The objective of this systematic review was to investigate the potential link between cognitive dissonance or its related constructs (emotional dissonance, emotional labor) and musculoskeletal disorders.
Background
The etiology of musculoskeletal disorders is complex, as pain arises from complex interactions among physical, social, and psychological stressors. It is possible that the psychological factor of cognitive dissonance may contribute to the etiology and/or maintenance of musculoskeletal disorders.
Method
MEDLINE, APA PsycInfo, and CINAHL Plus databases were searched for studies investigating cognitive dissonance or its related constructs as exposure(s) of interest and outcomes related to physical health (including, but not limited to, musculoskeletal pain). Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.
Results
The literature search yielded 7 studies eligible for inclusion. None of the included studies investigated cognitive dissonance directly but instead investigated dissonance-related constructs of emotional dissonance and emotional labor, in which a mismatch between required and felt emotions might elicit a psychological response consistent with the cognitive dissonance state. Moderate effect sizes between dissonance-related constructs and musculoskeletal disorders were noted (OR 1.25–2.22).
Conclusion
There is likely a relationship between the two factors studied. However, as the included studies were cross-sectional in nature, a causal relationship between cognitive dissonance-related constructs and musculoskeletal disorders cannot be inferred. Therefore, future study proposing and validating a causal pathway between these variables is warranted.
Application
Cognitive dissonance and its related constructs may serve as risk factors for musculoskeletal disorders that have not been considered previously.
AlnaserM. Z. (2007). Occupational musculoskeletal injuries in the health care environment and its impact on occupational therapy practitioners: a systematic review. Work, 29(2), 89-100. https://content.iospress.com/articles/work/wor00646
2.
AndersonS. P.OakmanJ. (2016). Allied Health Professionals and Work-Related Musculoskeletal Disorders: A Systematic Review. Saf Health Work, 7(4), 259–267. https://doi.org/10.1016/j.shaw.2016.04.001
3.
AndrewsB. K.KarczS.RosenbergB. (2008). Hooked on a feeling: emotional labor as an occupational hazard of the post-industrial age. New Solut, 18(2), 245–255. https://doi.org/10.2190/NS.18.2.m
4.
BaekK.YangS.LeeM.ChungI. (2018). The association of workplace psychosocial factors and musculoskeletal pain among Korean emotional laborers. Saf Health Work, 9(2), 216–223. https://doi.org/10.1016/j.shaw.2017.09.004
5.
BernardB. P., ed. (1997). Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back.
6.
BirzeA.LeBlancV.RegehrC.ParadisE.EinsteinG. (2020). The "Managed" or Damaged Heart? Emotional Labor, Gender, and Posttraumatic Stressors Predict Workplace Event-Related Acute Changes in Cortisol, Oxytocin, and Heart Rate Variability. Front Psychol, 11, 604. https://doi.org/10.3389/fpsyg.2020.00604
7.
BloemsaatJ. G.MeulenbroekR. G.Van GalenG. P. (2005). Differential effects of mental load on proximal and distal arm muscle activity. Exp Brain Res, 167(4), 622–634. https://doi.org/10.1007/s00221-005-0066-2
8.
BraitmanA. L.BattlesA. R.KelleyM. L.HamrickH. C.CramerR. J.EhlkeS.BravoA. J. (2018). Psychometric properties of a Modified Moral Injury Questionnaire in a military population. Traumatology, 24(4), 301–312. https://doi.org/10.1037/trm0000158
9.
BrotheridgeC.LeeR. (2003). Development and validation of the Emotional Labour Scale. Journal of Occupational and Organizational Psychology, 76(3), 365–379. https://doi.org/10.1348/096317903769647229
10.
ChanyA. M.ParakkatJ.YangG.BurrD. L.MarrasW. S. (2006). Changes in spine loading patterns throughout the workday as a function of experience, lift frequency, and personality. Spine J, 6(3), 296–305. https://doi.org/10.1016/j.spinee.2005.10.011
11.
CooperJ. (2019). Cognitive dissonance: Where we’ve been and where we’re going. International Review of Social Psychology, 32(1). https://doi.org/10.5334/irsp.277
12.
CooperJ.ZannaM. P.TavesP. A. (1978). Arousal as a necessary condition for attitude change following induced compliance. J Pers Soc Psychol, 36(10), 1101–1106. https://doi.org/10.1037//0022-3514.36.10.1101
13.
CôtéP.van der VeldeG.CassidyJ. D.CarrollL. J.Hogg-JohnsonS.HolmL. W.CarrageeEJHaldemanSNordinMHurwitzELGuzmanJPelosoP. M. (2008). The burden and determinants of neck pain in workers: Results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine, 33(4S), S60-S74. https://doi.org/10.1097/BRS.0b013e3181643ee4
14.
CronqvistA.TheorellT.BurnsT.LützénK. (2001). Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden. Intensive Crit Care Nurs, 17(4), 228–236. https://doi.org/10.1054/iccn.2000.1588
15.
CroyleR. T.CooperJ. (1983). Dissonance arousal: Physiological evidence. Journal of Personality and Social Psychology, 45(4), 782–791. https://doi.org/10.1037/0022-3514.45.4.782
16.
DavisK. G.MarrasW. S.HeaneyC. A.WatersT. R.GuptaP. (2002). The impact of mental processing and pacing on spine loading: 2002 Volvo Award in biomechanics. Spine (Phila Pa 1976), 27(23), 2645–2653. https://doi.org/10.1097/01.BRS.0000035263.63619.15
DevineP. G.TauerJ. M.BarronK. E.ElliotA. J.VanceK. M. (1999). Moving beyond attitude change in the study of dissonance-related processes Cognitive dissonance: Progress on a pivotal theory in social psychology (pp. 297–323). American Psychological Association.
19.
DielemanJ. L.BaralR.BirgerM.BuiA. L.BulchisA.ChapinA.HamavidHHorstCJohnsonEKJosephJLavadoRLomsadzeLReynoldsASquiresECampbellMDeCensoBDickerDFlaxmanADGabertRHighfillT (2016). US spending on personal health care and public health, 1996-2013. JAMA, 316(24), 2627–2646. https://doi.org/10.1001/jama.2016.16885
20.
DommerholtJ.BronC.FranssenJ. (2006). Myofascial Trigger Points: An Evidence-Informed Review. Journal of Manual & Manipulative Therapy, 14(4), 203–221. https://doi.org/10.1179/106698106790819991
21.
DownesM. J.BrennanM. L.WilliamsH. C.DeanR. S. (2016). Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open, 6(12), Article e011458. https://doi.org/10.1136/bmjopen-2016-011458
22.
DunningK. K.DavisK. G.CookC.KotowskiS. E.HamrickC.JewellG.LockeyJ. (2010). Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999–2004. American Journal of Industrial Medicine, 53(3), 276–284. https://doi.org/10.1002/ajim.20774
23.
ElbinouneI.AmineB.ShyenS.GueddariS.AbouqalR.Hajjaj-HassouniN. (2016). Chronic neck pain and anxiety-depression: prevalence and associated risk factors. Pan Afr Med J, 24, 89. https://doi.org/10.11604/pamj.2016.24.89.8831
24.
ElferingA.HäfligerE.CelikZ.GrebnerS. (2018). Lower back pain in nurses working in home care: linked to work-family conflict, emotional dissonance, and appreciation?Psychol Health Med, 23(6), 733–740. https://doi.org/10.1080/13548506.2017.1417614
25.
EngelR. M.SilverC. C.VeederC. L.BanksR. E. (2020). Cognitive dissonance in laboratory animal medicine and implications for animal welfare. J Am Assoc Lab Anim Sci, 59(2), 132–138. https://doi.org/10.30802/aalas-jaalas-19-000073
26.
EtgenM. P.RosenE. F. (1993). Cognitive dissonance: Physiological arousal in the performance expectancy paradigm. Bulletin of the Psychonomic Society, 31(3), 229–231. https://doi.org/10.3758/BF03337331
27.
EvansW. R.StanleyM. A.BarreraT. L.ExlineJ. J.PargamentK. I.TengE. J. (2018). Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles. Psychol Trauma, 10(3), 360–367. https://doi.org/10.1037/tra0000347
28.
FejerR.KyvikK. O.HartvigsenJ. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal: official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 15(6), 834–848. https://doi.org/10.1007/s00586-004-0864-4
29.
FestingerL. (1957). A theory of cognitive dissonance. Row-Peterson.
30.
GerritsM. M.van MarwijkH. W.van OppenP.van der HorstH.PenninxB. W. (2015). Longitudinal association between pain, and depression and anxiety over four years. J Psychosom Res, 78(1), 64–70. https://doi.org/10.1016/j.jpsychores.2014.10.011
31.
GerritsM. M. J. G.van OppenP.van MarwijkH. W. J.PenninxB. W. J. H.van der HorstH. E. (2014). Pain and the onset of depressive and anxiety disorders. Pain, 155(1), 53-59. https://doi.org/10.1016/j.pain.2013.09.005
32.
GilliamW. P.BurnsJ. W.GagnonC.StanosS.MatsuuraJ.BeckmanN. (2013). Strategic self-presentation may enhance effects of interdisciplinary chronic pain treatment. Health Psychology, 32(2), 156–163. https://doi.org/10.1037/a0029205
Harmon‐JonesE.AmodioD. M.Harmon‐JonesC. (2009). Chapter 3 action‐based model of dissonance: A review, integration, and expansion of conceptions of cognitive conflict advances in experimental social psychology (Vol. 41, pp. 119–166). Academic Press.
35.
HartvigsenJ.HancockM. J.KongstedA.LouwQ.FerreiraM. L.GenevayS.HoyDKarppinenJPranskyGSieperJSmeetsRJUnderwoodMBuchbinderRCherkinDFosterNEMaherCGUnderwoodMvan TulderMAnemaJRChouR (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X
36.
HarveyC.ThompsonS.OtisE.WillisE. (2020). Nurses’ views on workload, care rationing and work environments. J Nurs Manag, 28(4), 912–918. https://doi.org/10.1111/jonm.13019
37.
HigginsJ. P. T.AltmanD. G.GøtzscheP. C.JüniP.MoherD.OxmanA. D.SavovicJ.SchulzK. F.WeeksL.SterneJ. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928
38.
HoogendoornW. E.van PoppelM. N.BongersP. M.KoesB. W.BouterL. M. (1999). Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health, 25(5), 387-403. https://doi.org/10.5271/sjweh.451
39.
HoyD.MarchL.BrooksP.BlythF.WoolfA.BainC.WilliamsGSmithEVosTBarendregtJMurrayCBursteinRBuchbinderR. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 73(6), 968–974. https://doi.org/10.1136/annrheumdis-2013-204428
40.
HülshegerU. R.ScheweA. F. (2011). On the costs and benefits of emotional labor: A meta-analysis of three decades of research. Journal of Occupational Health Psychology, 16(3), 361–389. https://doi.org/10.1037/a0022876
41.
HwangW. J.YangH. K.KimJ. H. (2020). What Are the Experiences of Emotional Labor and Workplace Violence that Are More Harmful to Health in Korean Workforce?Int J Environ Res Public Health, 17(21), 8019. https://doi.org/10.3390/ijerph17218019
42.
IzumaK.MatsumotoM.MurayamaK.SamejimaK.SadatoN.MatsumotoK. (2010). Neural correlates of cognitive dissonance and choice-induced preference change. Proceedings of the National Academy of Sciences, 107(51), 22014–22019. https://doi.org/10.1073/pnas.1011879108
43.
JunD.ZoeM.JohnstonV.O'LearyS. (2017). Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis. Int Arch Occup Environ Health, 90(5), 373–410. https://doi.org/10.1007/s00420-017-1205-3
44.
JungK.KimD. H.RyuJ. Y. (2018). Relationship between concealment of emotions at work and musculoskeletal symptoms: results from the third Korean working conditions survey. Industrial health, 56(5), 367–372. https://doi.org/10.2486/indhealth.2017-0224
45.
JüniP.WitschiA.BlochR.EggerM. (1999). The hazards of scoring the quality of clinical trials for meta-analysis. JAMA, 282(11), 1054–1060. https://doi.org/10.1001/jama.282.11.1054
46.
KarasekR.BrissonC.KawakamiN.HoutmanI.BongersP.AmickB. (1998). The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol, 3(4), 322–355. https://doi.org/10.1037//1076-8998.3.4.322
47.
KimH.-J.ChooJ. (2016). Emotional Labor: Links to Depression and Work-Related Musculoskeletal Disorders in Call Center Workers. Workplace Health & Safety, 65(8), 346–354. https://doi.org/10.1177/2165079916667512
48.
KitayamaS.ChuaH. F.TompsonS.HanS. (2013). Neural mechanisms of dissonance: An fMRI investigation of choice justification. Neuroimage, 69, 206–212. https://doi.org/10.1016/j.neuroimage.2012.11.034
49.
LeakeR.FriendR.WadhwaN. (1999). Improving adjustment to chronic illness through strategic self-presentation: An experimental study on a renal dialysis unit. Health Psychol, 18(1), 54–62. https://doi.org/10.1037//0278-6133.18.1.54
50.
LoschM. E.CacioppoJ. T. (1990). Cognitive dissonance may enhance sympathetic tonus, but attitudes are changed to reduce negative affect rather than arousal. Journal of Experimental Social Psychology, 26(4), 289–304. https://doi.org/10.1016/0022-1031(90)90040-S
51.
MarrasW. S.DavisK. G.FergusonS. A.LucasB. R.GuptaP. (2001). Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine (Phila Pa 1976), 26(23), 2566-2574. https://doi.org/10.1097/00007632-200112010-00009
52.
MarrasW. S.DavisK. G.HeaneyC. A.MaronitisA. B.AllreadW. G. (2000). The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine. Spine (Phila Pa 1976), 25(23), 3045-3054. https://doi.org/10.1097/00007632-200012010-00012
53.
MarrasW. S.ParakkatJ.ChanyA. M.YangG.BurrD.LavenderS. A. (2006). Spine loading as a function of lift frequency, exposure duration, and work experience. Clin Biomech (Bristol, Avon), 21(4), 345–352. https://doi.org/10.1016/j.clinbiomech.2005.10.004
54.
MillerD. I.Verhoek-MillerN.GiesenJ. M.Wells-ParkerE. (2000). Some empirical evidence for ecological dissonance theory. Psychol Rep, 86(2), 415–420. https://doi.org/10.2466/pr0.2000.86.2.415
55.
MinerbiA.VulfsonsS. (2018). Challenging the Cinderella Hypothesis: A New Model for the Role of the Motor Unit Recruitment Pattern in the Pathogenesis of Myofascial Pain Syndrome in Postural Muscles. Rambam Maimonides medical journal, 9(3), Article e0021. https://doi.org/10.5041/RMMJ.10336
56.
OrtegoG.VillafañeJ. H.Doménech-GarcíaV.BerjanoP.BertozziL.HerreroP. (2016). Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res, 90, 70–81. https://doi.org/10.1016/j.jpsychores.2016.09.006
57.
PinheiroM. B.FerreiraM. L.RefshaugeK.MaherC. G.OrdoñanaJ. R.AndradeT. B.TsathasAFerreiraP. H. (2016). Symptoms of depression as a prognostic factor for low back pain: a systematic review. The Spine Journal, 16(1), 105–116. https://doi.org/10.1016/j.spinee.2015.10.037
58.
PinheiroM. B.FerreiraM. L.RefshaugeK.OrdoñanaJ. R.MachadoG. C.PradoL. R.MaherCGFerreiraP. H. (2015). Symptoms of depression and risk of new episodes of low back pain: A systematic review and meta-analysis. Arthritis Care & Research, 67(11), 1591–1603. https://doi.org/10.1002/acr.22619
SimmonsV. N.HeckmanB. W.FinkA. C.SmallB. J.BrandonT. H. (2013). Efficacy of an experiential, dissonance-based smoking intervention for college students delivered via the internet. Journal of Consulting and Clinical Psychology, 81(5), 810–820. https://doi.org/10.1037/a0032952
61.
SimpsonP. A.StrohL. K. (2004). Gender differences: emotional expression and feelings of personal inauthenticity. J Appl Psychol, 89(4), 715–721. https://doi.org/10.1037/0021-9010.89.4.715
62.
SterneJ. A.HernánM. A.ReevesB. C.SavovićJ.BerkmanN. D.ViswanathanM.HenryDAltmanDGAnsariMTBoutronICarpenterJRChanAWChurchillRDeeksJJHrobjartssonAKirkhamJJuniPLokeYKPigottTDRamsayCR (2016). ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355, i4919. https://doi.org/10.1136/bmj.i4919
63.
SterneJ. A. C.SavovićJ.PageM. J.ElbersR. G.BlencoweN. S.BoutronI.CatesCJChengHYCorbettMSEldridgeSMEmbersonJRHernanMAHopewellSHrobjartssonAJunqueiraDRJuniPKirkhamJJLassersonTLiTMcAleenanA (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898. https://doi.org/10.1136/bmj.l4898
64.
StoneJ.CooperJ. (2001). A self-standards model of cognitive dissonance. Journal of Experimental Social Psychology, 37(3), 228–243. https://doi.org/10.1006/jesp.2000.1446
65.
van PoppelM. N.KoesB. W.SmidT.BouterL. M. (1997). A systematic review of controlled clinical trials on the prevention of back pain in industry. Occupational and Environmental Medicine, 54(12), 841–847. https://doi.org/10.1136/oem.54.12.841
ZapfD.VogtC.SeifertC.MertiniH.IsicA. (1999). Emotion Work as a Source of Stress: The Concept and Development of an Instrument. European Journal of Work and Organizational Psychology, 8(3), 371–400. https://doi.org/10.1080/135943299398230
