Exploring the Role of Attention and Interpretation Biases in Understanding and Treating Pain

Abstract

The processes that lead to the development and maintenance of chronic pain are still not well understood, however prominent theories and growing empirical research indicate that cognitive processes are likely to be relevant to pain. The aim of this thesis was therefore to investigate the role of attentional bias and interpretation bias in the experience of pain. Chapter 2 presents a meta-analysis of dot-probe studies investigating whether attentional biases exist, and found attentional biases towards sensory pain words for chronic pain patients compared to healthy individuals. Chapter 3 presents a systematic review investigating the clinical relevance of attentional bias to pain through prospective and intervention research. This review found that changes in pain outcomes occur when attentional biases are successfully modified, and that avoidance of affective pain information appears particularly relevant for pain chronicity. This review formed the basis for a new theory, the threat interpretation model, which proposes a specific pattern of attentional bias dependent on threat interpretation. This model was tested experimentally. Chapters 4 and 5 explored the effect of threat on interpretation bias, attentional bias and pain using different paradigms accompanied by eye-tracking. Chapter 6 tested an attentional bias modification (ABM) procedure using a randomised controlled trial design. Together, the results suggest that avoidance of affective pain words predicts pain outcomes and can be modified, however mechanisms of change were not established. Overall, attentional biases appear important for pain; sensory pain biases are most reliably detected although avoidance of affective pain information may be more clinically relevant to pain development and maintenance. The clinical and theoretical implications of this research will be beneficial in advancing this field, so that novel interventions can be developed to improve the experience of pain.