Cognitive Reappraisal and Pain in Temporomandibular Disorders Patients: The Chain Mediating Role of Anxiety and Oral Behaviours—A Cross‐Sectional Study

BACKGROUND: Pain is the primary symptom of Temporomandibular disorders (TMD) and the main reason patients seek treatment. Cognitive reappraisal has been shown to effectively alleviate pain, but evidence regarding its impact on TMD patients' pain remains insufficient. Furthermore, the mechanism by which cognitive reappraisal affects pain in TMD patients remains unclear. OBJECTIVES: To investigate the influence of cognitive reappraisal, anxiety, and oral behaviours on pain among TMD patients and to verify the chain mediating role of anxiety and oral behaviours. METHODS: This study is a cross-sectional study conducted at West China Stomatological Hospital, Sichuan University, which enrolled 360 TMD patients. The Chinese version of the Emotion Regulation Questionnaire, the brief version of the Depression-Anxiety-Stress scale, the Oral Behaviour Checklist, and the Visual Analogue Scale were used. SPSS 27.0 software and PROCESS macro 3.0 were used to analyze data and verify all the hypotheses. RESULTS: A total of three mediation pathways between cognitive reappraisal and pain: (1) cognitive reappraisal → anxiety → pain (β = -0.11, 95% CI: -0.15 to -0.07); (2) cognitive reappraisal → oral behaviours → pain (β = -0.12, 95% CI: -0.19 to -0.07); (3) cognitive reappraisal → anxiety → oral behaviours → pain (β = -0.06, 95% CI: -0.09 to -0.04). Direct effect was estimated as β = -0.40 (95% CI: -0.46 to -0.34). Total effect was estimated as β = -0.70 (95% CI: -0.77 to -0.63). CONCLUSIONS: Cognitive reappraisal reduces pain scores in TMD patients through multiple pathways, with anxiety and oral maladaptive behaviours acting as chain mediators. Cognitive reappraisal serves as one of the protective factors against pain in TMD patients.