Attentional and interpretation biases in the context of pain

Abstract

The tendency to negatively interpret ambiguous information (i.e., interpretation biases) and the tendency to attend towards or away from concern-relevant information (i.e., attentional biases) have been suggested to underlie the course and severity of chronic pain. Although extensive research on pain-related cognitive biases has been conducted, a clear picture of how these biases interact with each other and contribute to the chronicity of pain remains to be a major gap in our current knowledge. Study 1 of this thesis provided a systematic review of previous eye-tracking investigations of pain-related attentional biases. We examined the presence of attentional biases in people with chronic pain, and also examined associations between gaze biases and important pain-related constructs such as fear of pain, pain catastrophising, and pain-related threat. Study 2 featured a factor-analytic study examining the psychometric properties and content specificity of a novel task that measures interpretation biases. Results demonstrated the suitability of this task for measuring interpretation biases in Asian adults, and also showed good correlations between responses to this task and health and social anxiety symptoms. Three eye-tracking studies were then proposed based on these two studies. In Study 3, pain-free participants were given threatening or reassuring information about an upcoming pain task and then completed a free-viewing task of injury and neutral scene images. Results showed that threat-related verbal information did not influence participants’ eye movements. However, participants with more negative interpretations anticipated more bodily harm from the pain task, which then contributed to a gaze pattern of excessive monitoring of injury scenes. Study 4 assessed interpretation biases in young adults with and without chronic pain and recorded participants’ eye movements as they freely viewed neutral faces with pain-/health-related identity labels (i.e., “doctors”, “healthy people”, “patients”). Participants with chronic pain endorsed more negative interpretations for injury-/illness-related scenarios than controls, but no difference in eye movements was found. Interestingly, participants with more negative interpretations for long-term illness avoided looking at the eyes of patients’ and healthy people’s faces and, to a lesser extent, doctors’ faces. These associations appeared to be stronger in people with chronic pain. Finally, in Study 5, younger and older adults with and without chronic pain were assessed at baseline for their interpretation biases and eye movements on injury and neutral images. Participants’ pain functioning was assessed at baseline and six months later. Results showed that participants with chronic pain had more negative interpretations for injury-/illness-related situations than pain-free controls. Also, older adults had more negative interpretations for illness-related situations than younger adults. However, there was no group difference in eye movements. Longitudinal analyses suggested that interpretation biases were associated with baseline pain disability, whereas hypervigilance towards injury scenes predicted follow-up disability. Additionally, there was an indirect effect of interpretation biases on follow-up pain disability through hypervigilance towards pain. Overall, the five studies provided novel insights into the associations between attentional and interpretation biases, and their roles in the exacerbation of pain. Based on these findings, theoretical and clinical implications as well as future research ideas were recommended.