severity. Pain, 31(2), 137-144. [Link]
Landa, A., Peterson, B. S., & Fallon, B. A. (2012). Somatoform pain: a developmental theory and translational research review. Psychosomatic medicine74(7), 717–727. [Link]
McNaughton, N., DeYoung, C. G., & Corr, P. J. (2016). Chapter 2 - Approach/Avoidance. In J. R. Absher & J. Cloutier (Eds.), Neuroimaging Personality, Social Cognition, and Character (pp. 25-49). Academic Press. [Link]
Merchán-Clavellino, A., Alameda-Bailén, J. R., Zayas García, A., & Guil, R. (2019). Mediating Effect of Trait Emotional Intelligence Between the Behavioral Activation Systems (BAS)/Behavioral Inhibition System (BIS) and Positive and Negative Affect. Frontiers in psychology10, 424. [Link]
Penn, T. M., Trost, Z., Parker, R., Wagner, W. P., Owens, M. A., Gonzalez, C. E., White, D. M., Merlin, J. S., & Goodin, B. R. (2019). Social support buffers the negative influence of perceived injustice on pain interference in people living with HIV and chronic pain. PAIN Reports, 4(2), e710. [Link]
Serrano-Ibáñez, E. R., López-Martínez, A. E., Ramírez-Maestre, C., Esteve, R., & Jensen, M. P. (2019). The behavioral inhibition and activation systems and function in patients with chronic pain. Personality and Individual Differences, 138, 56-62. [Link]
Sibille, K. T., Langaee, T., Burkley, B., Gong, Y., Glover, T. L., King, C., & Fillingim, R. B. (2012). Chronic pain, perceived stress, and cellular aging: An exploratory study. Molecular Pain, 8, 12. [Link]
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and Validation of a Self-Report Measure. Motivation and Emotion, 29(2), 83-102. [Link]
Turner, A. P., Jensen, M. P., Day, M. A., & Williams, R. M. (2021). Behavioral activation and behavioral inhibition: An examination of function in chronic pain. Rehabilitation psychology66(1), 57–64. [Link]
Waller, D. G., & Sampson, A. P. (2018). 26 - Migraine and other headaches. In D. G. Waller & A. P. Sampson (Eds.), Medical Pharmacology and Therapeutics (Fifth Edition) (pp. 341-347). Elsevier. [Link]
Zaorska, J., Kopera, M., Trucco, E. M., Suszek, H., Kobyliński, P., & Jakubczyk, A. (2020). Childhood Trauma, Emotion Regulation, and Pain in Individuals with Alcohol Use Disorder. Frontiers in psychiatry11, 554150. [Link]
Zimet, G. D., Dahlen, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional scale of perceived social support. Journal of personality assessment, 52, 30-41. [Link]
Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of personality assessment, 55(3-4), 610-617. [Link]