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Fernandes-Magalhaes R, Carpio A, Ferrera D, Peláez I, De Lahoz ME, Van Ryckeghem D, Van Damme S, Mercado F. Neural mechanisms underlying attentional bias modification in fibromyalgia patients: a double-blind ERP study. Eur Arch Psychiatry Clin Neurosci 2024; 274:1197-1213. [PMID: 37980687 DOI: 10.1007/s00406-023-01709-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/15/2023] [Indexed: 11/21/2023]
Abstract
There is a growing interest in the potential benefits of attentional bias modification (ABM) training in chronic pain patients. However, studies examining the effectiveness of ABM programs in fibromyalgia patients have demonstrated inconclusive effects on both behavioral indices and clinical symptoms. Additionally, underlying neural dynamics of ABM effects could yield new insights but remain yet unexplored. Current study, therefore, aims to investigate the effects of ABM training on known neural electrophysiological indicators of attentional bias to pain (P2, N2a). Thirty-two fibromyalgia patients were enrolled and randomly assigned to an ABM training (N = 16) or control (N = 16) condition (2 weeks duration). Within the ABM training condition participants performed five sessions consisting of a modified version of the dot-probe task in which patients were trained to avoid facial pain expressions, whereas in the control group participants performed five sessions consisting of a standard version of the dot-probe task. Potential ABM training effects were evaluated by comparing a single pre- and post-treatment session, in which event-related potentials (ERPs) were recorded in response to both facial expressions and target stimuli. Furthermore, patients filled out a series of self-report questionnaires assessing anxiety, depression, pain-related worrying, fear of pain, fatigue and pain status. After training, results indicated an overall reduction of the amplitude of the P2 component followed by an enhancement of N2a amplitude for the ABM condition compared to control condition. In addition, scores on anxiety and depression decreased in patients assigned to the training condition. However, we found no effects derived from the training on pain-related and fatigue status. Present study offers new insights related to the possible neural mechanisms underlying the effect of ABM training in fibromyalgia. Clinical trial (TRN: NCT05905159) retrospectively registered (30/05/2023).
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Affiliation(s)
- Roberto Fernandes-Magalhaes
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Alberto Carpio
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - David Ferrera
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Irene Peláez
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - María Eugenia De Lahoz
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Dimitri Van Ryckeghem
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Francisco Mercado
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain.
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2
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Waisman A, Katz J. The autobiographical memory system and chronic pain: A neurocognitive framework for the initiation and maintenance of chronic pain. Neurosci Biobehav Rev 2024; 162:105736. [PMID: 38796124 DOI: 10.1016/j.neubiorev.2024.105736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Chronic pain affects approximately 20% of the world's population, exerting a substantial burden on the affected individual, their families, and healthcare systems globally. Deficits in autobiographical memory have been identified among individuals living with chronic pain, and even found to pose a risk for the transition to chronicity. Recent neuroimaging studies have simultaneously implicated common brain regions central to autobiographical memory processing in the maintenance of and susceptibility to chronic pain. The present review proposes a novel neurocognitive framework for chronic pain explained by mechanisms underlying the autobiographical memory system. Here, we 1) summarize the current literature on autobiographical memory in pain, 2) discuss the role of the hippocampus and cortical brain regions including the ventromedial prefrontal cortex, anterior temporal lobe, and amygdala in relation to autobiographical memory, memory schemas, emotional processing, and pain, 3) synthesize these findings in a neurocognitive framework that explains these relationships and their implications for patients' pain outcomes, and 4) propose translational directions for the prevention, management, and treatment of chronic pain.
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Affiliation(s)
- Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada.
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Rooney T, Sharpe L, Todd J, Livesey E, Colagiuri B. Understanding the Role of Expectancy, Anticipatory Anxiety, and Attention Bias in Nocebo Hyperalgesia: A Gaze-Contingent Attention Bias Modification Study. THE JOURNAL OF PAIN 2024; 25:946-961. [PMID: 37879546 DOI: 10.1016/j.jpain.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
Nocebo effects in pain (nocebo hyperalgesia) have been thoroughly researched, and negative expectancies have been proposed as a key factor in causing nocebo hyperalgesia. However, little is known about the psychological mechanisms by which expectations exacerbate the perception of pain. A potential mechanism that has been proposed within wider pain research is pain-related attention. The aim of the present study was thus to explore whether attention bias (AB) to pain influenced nocebo hyperalgesia. One-hundred and thirty-four healthy participants were randomized in a 2 (AB training: towards vs away from pain) × 2 (nocebo condition: nocebo vs control) design. Pain-related AB was manipulated through a novel, partially gaze-contingent dot-probe task. Participants then completed either a nocebo instruction and conditioning paradigm or a matched control condition. Primary outcomes were measures of expectancy, anticipatory anxiety, and pain intensity completed during a nocebo test phase. Results showed that the AB manipulation was unsuccessful in inducing ABs either toward or away from pain. The nocebo paradigm induced significantly greater expectancy, anticipatory anxiety, and pain intensity for the nocebo groups compared to the control groups. In a posthoc analysis of participants with correctly induced ABs, AB towards pain amplified nocebo hyperalgesia, expectancy, and anticipatory anxiety relative to AB away from pain. The results are consistent with the expectancy model of nocebo effects and additionally identify anticipatory anxiety as an additional factor. Regarding AB, research is needed to develop reliable means to change attention sample-wide to corroborate the present findings. PERSPECTIVE: This article explores the role of AB, expectancy, and anticipatory anxiety in nocebo hyperalgesia. The study shows that expectancy can trigger anticipatory anxiety that exacerbates nocebo hyperalgesia. Further, successful AB training towards pain heightens nocebo hyperalgesia. These findings identify candidate psychological factors to target in minimizing nocebo hyperalgesia.
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Affiliation(s)
- Tessa Rooney
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jemma Todd
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Evan Livesey
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ben Colagiuri
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
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Becker JM, Van Ryckeghem DML, Van Damme S, Crombez G, Schoot Y, Wiers RWHJ, Rippe RCA, van Laarhoven AIM. Subliminal attentional bias modification training for itch. Front Med (Lausanne) 2023; 10:1104641. [PMID: 37275368 PMCID: PMC10232774 DOI: 10.3389/fmed.2023.1104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Itch is unpleasant and induces the urge to scratch. This is adaptive to remove the itch-inducing stimulus from the skin. Accordingly, itch draws attention to protect our bodily integrity. Recent studies investigated whether attention is preferentially drawn towards its location, i.e., attentional bias (AB), and also whether this bias could be changed in healthy individuals. So far, results are mixed concerning the existance of an attentional bias towards itch stimuli in healthy individuals as well as the impact of modifications. However, available studies have typically focused on conscious processing and might miss preconscious aspects of attention and potential biases at these stages. Methods This study included 117 healthy individuals who underwent a subliminal Attentional Bias Modification (ABM)- training for itch based on a dot-probe paradigm with itch- related pictures. Participants were randomly assigned to a training towards itch group, a training away from itch group and a control group. This was done by manipulating the itch-target congruency of the dot-probe task during a training block. Pre- and post-training assessments were regular dot-probe tasks. Exploratorily, also attentional inhibition, cognitive flexibility and itch-related cognitions were assessed. Lastly, participants received an itchy stimulus on the inner forearm before and after the ABM-training to assess potential effects on itch sensitivity. Results Results showed no AB towards itch across groups at baseline, i.e., pre-training, but an AB away from itch, hence, avoidance of itch, post-training. Further analyses showed that this effect was driven by an attentional bias away from itch in the control group, while there were no significant effects in the experimental groups. There was no effect on itch sensitivity. Conclusion These findings are in line with recent studies on conscious ABM-training for itch and pain that also did not find significant training effects. Therefore, it is suggested that the field of AB might need to reconsider the current assessment of AB. Moreover, AB is probably a dynamic process that is highly dependent on current itch-related goals and relevance of itch in a specific situation. This suggests that processes probably differ in patients with chronic itch and that also ABM-training might work differently in these populations. Clinical trial registration https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7561, identifier NTR7561.
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Affiliation(s)
- Jennifer M. Becker
- Health, Medical and Neuropsychology, Faculty of Social and Behavioural Science, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Dimitri M. L. Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Research Unit INSIDE, Faculty of Humanities and Social Sciences, Institute of Health and Behavior, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Yalou Schoot
- Health, Medical and Neuropsychology, Faculty of Social and Behavioural Science, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Reinout W. H. J. Wiers
- Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Ralph C. A. Rippe
- Research Methods and Statistics, Faculty of Social and Behavioral Sciences, Institute of Education and Child Studies, Leiden University, Leiden, Netherlands
| | - Antoinette I. M. van Laarhoven
- Health, Medical and Neuropsychology, Faculty of Social and Behavioural Science, Institute of Psychology, Leiden University, Leiden, Netherlands
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MacLean RR, Heapy AA, Waters AJ, Wolkowicz N, Szollosy SK, Meyerovich J, Sofuoglu M. Integrating cognitive bias modification for pain and opioid cues into medication for opioid use disorder clinical care: Feasibility, acceptability, and preliminary results. Drug Alcohol Depend 2023; 246:109857. [PMID: 37004461 PMCID: PMC10189744 DOI: 10.1016/j.drugalcdep.2023.109857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Despite high co-occurrence, chronic pain is often unaddressed in treatment for opioid use disorder (OUD) and little is known about mechanisms that may underlie associations between pain and opioid use. Using an attentional bias (AB) task with both pain and opioid cues, we evaluated a cognitive bias modification (CBM) task administered during regularly scheduled medications for OUD (mOUD) dosing visits. The current study evaluated the feasibility, acceptability, and preliminary efficacy of the CBM task. Outcomes for AB tasks used traditional mean-based score and trial-level bias scores (TLBS). METHODS In a double-blind, randomized controlled trial, 28 individuals with OUD and chronic pain engaged in mOUD were randomized to either CBM or an AB control condition and completed up to three tasks per week for four weeks. Standard AB task was completed at baseline and post-treatment. Participants completed feasibility and acceptability measures, and preliminary efficacy (i.e., change in AB) was assessed using ANOVA models. RESULTS Participants attended 83.3% of scheduled sessions and generally reported the task was enjoyable, credible, and easy to complete. Preliminary results demonstrated a condition by time interaction highlighting a reduction in AB in the CBM group but not the control group in opioid TLBS variability (F[1,26]=5.01, p = .034) and pain TLBS towards (F[1,26]=6.42, p = .018) and pain TLBS variability (F[1,26]=5.24, p = .03). CONCLUSIONS The current study supports integrating brief, computer-based tasks designed to reduce AB into mOUD clinical care. The preliminary results suggest that TLBS outcomes may be more sensitive to capture changes in AB; however, larger studies are required.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Alicia A Heapy
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Waters
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Noah Wolkowicz
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | | | - Julia Meyerovich
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
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6
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Todd J, Clarke PJF, Hughes AM, van Ryckeghem D. Attentional bias malleability as a predictor of daily pain interference. Pain 2023; 164:598-604. [PMID: 35947081 DOI: 10.1097/j.pain.0000000000002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Despite a preponderance of pain-related attentional bias research, little is known about how these biases arise and change over time. We tested whether the degree of attentional bias malleability , that is, ability to acquire and relinquish patterns of selective attention towards pain information, predicts daily pain interference. Individuals with chronic pain (N = 66) completed a novel attentional bias malleability procedure based on a modified dot-probe paradigm. Participants received a contingency that encouraged an attentional preference toward and away from pain words across 2 counterbalanced blocks, and attentional bias was assessed before and after each contingency block. Participants then completed a daily diary for 7 days, including the Patient-Reported Outcomes Measurement Information System-29 pain severity and interference. Multilevel modelling was conducted to predict daily pain interference from attentional bias malleability constructs, controlling for pain severity and demographic factors. Greater attentional bias (F 1,391 = 3.97, P = 0.047), greater readiness to acquire an attentional bias (F 1,389 = 4.92, P = 0.027), and less readiness to lose an acquired attentional bias toward pain (F 1,354 = 5.18, P = 0.024) all predicted less pain interference. There was also an interaction between pain severity and overall attentional bias malleability (F 1,62 = 5.48, P = 0.023), such that as pain severity increased, those who showed greater attentional bias malleability showed less corresponding increase in their pain interference than those who showed less attentional bias malleability. This study adds new thinking to the dynamic nature of attentional bias and how such biases might arise and influence pain outcomes.
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Affiliation(s)
- Jemma Todd
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Patrick J F Clarke
- Cognition and Emotion Research Group, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alicia Maria Hughes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dimitri van Ryckeghem
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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7
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Broadbent P, Schoth DE, Liossi C. Association between attentional bias to experimentally induced pain and to pain-related words in healthy individuals: the moderating role of interpretation bias. Pain 2022; 163:319-333. [PMID: 34086628 DOI: 10.1097/j.pain.0000000000002318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/13/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Attentional bias to pain-related information may contribute to chronic pain maintenance. It is theoretically predicted that attentional bias to pain-related language derives from attentional bias to painful sensations; however, the complex interconnection between these types of attentional bias has not yet been tested. This study aimed to investigate the association between attentional bias to pain words and attentional bias to the location of pain, as well as the moderating role of pain-related interpretation bias in this association. Fifty-four healthy individuals performed a visual probe task with pain-related and neutral words, during which eye movements were tracked. In a subset of trials, participants were presented with a cold pain stimulus on one hand. Pain-related interpretation and memory biases were also assessed. Attentional bias to pain words and attentional bias to the pain location were not significantly correlated, although the association was significantly moderated by interpretation bias. A combination of pain-related interpretation bias and attentional bias to painful sensations was associated with avoidance of pain words. In addition, first fixation durations on pain words were longer when the pain word and cold pain stimulus were presented on the same side of the body, as compared to on opposite sides. This indicates that congruency between the locations of pain and pain-related information may strengthen attentional bias. Overall, these findings indicate that cognitive biases to pain-related information interact with cognitive biases to somatosensory information. The implications of these findings for attentional bias modification interventions are discussed.
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Affiliation(s)
| | | | - Christina Liossi
- University of Southampton, Southampton, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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8
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Vermeir JF, White MJ, Johnson D, Crombez G, Van Ryckeghem DML. Gamified Web-Delivered Attentional Bias Modification Training for Adults With Chronic Pain: Protocol for a Randomized, Double-blind, Placebo-Controlled Trial. JMIR Res Protoc 2022; 11:e32359. [PMID: 35084344 PMCID: PMC8943713 DOI: 10.2196/32359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background To date, research has found variable success in using attentional bias modification training (ABMT) procedures in pain samples. Several factors could contribute to these mixed findings, including boredom and low motivation. Indeed, training paradigms are repetitive, which can lead to disengagement and high dropout rates. A potential approach to overcoming some of these barriers is to attempt to increase motivation and engagement through gamification (ie, the use of game elements) of this procedure. To date, research has yet to explore the gamified format of ABMT for chronic pain and its potential for the transfer of benefits. Objective The aim of this study is to investigate the effects of a gamified web-delivered ABMT intervention in a sample of adults with chronic pain via a randomized, double-blind, placebo-controlled trial. Methods A total of 120 adults with chronic musculoskeletal pain, recruited from clinical (hospital outpatient waiting list) and nonclinical (wider community) settings, will be included in this randomized, double-blind, placebo-controlled, 3-arm trial. Participants will be randomly assigned to complete 6 web-based sessions of dot-probe nongamified sham control ABMT, nongamified standard ABMT, or gamified ABMT across a period of 3 weeks. Active ABMT conditions will aim to train attention away from pain-relevant words. Participant outcomes will be assessed at pretraining, during training, immediately after training, and at the 1-month follow-up. Primary outcomes include pain intensity, pain interference, and behavioral and self-reported engagement. Secondary outcomes include attentional bias for pain, anxiety, depression, interpretation bias for pain, and perceived improvement. Results The ethical aspects of this research project have been approved by the human research ethics committees of the Royal Brisbane and Women’s Hospital (HREC/2020/QRBW/61743) and Queensland University of Technology (2000000395). Study recruitment commenced in August 2021 and is ongoing. Data collection and analysis are expected to be concluded by October 2022 and January 2023, respectively. Conclusions This trial will be the first to evaluate the effects of gamification techniques in a pain ABMT intervention. The findings will provide important information on the potential therapeutic benefits of gamified pain ABMT programs, shed light on the motivational influences of certain game elements in the context of pain, and advance our understanding of chronic pain. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000803998; https://anzctr.org.au/ACTRN12620000803998.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/32359
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Affiliation(s)
- Julie F Vermeir
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Melanie J White
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Daniel Johnson
- Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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9
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Chan FHF, Suen H, Chan AB, Hsiao JH, Barry TJ. The effects of attentional and interpretation biases on later pain outcomes among younger and older adults: A prospective study. Eur J Pain 2021; 26:181-196. [PMID: 34399011 DOI: 10.1002/ejp.1853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies examining the effect of biased cognitions on later pain outcomes have primarily focused on attentional biases, leaving the role of interpretation biases largely unexplored. Also, few studies have examined pain-related cognitive biases in elderly persons. The current study aims to fill these research gaps. METHODS Younger and older adults with and without chronic pain (N = 126) completed an interpretation bias task and a free-viewing task of injury and neutral scenes at baseline. Participants' pain intensity and disability were assessed at baseline and at a 6-month follow-up. A machine-learning data-driven approach to analysing eye movement data was adopted. RESULTS Eye movement analyses revealed two common attentional pattern subgroups for scene-viewing: an "explorative" group and a "focused" group. At baseline, participants with chronic pain endorsed more injury-/illness-related interpretations compared to pain-free controls, but they did not differ in eye movements on scene images. Older adults interpreted illness-related scenarios more negatively compared to younger adults, but there was also no difference in eye movements between age groups. Moreover, negative interpretation biases were associated with baseline but not follow-up pain disability, whereas a focused gaze tendency for injury scenes was associated with follow-up but not baseline pain disability. Additionally, there was an indirect effect of interpretation biases on pain disability 6 months later through attentional bias for pain-related images. CONCLUSIONS The present study provided evidence for pain status and age group differences in injury-/illness-related interpretation biases. Results also revealed distinct roles of interpretation and attentional biases in pain chronicity. SIGNIFICANCE Adults with chronic pain endorsed more injury-/illness-related interpretations than pain-free controls. Older adults endorsed more illness interpretations than younger adults. A more negative interpretation bias indirectly predicted pain disability 6 months later through hypervigilance towards pain.
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Affiliation(s)
- Frederick H F Chan
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hin Suen
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong
| | - Antoni B Chan
- Department of Computer Science, The City University of Hong Kong, Hong Kong
| | - Janet H Hsiao
- Department of Psychology, The University of Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Tom J Barry
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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10
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van Laarhoven AIM, Becker JM, van Ryckeghem DML, Van Damme S, Crombez G, Wiers RWHJ. Attentional Bias Modification Training for Itch: A Proof-of-Principle Study in Healthy Individuals. Front Med (Lausanne) 2021; 8:627593. [PMID: 34277649 PMCID: PMC8278002 DOI: 10.3389/fmed.2021.627593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Itch draws our attention to allow imposing action against bodily harm (e.g., remove insects). At the same time, itch is found to interfere with ongoing tasks and daily life goals. Despite the key role of attention in itch processing, interventions that train individuals to automatically disengage attention from itch cues are lacking. The present proof-of-principle attention bias modification (ABM) training study was aimed at investigating whether attention to itch as well as sensitivity to mild itch can be changed. Healthy volunteers were randomized over three ABM-training conditions. Training was done via a modified pictorial dot-probe task. In particular, participants were trained to look away from itch stimuli (n = 38), toward itch stimuli (n = 40) or not trained toward or away from itch at all (sham training, n = 38). The effects of the ABM-training were tested primarily on attention to itch pictures. Secondarily, it was investigated whether training effects generalized to alterations in attention to itch words and mechanical itch sensitivity. The ABM-training did not alter attention toward the itch pictures, and there was no moderation by baseline levels of attention bias for itch. Also, attention bias to the itch words and itch sensitivity were not affected by the ABM-training. This study was a first step toward trainings to change attention toward itch. Further research is warranted to optimize ABM-training methodology, for example increasing motivation of participants. Eventually, an optimized training could be used in patient populations who suffer most from distraction by their symptoms of itch. Clinical Trial Registration: Identifier: NL6134 (NTR6273). The website URL is: https://www.trialregister.nl/
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Affiliation(s)
- Antoinette I M van Laarhoven
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Jennifer M Becker
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Dimitri M L van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Research Unit Integrative Research Unit on Social and Individual Development (INSIDE), Institute of Health and Behaviour, Faculty of Humanities and Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Section Experimental Health Psychology, Clinical Psychological Science Departments, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Reinout W H J Wiers
- Addiction Development and Psychopathology Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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11
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Broadbent P, Liossi C, Schoth DE. Attentional bias to somatosensory stimuli in chronic pain patients: a systematic review and meta-analysis. Pain 2021; 162:332-352. [PMID: 32833792 DOI: 10.1097/j.pain.0000000000002040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
ABSTRACT This systematic review and meta-analysis aimed to evaluate the evidence pertaining to attentional bias for painful and nonpainful somatosensory stimuli in individuals with chronic pain. Eligible studies were identified through searches of Medline, PsycINFO, CINAHL, Web of Science, Scopus, and Cochrane Library databases. Search terms were words and phrases organised into 3 concept blocks: pain condition, cognitive process, and stimuli/paradigm. The search identified 29 eligible studies (reporting 32 eligible experiments), of which quantitative meta-analysis was possible for 16 studies (19 experiments). The meta-analysis found that chronic pain patients, excluding somatoform pain patients, showed significantly greater attentional bias to stimuli in the somatosensory modality than healthy controls (k = 9, g = 0.34). In addition, meta-analysis of studies that used a temporal order judgement task found that patients with unilateral chronic pain showed a spatial attentional bias away from somatosensory stimuli (k = 7, effect estimate = 22.43 ms) and visual stimuli (k = 2, effect estimate = 13.75 ms) on or near the painful body side. Most studies of attentional bias to the somatosensory modality recruited samples of patients with fibromyalgia, whereas most studies of spatial attentional bias assessed patients with complex regional pain syndrome. The extent to which these results generalise to other pain conditions is therefore unclear. We recommend future research test spatial and modality attentional biases across chronic pain conditions and examine the psychometric properties of attentional bias measurement paradigms for use with chronic pain populations. PROSPERO registration number CRD42019124510.
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Affiliation(s)
- Philippa Broadbent
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- Paediatric Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Daniel E Schoth
- Department of Psychology, University of Southampton, Southampton, United Kingdom
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12
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Tabira T, Maruta M, Matsudaira K, Matsuo T, Hasegawa T, Sagari A, Han G, Takahashi H, Tayama J. Relationship Between Attention Bias and Psychological Index in Individuals With Chronic Low Back Pain: A Preliminary Event-Related Potential Study. Front Hum Neurosci 2020; 14:561726. [PMID: 33192394 PMCID: PMC7649764 DOI: 10.3389/fnhum.2020.561726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction: Attention bias towards pain-related information exists in patients with chronic pain, and recently, attention bias modification (ABM) training has been administered to patients with chronic pain. In this study, we conducted an attention bias modification task in conjunction with event-related potential measurements for individuals with chronic low back pain (LBP) and investigated the relationship between attention bias and psychological assessment. Methods: Eleven women and two men with chronic LBP participated in the study. Results: The Japanese version of the STarT Back Screening Tool (J-SBST) total score was significantly correlated with the N1 amplitude of Cz. The J-SBST psychological score was significantly correlated with the N1 amplitude of Cz and with reaction time (RT). The Japanese version of the Pain Catastrophizing Scale (PCS) and Japanese version of the Beck Depression Inventory-Second Edition (BDI-II) scores were significantly correlated with the P2 amplitude at Fz (only PCS), Cz, and Pz. Conclusions: Our findings suggest that J-SBST, which provides a comprehensive evaluation of psychological factors, PCN with measuring of catastrophizing in the context of actual or anticipated pain, and BDI-II, can likely help identify chronic LBP patients with attention bias. For chronic LBP patients who are classified according to J-SBST or PCN pain-related outcome improvement with ABM training can be expected.
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Affiliation(s)
- Takayuki Tabira
- Department of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Michio Maruta
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo-Hospital, Tokyo, Japan
| | - Takashi Matsuo
- Division of Occupational Therapy, Department of Rehabilitation, Kumamoto Health Science University, Kumamoto, Japan
| | - Takashi Hasegawa
- Unit of Medical Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akira Sagari
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Shinshu University, Nagano, Japan
| | - Gwanghee Han
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroki Takahashi
- Department of Rehabilitation Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Jun Tayama
- Faculty of Human Sciences, Waseda University, Saitama, Japan
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13
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Chan FH, Suen H, Jackson T, Vlaeyen JW, Barry TJ. Pain-related attentional processes: A systematic review of eye-tracking research. Clin Psychol Rev 2020; 80:101884. [DOI: 10.1016/j.cpr.2020.101884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 05/03/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023]
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14
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Clinical relevance of attentional biases in pediatric chronic pain: an eye-tracking study. Pain 2020; 163:e261-e273. [PMID: 34285155 DOI: 10.1097/j.pain.0000000000002346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical prominence, a comprehensive understanding of the nature of biased attentional processing in chronic pain and its relationship to theorized antecedents and clinical outcomes is lacking, particularly in youth. This study used eye-tracking to assess attentional bias for painful facial expressions and its relationship to theorized antecedents of chronic pain and clinical outcomes. Youth with chronic pain (n = 125) and without chronic pain (n = 52) viewed face images of varying levels of pain expressiveness while their eye gaze was tracked and recorded. At baseline, youth completed questionnaires to assess pain characteristics, theorized antecedents (pain catastrophizing, fear of pain, and anxiety sensitivity), and clinical outcomes (pain intensity, interference, anxiety, depression, and posttraumatic stress). For youth with chronic pain, clinical outcomes were reassessed at 3 months to assess for relationships with attentional bias while controlling for baseline symptoms. In both groups, youth exhibited an attentional bias for painful facial expressions. For youth with chronic pain, attentional bias was not significantly associated with theorized antecedents or clinical outcomes at baseline or 3-month follow-up. These findings call into question the posited relationships between attentional bias and clinical outcomes. Additional studies using more comprehensive and contextual paradigms for the assessment of attentional bias are required to clarify the ways in which such biases may manifest and relate to clinical outcomes.
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15
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Heathcote LC, Simons LE. Stuck on pain? Assessing children's vigilance and awareness of pain sensations. Eur J Pain 2020; 24:1339-1347. [PMID: 32383315 DOI: 10.1002/ejp.1581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Attending towards pain is proposed as a key mechanism influencing the experience and chronification of pain. Persistent attention towards pain is proposed to drive poor outcomes in both adults and children with chronic pain. However, there are no validated self-report measures of pain-related attention for children. METHODS The goals of this study were to adapt the Pain Vigilance and Awareness Questionnaire (PVAQ) for use in a child sample, to preliminary examine its psychometric properties, and to assess its utility over and above a measure of general attentional capacities. We adapted the language of the PVAQ to be more easily understood by children as young as 8 years. In a sample of 160 children (8-18 years) with chronic pain, we examined the factor structure, internal consistency and criterion validity of the PVAQ-C. RESULTS The PVAQ-C demonstrated excellent internal consistency (α = 0.92) and moderate-to-strong criterion validity. A one-factor structure best fit the data. Children who reported greater attention to pain also reported greater pain catastrophizing, fear of pain, avoidance of activities and poorer physical functioning. Pain-related attention remained a significant predictor of functioning while controlling for demographics, catastrophizing and fear-avoidance. Pain-related attention also significantly predicted child outcomes independent of the child's general attention control capacities, indicating added value of a pain-specific measure of attention. CONCLUSIONS The PVAQ-C shows strong indices of internal reliability and criterion validity, and indicates unique predictive utility. It will be important to study the role of pain-related attention in youth within developmental and functional-motivational frameworks. SIGNIFICANCE Pain-related attention is proposed as a key factor influencing fear-avoidance outcomes in both adults and youth with chronic pain, yet no self-report measures of pain-related attention have been validated for children. This paper presents a child version of the Pain Vigilance and Awareness Questionnaire (PVAQ-C), which indicates strong internal consistency, criterion validity and unique predictive validity, and provides evidence to support the Fear-Avoidance Model in youth with chronic pain.
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Affiliation(s)
- Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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16
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Efficacy of Interpretation Bias Modification in Patients With Chronic Pain. THE JOURNAL OF PAIN 2020; 21:648-662. [DOI: 10.1016/j.jpain.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022]
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17
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Liossi C, Georgallis T, Zhang J, Hamilton F, White P, Schoth DE. Internet-delivered attentional bias modification training (iABMT) for the management of chronic musculoskeletal pain: a protocol for a randomised controlled trial. BMJ Open 2020; 10:e030607. [PMID: 32086350 PMCID: PMC7045192 DOI: 10.1136/bmjopen-2019-030607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain is a complex medical condition that can significantly impact quality of life. Patients with chronic pain demonstrate attentional biases towards pain-related information. The therapeutic benefits of modifying attentional biases by implicitly training attention away from pain-related information towards neutral information have been supported in a small number of published studies. Limited research however has explored the efficacy of modifying pain-related biases via the internet. This protocol describes a randomised, double-blind, internet-delivered attentional bias modification intervention, aimed to evaluate the efficacy of the intervention on reducing pain interference. Secondary outcomes are pain intensity, state and trait anxiety, depression, pain-related fear, and sleep impairment. This study will also explore the effects of training intensity on these outcomes, along with participants' perceptions about the therapy. METHODS AND ANALYSIS The study is a double-blind, randomised controlled trial with four arms exploring the efficacy of online attentional bias modification training versus placebo training theorised to offer no specific therapeutic benefit. Participants with chronic musculoskeletal pain will be randomised to one of four groups: (1) 10-session attentional modification group; (2) 10-session placebo training group; (3) 18-session attentional modification group; or (4) 18-session placebo training group. In the attentional modification groups, the probe-classification version of the visual-probe task will be used to implicitly train attention away from threatening information towards neutral information. Following the intervention, participants will complete a short interview exploring their perceptions about the online training. In addition, a subgroup analysis for participants aged 16-24 and 25-60 will be undertaken. ETHICS AND DISSEMINATION This study has been approved by the University of Southampton Research Ethics Committee. Results will be published in peer-reviewed journals, academic conferences, and in lay reports for pain charities and patient support groups. TRIAL REGISTRATION NUMBER NCT02232100; Pre-results.
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Affiliation(s)
- Christina Liossi
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Tsampikos Georgallis
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Jin Zhang
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Fiona Hamilton
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Paul White
- Applied Statistics Group, Engineering, Design and Mathematics, University of the West of England, Bristol, Bristol, UK
| | - Daniel Eric Schoth
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, Hampshire, UK
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18
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Schoth DE, Beaney R, Broadbent P, Zhang J, Liossi C. Attentional, interpretation and memory biases for sensory-pain words in individuals with chronic headache. Br J Pain 2019; 13:22-31. [PMID: 30671235 PMCID: PMC6327358 DOI: 10.1177/2049463718789445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cognitive biases in attention, interpretation and less consistently memory have been observed in individuals with chronic pain and play a critical role in the onset and maintenance of chronic pain. Despite operating in combination cognitive biases are typically explored in isolation. AIM The primary aim of this study was to explore attentional, interpretation and memory biases and their interrelationship in individuals with chronic headache. METHODS Twenty-eight participants with chronic headache and 34 healthy controls completed paradigms assessing attentional, interpretation and memory biases with ambiguous sensory-pain and neutral words. RESULTS Individuals with chronic pain showed significantly greater pain-related attentional and interpretation biases relative to controls, with no differences in memory bias. No significant correlation was found between any of the three forms of cognitive bias assessed. DISCUSSION AND CONCLUSION The clinical implications of cognitive biases in individuals with chronic pain remain to be fully explored, although one avenue for future research would be specific investigation of the implications of biased interpretations considering the consistency of results found across the literature for this form of bias.
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Affiliation(s)
- Daniel E Schoth
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Beaney
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Philippa Broadbent
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Jin Zhang
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Christina Liossi
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
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19
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Franklin ZC, Holmes PS, Fowler NE. Eye Gaze Markers Indicate Visual Attention to Threatening Images in Individuals with Chronic Back Pain. J Clin Med 2018; 8:jcm8010031. [PMID: 30602663 PMCID: PMC6352204 DOI: 10.3390/jcm8010031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/23/2022] Open
Abstract
Research into attentional biases and threatening, pain-related information has primarily been investigated using reaction time as the dependent variable. This study aimed to extend previous research to provide a more in depth investigation of chronic back pain and individuals’ attention to emotional stimuli by recording eye movement behavior. Individuals with chronic back pain (n = 18) were recruited from a back rehabilitation program and age and sex matched against 17 non-symptomatic controls. Participants’ eye movements were recorded whilst they completed a dot probe task, which included back pain specific threatening images and neutral images. There were no significant differences between chronic pain and control participants in attentional biases recorded using reaction time from the dot probe task. Chronic pain participants, however, demonstrated a significantly higher percentage of fixations, larger pupil diameter, a longer average fixation duration and faster first fixation to threatening compared to neutral images. They also had a significantly longer average fixation duration and larger pupil diameter to threatening images compared to control participants. The findings of this study suggest eye gaze metrics may provide a more sensitive measure of attentional biases in chronic pain populations. These findings may have important therapeutic implications for the patient and therapist.
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Affiliation(s)
- Zoë C Franklin
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M15 6BH, UK.
| | - Paul S Holmes
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M15 6BH, UK.
| | - Neil E Fowler
- Vice Chancellor's Office, University of Salford, Salford M5 4WT, UK.
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20
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Van Ryckeghem DML, Van Damme S, Vervoort T. Does attention bias modification training impact on task performance in the context of pain: An experimental study in healthy participants. PLoS One 2018; 13:e0200629. [PMID: 30020983 PMCID: PMC6051628 DOI: 10.1371/journal.pone.0200629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/29/2018] [Indexed: 11/18/2022] Open
Abstract
Attention has been theorized to play a key role in the experience of pain and associated task interference. Training attention away from pain via attention bias modification (ABM) training techniques has been proposed to improve pain-related outcomes, but evidence is inconsistent. In an experimental study, we investigated the impact of a single session ABM training -using a visual probe paradigm with idiosyncratic pain words- on cold pressor test (CPT) pain experience and task interference by pain. Fifty-eight healthy volunteers were randomly assigned to an ABM training group (N = 28; attending away from pain) and a sham training group (N = 30; no training direction). At pre-training, participants performed a baseline Random-Interval-Repetition (RIR) task and the CPT. Participants reported on sensations they experienced during the baseline CPT. Relevant descriptors were integrated in the visual probe paradigm during the training phase. At post-training, participants completed the RIR task again while experiencing CPT pain. Participants also reported on the extent they attended to the pain and the intensity/unpleasantness of the pain. Results indicated that, in contrast with our hypotheses, ABM training did also not reduce task interference due to CPT pain. Furthermore, ABM training did not change self-reported attending to CPT pain. Finally, ABM training did not reduce CPT pain intensity or pain unpleasantness. Overall, the current study provides no support for the effectiveness of a single session ABM training in improving pain-related outcomes. Future research addressing the conditions under which ABM training improves or fails to improve pain-related outcomes is warranted.
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Affiliation(s)
- Dimitri M. L. Van Ryckeghem
- Institute for Health and Behaviour, INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Stefaan Van Damme
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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21
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Giel KE, Paganini S, Schank I, Enck P, Zipfel S, Junne F. Processing of Emotional Faces in Patients with Chronic Pain Disorder: An Eye-Tracking Study. Front Psychiatry 2018; 9:63. [PMID: 29556205 PMCID: PMC5845113 DOI: 10.3389/fpsyt.2018.00063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/16/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Problems in emotion processing potentially contribute to the development and maintenance of chronic pain. Theories focusing on attentional processing have suggested that dysfunctional attention deployment toward emotional information, i.e., attentional biases for negative emotions, might entail one potential developmental and/or maintenance factor of chronic pain. METHODS We assessed self-reported alexithymia, attentional orienting to and maintenance on emotional stimuli using eye tracking in 17 patients with chronic pain disorder (CP) and two age- and sex-matched control groups, 17 healthy individuals (HC) and 17 individuals who were matched to CP according to depressive symptoms (DC). In a choice viewing paradigm, a dot indicated the position of the emotional picture in the next trial to allow for strategic attention deployment. Picture pairs consisted of a happy or sad facial expression and a neutral facial expression of the same individual. Participants were asked to explore picture pairs freely. RESULTS CP and DC groups reported higher alexithymia than the HC group. HC showed a previously reported emotionality bias by preferentially orienting to the emotional face and preferentially maintaining on the happy face. CP and DC participants showed no facilitated early attention to sad facial expressions, and DC participants showed no facilitated early attention to happy facial expressions, while CP and DC participants did. We found no group differences in attentional maintenance. CONCLUSION Our findings are in line with the clinical large overlap between pain and depression. The blunted initial reaction to sadness could be interpreted as a failure of the attentional system to attend to evolutionary salient emotional stimuli or as an attempt to suppress negative emotions. These difficulties in emotion processing might contribute to etiology or maintenance of chronic pain and depression.
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Affiliation(s)
- Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Sarah Paganini
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Irena Schank
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
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22
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Attention bias modification training for adolescents with chronic pain: a randomized placebo-controlled trial. Pain 2017; 159:239-251. [DOI: 10.1097/j.pain.0000000000001084] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Hughes AM, Chalder T, Hirsch CR, Moss-Morris R. An attention and interpretation bias for illness-specific information in chronic fatigue syndrome. Psychol Med 2017; 47:853-865. [PMID: 27894380 DOI: 10.1017/s0033291716002890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have shown that specific cognitions and behaviours play a role in maintaining chronic fatigue syndrome (CFS). However, little research has investigated illness-specific cognitive processing in CFS. This study investigated whether CFS participants had an attentional bias for CFS-related stimuli and a tendency to interpret ambiguous information in a somatic way. It also determined whether cognitive processing biases were associated with co-morbidity, attentional control or self-reported unhelpful cognitions and behaviours. METHOD A total of 52 CFS and 51 healthy participants completed self-report measures of symptoms, disability, mood, cognitions and behaviours. Participants also completed three experimental tasks, two designed specifically to tap into CFS salient cognitions: (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) v. neutral words; (ii) interpretive bias task measuring positive v. somatic interpretations of ambiguous information; and (iii) the Attention Network Test measuring general attentional control. RESULTS Compared with controls, CFS participants showed a significant attentional bias for fatigue-related words and were significantly more likely to interpret ambiguous information in a somatic way, controlling for depression and anxiety. CFS participants had significantly poorer attentional control than healthy individuals. Attention and interpretation biases were associated with fear/avoidance beliefs. Somatic interpretations were also associated with all-or-nothing behaviour and catastrophizing. CONCLUSIONS People with CFS have illness-specific biases which may play a part in maintaining symptoms by reinforcing unhelpful illness beliefs and behaviours. Enhancing adaptive processing, such as positive interpretation biases and more flexible attention allocation, may provide beneficial intervention targets.
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Affiliation(s)
- A M Hughes
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - T Chalder
- Department of Psychological Medicine,King's College London,London,UK
| | - C R Hirsch
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - R Moss-Morris
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
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24
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Schoth DE, Parry L, Liossi C. Combined cognitive biases for pain and disability information in individuals with chronic headache: A preliminary investigation. J Health Psychol 2016; 23:1610-1621. [DOI: 10.1177/1359105316664136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pain-related cognitive biases have been demonstrated in chronic pain patients, yet despite theoretical predictions are rarely investigated in combination. Combined cognitive biases were explored in individuals with chronic headache ( n = 17) and pain-free controls ( n = 20). Participants completed spatial cueing (attentional bias), sentence generation (interpretation bias) and free recall tasks (memory bias), with ambiguous sensory-pain, disability and neutral words. Individuals with chronic headache, relative to controls, showed significantly greater interpretation and memory biases favouring ambiguous sensory-pain words and interpretation bias favouring ambiguous disability words. No attentional bias was found. Further research is needed exploring the temporal pattern of cognitive biases.
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25
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Bowler J, Bartholomew K, Kellar I, Mackintosh B, Hoppitt L, Bayliss A. Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance. Eur J Pain 2016; 21:112-124. [DOI: 10.1002/ejp.908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/01/2023]
Affiliation(s)
- J.O. Bowler
- School of Psychology; University of East Anglia; Norwich Norfolk UK
| | - K.J. Bartholomew
- School of Psychology; University of East Anglia; Norwich Norfolk UK
| | - I. Kellar
- School of Psychology; University of Leeds; Leeds UK
| | - B. Mackintosh
- Department of Psychology; University of Essex; Colchester UK
| | - L. Hoppitt
- MRC Cognition and Brain Sciences Unit; Cambridge UK
| | - A.P. Bayliss
- School of Psychology; University of East Anglia; Norwich Norfolk UK
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26
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Franklin ZC, Holmes PS, Smith NC, Fowler NE. Personality Type Influences Attentional Bias in Individuals with Chronic Back Pain. PLoS One 2016; 11:e0147035. [PMID: 26789517 PMCID: PMC4720440 DOI: 10.1371/journal.pone.0147035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022] Open
Abstract
Attentional biases reflect an individual's selective attention to salient stimuli within their environment, for example an experience of back pain. Eysenck suggests that different personality types show different attentional biases to threatening information. This study is the first to test Eysenck's theory within a chronic back pain population by investigating the attentional biases of four different personality types using a back pain specific dot-probe paradigm. Participants were 70 volunteers (45 female) recruited from a back rehabilitation program at an NHS Trust. The four groups were selected on their trait anxiety and defensiveness scores: defensive high-anxious; high-anxious; repressor and non-extreme. Participants completed a dot probe task comprising 20 practice trials and 250 experimental trials. The experimental trials contained 100 threat-neutral pairs, 100 positive-neutral pairs and 50 neutral-neutral image pairings. The threat images were taken from the Photograph Series of Daily Activities (PHODA) and the neutral and positive images from the International Affective Picture System (IAPS) image bank. The results provided partial support for Eysenck's theory; defensive high-anxious individuals showed an attentional bias for threatening information compared to high-anxious individuals who demonstrated no bias. Repressors showed an avoidant bias to threatening images and an attentional bias to positive stimuli relative to neutral images. The clear difference in responses demonstrated by high-anxious individuals who vary in defensiveness highlight the need for separate investigation of these heterogeneous groups and help to explain the cognitive processes of defensive high-anxious individuals within a pain population. The demonstration of an attentional bias in this group to threatening information could explain why defensive high-anxious individuals are more likely to re-present for treatment.
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Affiliation(s)
- Zoë C. Franklin
- Manchester Metropolitan University, Centre for Health, Exercise and Active Living, Crewe Campus, Crewe Green Road, Crewe, Cheshire, CW1 5DU, United Kingdom
| | - Paul S. Holmes
- Manchester Metropolitan University, Centre for Health, Exercise and Active Living, Crewe Campus, Crewe Green Road, Crewe, Cheshire, CW1 5DU, United Kingdom
| | - Nickolas C. Smith
- Manchester Metropolitan University, Centre for Health, Exercise and Active Living, Crewe Campus, Crewe Green Road, Crewe, Cheshire, CW1 5DU, United Kingdom
| | - Neil E. Fowler
- Manchester Metropolitan University, Centre for Health, Exercise and Active Living, Crewe Campus, Crewe Green Road, Crewe, Cheshire, CW1 5DU, United Kingdom
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Simons LE, Basch MC. State of the art in biobehavioral approaches to the management of chronic pain in childhood. Pain Manag 2015; 6:49-61. [PMID: 26678858 DOI: 10.2217/pmt.15.59] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pain in childhood is prevalent, persistent and significantly impactful on most domains of life. The chronic pain experience occurs within a complex biopsychosocial framework, with particular emphasis on the social context. Currently, psychological treatments involve a cognitive-behavioral therapy treatment plan, providing some combination of psychoeducation, self-regulation training, maladaptive cognition identification, behavioral exposure and parent involvement. New treatment areas are emerging, such as group- and internet-based cognitive-behavioral therapy, motivational interviewing, comorbid obesity intervention and intensive multidisciplinary rehabilitation. Preliminary studies of emerging treatments demonstrate encouraging results; however, treatment effectiveness hinges on accurate matching of patient to treatment modality. Overall, the current direction of the field promises many innovative breakthroughs to ameliorate suffering in youth with chronic pain.
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Affiliation(s)
- Laura E Simons
- Department of Anesthesiology, Division of Pain Medicine, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,P.A.I.N. Group, Boston Children's Hospital, Center for Pain & the Brain, Harvard Medical School, USA
| | - Molly C Basch
- Department of Anesthesiology, Division of Pain Medicine, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,P.A.I.N. Group, Boston Children's Hospital, Center for Pain & the Brain, Harvard Medical School, USA
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28
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Exploring Attentional Bias for Real-World, Pain-related Information in Chronic Musculoskeletal Pain Using a Novel Change Detection Paradigm. Clin J Pain 2015; 31:680-8. [DOI: 10.1097/ajp.0000000000000149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharpe L, Johnson A, Dear B. Attention bias modification and its impact on experimental pain outcomes: Comparison of training with words versus faces in pain. Eur J Pain 2014; 19:1248-57. [DOI: 10.1002/ejp.648] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/07/2022]
Affiliation(s)
- L. Sharpe
- School of Psychology A18; The University of Sydney; Australia
| | - A. Johnson
- School of Psychology A18; The University of Sydney; Australia
| | - B.F. Dear
- Department of Psychology; Centre for Emotional Health; Macquarie University; Sydney Australia
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30
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Schoth D, Godwin H, Liversedge S, Liossi C. Eye movements during visual search for emotional faces in individuals with chronic headache. Eur J Pain 2014; 19:722-32. [DOI: 10.1002/ejp.595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- D.E. Schoth
- Academic Unit of Psychology; University of Southampton; UK
| | - H.J. Godwin
- Academic Unit of Psychology; University of Southampton; UK
| | | | - C. Liossi
- Academic Unit of Psychology; University of Southampton; UK
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31
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The effect of cognitive bias modification for interpretation on avoidance of pain during an acute experimental pain task. Pain 2014; 155:1569-1576. [DOI: 10.1016/j.pain.2014.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/07/2014] [Accepted: 05/01/2014] [Indexed: 11/21/2022]
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32
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Sharpe L. Attentional biases in pain: More complex than originally thought? Pain 2014; 155:439-440. [DOI: 10.1016/j.pain.2013.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 12/31/2022]
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