Objective: Gray's reinforcement sensitivity, describing elementary motivational systems that mediate cognitive-affective and behavioral responses to punishing (behavioral inhibition system BIS) and Rewarding (behavioral activation system BAS) stimuli, has been most widely applied in the study of the motivational underpinnings of pain-related responses. Empirical findings regarding the associations of BIS and BAS with pain-relevant clinical outcomes are inconsistent, however. Drawing on personality systems interaction theory, the present cross-sectional study aimed at evaluating the mediating role of self-regulatory and volitional abilities in the relationship between BIS and BAS-Reward sensitivity and pain-related activity patterns. Method: Our data analyses were based on 579 patients (74.8% women) with musculoskeletal pain who filled in self-report questionnaires operationalizing the constructs of interest. The projected relations among three levels of observed variables (level of temperament, self-regulation as mediating level, and behavioral dimensions as outcome level) were statistically tested by mediation analysis based on structural equation modeling. Results: Consistent with our predictions, we found the facilitating effects of BIS sensitivity on activity avoidance, and maladaptive dimensions of persistence and pacing behavioral dimensions to be mediated by self-regulation and volitional facilitation. Full mediation was also observed for the negative associations of BAS-Reward with pain avoidance, activity avoidance, and excessive persistence. Conclusions: Our study complements previous work by emphasizing the importance of emotional self-regulation and volition in behavioral responses to pain. New perspectives on the role of BAS-Reward in chronic pain are opened up. Our findings indicate that multimodal interventions fostering emotional self-regulation should be increasingly incorporated into existing pain management programs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Kästner et al. (Thu,) studied this question.