A theory-driven structural equation modeling approach to the behavioral inhibition and behavioral activation systems model of chronic pain: Evaluating the mediating role of self-regulatory and volitional abilities.

<i><b>Objective:</b></i> 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. <i><b>Method:</b></i> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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).