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Journal ArticleDOI

Winning or not losing? The impact of non-pain goal focus on attentional bias to learned pain signals.

TL;DR: This experiment aimed to replicate the finding that attentional bias for pain signals in healthy participants can be reduced when a non-pain goal is pursued, and to extend this finding by taking into account the outcome focus of the non- pain goal.
About: This article is published in Scandinavian Journal of Pain.The article was published on 2018-10-25 and is currently open access. It has received 5 citations till now. The article focuses on the topics: Attentional bias & Cognitive bias.

Summary (4 min read)

Introduction

  • Insights into the precise nature of cognitive bias, including attentional bias to threat signals, are considered pivotal to understanding pain and related distress, also known as Background and aims.
  • In healthy participants, attentional bias for pain signals can be reduced when a non-pain goal is pursued, and (ii) to extend this finding by taking into account the outcome focus of the non-pain goal.the authors.
  • The pattern of results suggests that this effect was indeed reduced in the goal groups as compared to the control group, but there was no significant group difference.
  • The motivational perspective suggests that attentional bias varies with the goals that people pursue [34,45].
  • Similarly, individuals may be more motivated to pursue non-pain prevention goals than non-pain promotion goals.

2. Methods

  • 1. Participants advertisements at campus, participated in this experiment, with 36 participants assigned to each of the three study groups (promotion goal group, prevention goal group, and control group; see Section 2.2.4.).
  • For safety reasons, pregnant women and people with an electronic implant such as a cardiac pacemaker were excluded as they should not be exposed to the electrocutaneous stimulation.
  • All participants were fluent in Dutch, gave written informed consent and received 10€ compensation for their participation, paid in the form of vouchers.
  • Characteristics of the final sample included for analysis are reported in the Results Section.
  • The study was approved by the Ethics Committee of the Faculty of Psychology and Neuroscience at Maastricht University (Reg. nr. 74_5-10-2008-2).

2.2.1. Electrocutaneous stimuli

  • Electrocutaneous stimuli (300-millisecond duration; bipolar sinus waveform; 50 Hz) were delivered by an isolated bipolar constant current stimulator (DS5; Digitimer Ltd, Hertfordshire, United Kingdom).
  • These stimuli were applied to the left ankle (external side) using two 8-mm stainless steel surface electrodes, vertically placed with 1-cm inter-electrode distance, secured to the participant's skin by adhesive collars, and filled with microlyte electrode gel.
  • Unpleasant and demanding some effort to tolerate [35,41,46].
  • Stimulus intensity was increased until the participant rated the stimulus as a 9.
  • Participants were not informed about these procedural details.

2.2.2. Spatial cueing task

  • Spatial cueing tasks have been successfully used as a methodology to assess attentional bias to pain signals [35,41,42,43,46].
  • Participants were encouraged to maintain central fixation consistently.
  • Thirty ms after cue offset, a small target (‘/’or ‘\’; 4 mm) appeared at the centre of either the left or the right frame, either at the position previously occupied by the spatial cue (valid trials) or at the other position (invalid trials).
  • Targets remained on the screen until a response was made or for max.
  • Each cue colour appeared equally often (at either position) and was equally often followed by each target identity.

2.2.3. Differential conditioning

  • A differential conditioning procedure was used to create pain cues that were sometimes followed by painful stimulation and no-pain cues that were never followed by painful stimulation [35,41,42,43,46].
  • In the test phase (see Section 2.3.4.), one of the cue colours (pink or green; counterbalanced between participants) was immediately followed by the unpleasant electrocutaneous stimulus on one-third of the trials in which it appeared (pain cue).
  • The other colour was never followed by electrocutaneous stimulation (no-pain cue).
  • Larger cue validity effects for pain cues than for no-pain cues were taken to reflect biases in attention to pain signals [14,43].

2.2.4. Non-pain goal task and goal focus instructions

  • This study included two goal groups, who performed the same non-pain goal task but with a different goal focus.
  • The non-pain goal task consisted of digit trials that were similar to the cueing task trials (see Section 2.2.2.), except that a random digit from 1 to 9 (black; 7 mm) replaced the fixation cross for 50 ms during the inter-trial interval or during the trial (but not simultaneously with targets or responses to targets, for technical reasons).
  • Participants in both goal groups received 10€ at the start of the session and were led to believe that the monetary compensation for their participation at the end of the session would depend on digit naming performance (i.e., end score on the non-pain goal task, at the end of the test phase; see Section 2.3.4.).
  • It was explained that one would get one point for each fast and accurate response, but lose one point for each slow, inaccurate, or missed response.
  • Intermediate scores were provided during regular task breaks (see Section 2.3.).

2.2.5. Apparatus

  • In the goal groups, verbal response latency was registered via a Sennheiser HMD/HME 25-1 (Sennheiser Electronic Corporation, Old Lyme, CT, USA) microphone/headphone combination connected to a voice key.
  • Self-report questions and questionnaires were completed via a secure online survey system (EMIUM ; Research Institute Experimental Psychopathology, Maastricht University, the Netherlands).

2.3. Procedure

  • Participants were tested individually in a dimly lit, quiet testing room in the department of Clinical Psychological Science at Maastricht University.
  • During the lab session, the participants did not drink or eat anything containing caffeine or other stimulants (e.g. coffee, tea and chocolate).
  • They received debriefing about the actual purpose and procedures of the experiment after all participants had completed the study.
  • Then they completed the 13- item Pain Catastrophizing Scale [39], the most commonly used questionnaire measure of pain catastrophizing [51].
  • The goal groups were instructed to respond manually to targets (‘/’or ‘\’) on every trial and verbally to digits that appeared on 25% of the trials; the control group had only to respond to targets.

2.3.1. Practice phase

  • The goal groups practiced first the cueing task without the digit naming task (32 cueing task trials), then in combination with the digit naming task (16 cueing task trials intermixed with 16 digit trials).
  • The control group practiced the cueing task only without the digit naming task (2 x [16 cueing task trials intermixed with 16 digit trials]).
  • Participants received no electrocutaneous stimulation and were informed about this.
  • Following practice, all participants assigned to the goal groups were able to repeat the rules for gaining/losing points and money.

2.3.2. Baseline phase

  • For all groups, the baseline phase consisted of 96 cueing task trials intermixed with 32 digit trials.
  • The goal groups performed the cueing task in combination with the digit naming task, whereas the control group performed only the cueing task.
  • Participants received no electrocutaneous stimulation and were informed about this.
  • 3.3. Acquisition phase break) followed by the test phase.
  • On 4 trials, the spatial cue was a pain cue, followed by electrocutaneous stimulation; on the other 4 trials, the spatial cue was a no-pain cue.

2.3.4. Test phase

  • The test phase consisted of 144 cueing task trials intermixed with 48 digit trials.
  • On one-third of the trials in which a pain cue appeared (24 cueing task trials; 8 digit trials), participants received electrocutaneous stimulation.
  • On the other trials, no electrocutaneous stimuli were delivered.
  • During all phases, incorrect and premature responses to targets (‘/’or ‘\’) were signalled by a short beep along with the display of an error message at screen centre for 500 ms (+ 1000 ms pause).
  • Every 32 trials, feedback about target responses (i.e., mean reaction time; number incorrect) and digitnaming performance (i.e., intermediate score on goal task; goal groups only) was presented at screen centre during short breaks terminated by the participant.

2.3.5. End of session

  • All ratings were made on 11-point numeric rating scales with end points labelled 0 (not at all) and 10 (to a very large extent or extremely).
  • An index of promotion goal strength strength is created by averaging all items relevant to prevention goals [26].
  • The participants also completed the Fear of Pain Questionnaire [28,33], the BIS/BAS Scales [3,15], and the Goal Pursuit Questionnaire [24].
  • All questions and questionnaires appeared on the computer screen and participants answered by using a keyboard and computer mouse.

2.4. Experimental design and data analysis

  • This experiment employed a 2 (valid cueing vs. invalid cueing) x 2 (pain cue vs. no- pain cue) x 3 (promotion goal group vs. prevention goal group vs. control group) factorial design with reaction time (RT) to targets as main dependent variable.
  • This design was used to examine group differences in attentional bias for pain cues during the test phase and to check for attentional bias for one of the cues as a function of its distinctive visual features rather than its conditioned signal value during the baseline phase (prior to differential conditioning in the test phase).
  • The reported RT analyses were based on median correct RTs to reduce the impact of outliers, but the same pattern of results was obtained with mean correct RTs (also when responses deviating more than 2.5 SDs from the mean latency per condition were discarded).
  • The sample size was informed by previous findings in this field.

3.1. Group characteristics

  • Six participants were excluded from the analyses: four because of incomplete (computer task) data; two because of meeting exclusion criteria (see Section 2.1.).
  • The final groups did not significantly differ in gender ratio, χ2 (2, N = 93) = 1.7, p = .4, mean age, fatigue at the start of the lab session, pain catastrophizing, or electrocutaneous stimulus perception (Table 1).
  • That is, and as can been seen in Table 1, electrocutaneous stimulation was more often expected after pain cues than after no-pain cues, and participants were more fearful when pain cues were presented than when no-pain cues were presented, with no differences between groups.
  • They are included in the reported analyses.
  • In the lab situation, groups did not differ in self-reported focus or motivation (Table 2), except for motivation to perform the target classification task well.

3.2.1. Baseline phase

  • Median correct RTs on cueing task trials (Table 3) were subjected to an ANOVA with cue validity, cue identity, and group as factors.
  • There were no other significant results from the ANOVA.

3.2.2. Test phase

  • Median correct RTs on cueing task trials (Table 3) were subjected to an ANOVA with cue validity, cue identity, and group as factors.
  • There were no other significant results from the ANOVA.
  • The authors sample of 93 provided good statistical power to detect a large-sized difference between the three groups in attentional bias, but the study was underpowered to detect a small-to-medium-sized group difference (30.0% for ηp2 = .03).
  • So, smaller effects may exist that were not captured.

4. Discussion

  • The current experiment was designed to test (i) whether attentional bias to learned pain signals is reduced with non-pain goal pursuit and (ii) whether this reduction is stronger with non-pain prevention focus than with non-pain promotion focus.
  • This crucial difference in goal focus instructions with the original study [35] might explain differences in findings.

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Citations
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Abstract: Originally published in Contemporary Psychology: APA Review of Books, 1974, Vol 19(7), 564. Reviews the book, The Psychology of Fear and Stress by Jeffrey A. Gray (see record 1974-04271-001). In this book, the author has provided a readable,accurate, and contemporary treatment of his topic. The cove

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Journal ArticleDOI
01 Jul 2019-Pain
TL;DR: This work aims to demonstrate the efforts towards in-situ applicability of EMT in the context of clinical practice and to provide a basis for future research in this area.
Abstract: 1 Section Experimental Health Psychology, Clinical Psychological Science, Departments, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands 2 Institute for Health and Behaviour, INSIDE, University of Luxembourg, Luxembourg 3 Department of Psychology, University of Calgary; Alberta Children’s Hospital Research Institute; Hotchkiss Brain Institute; Canada 4 Department of Psychology, Royal Holloway University of London, United Kingdom 5 School of Psychology, University of Sydney, Australia 6 Department of Experimental Clinical and Health Psychology, Ghent University, Belgium

41 citations

Journal ArticleDOI
TL;DR: In taking a wide view of pain and action, this review places the relationship between pain, motivation and action at its core, unpicking a dynamic process that can become stuck.
Abstract: Background What is it that motivates our actions? As human beings, existing as part of complex societies, the actions we take are subject to multiple, often competing motives. Spanning non-conscious reflexes, cognitively derived choice as well as long- and short-term goals, our actions allow us to make sense of our environment. Pain disrupts action and hijacks our intentions. Whilst considered adaptive when temporary, pain that persists continues to interrupt and can threaten our ability to actively investigate a changing world. Objective This work is a narrative review. Results Drawing upon three complementary theoretical approaches to pain: an embodied framework, a motivational approach and the avoidance-endurance model, this review places the relationship between pain, motivation and action at its core, unpicking a dynamic process that can become stuck. Conclusions In taking a wide view of pain and action, we expose the nuances within drive to goal behaviour in the presence of pain. This has implications for the clinic, specifically in relation to assessing the multifactorial influences that shape action in pain. But it also seeks to go further, considering the broader environment in which we make decisions and the influence that other professionals, outside of typical healthcare roles, may play a part in the maintenance and resolution of pain.

16 citations

Journal ArticleDOI
01 Mar 2021-Pain
TL;DR: Findings support biases in both vigilance and attentional maintenance for pain-related stimuli but suggest attentional biases towards pain are ubiquitous and not related to pain status.
Abstract: Previous meta-analyses investigating attentional biases towards pain have used reaction time measures. Eye-tracking methods have been adopted to more directly and reliably assess biases, but this literature has not been synthesized in relation to pain. This meta-analysis aimed to investigate the nature and time course of attentional biases to pain-related stimuli in participants of all ages with and without chronic pain using eye-tracking studies and determine the role of task parameters and theoretically relevant moderators. After screening, 24 studies were included with a total sample of 1425 participants. Between-group analyses revealed no significant overall group differences for people with and without chronic pain on biases to pain-related stimuli. Results indicated significant attentional biases towards pain-related words or pictures across both groups on probability of first fixation (k = 21, g = 0.43, 95% confidence interval [CI] 0.15-0.71, P = 0.002), how long participants looked at each picture in the first 500 ms (500-ms epoch dwell: k = 5, g = 0.69, 95% CI 0.034-1.35, P = 0.039), and how long participants looked at each picture overall (total dwell time: k = 25, g = 0.44, 95% CI 0.15-0.72, P = 0.003). Follow-up analyses revealed significant attentional biases on probability of first fixation, latency to first fixation and dwell time for facial stimuli, and number of fixations for sensory word stimuli. Moderator analyses revealed substantial influence of task parameters and some influence of threat status and study quality. Findings support biases in both vigilance and attentional maintenance for pain-related stimuli but suggest attentional biases towards pain are ubiquitous and not related to pain status.

12 citations

Journal ArticleDOI
TL;DR: Results provide first evidence that pain-related fear conditioning may induce attentional biases differentially in healthy women and men, and suggest sex differences may play a role in attentional mechanisms underlying hypervigilance, and may be modulated by psychological vulnerability factors relevant to chronic visceral pain.
Abstract: Although the broad role of fear and hypervigilance in conditions of the gut-brain axis like irritable bowel syndrome is supported by converging evidence, the underlying mechanisms remain incompletely understood. Even in healthy individuals, it remains unclear how pain-related fear may contribute to pain-related attentional biases for acute visceral pain. Building on our classical fear conditioning work in a clinically relevant model of visceral pain, we herein elucidated pain-related attentional biases shaped by associative learning in healthy women and men, aiming to elucidate possible sex differences and the role of psychological traits. To this end, we compared the impact of differentially conditioned pain-predictive cues on attentional biases in healthy women and men. Sixty-four volunteers accomplished a visual dot-probe task and subsequently underwent pain-related fear conditioning where one visual cue (CS+) was contingently paired with a painful rectal distention (US) while another cue remained unpaired (CS-). During the following test phase, the dot-probe task was repeated to investigate changes in attentional biases in response to differentially valenced cues. While pain-related learning was comparable between groups, men revealed more pronounced attentional engagement with the CS+ and CS- whereas women demonstrated stronger difficulties to disengage from the CS+ when presented with a neutral cue. However, when both CS+ and CS- were presented together, women revealed stronger difficulties to disengage from the CS-. Regression analyses revealed an interaction of sex, with negative affect predicting stronger avoidance of the CS+ and stronger difficulties to disengage attention from the CS- in men. These results provide first evidence that pain-related fear conditioning may induce attentional biases differentially in healthy women and men. Hence, sex differences may play a role in attentional mechanisms underlying hypervigilance, and may be modulated by psychological vulnerability factors relevant to chronic visceral pain.

7 citations


Cites background from "Winning or not losing? The impact o..."

  • ...In the context of attentional bias research, the utilization of semantic and pictorial threat stimuli has raised concerns about their ecological validity and generalizability (26), resulting in calls for research with paradigms that closely resemble real-life situations (77) or considermotivational context (69)....

    [...]

References
More filters
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TL;DR: The authors found that individuals are less motivated when an incentive is framed as a means to accrue a gain (positive framing) as compared with when the same incentive was framed as the means to avoid a loss (negative framing), and provided evidence for the role of the negativity bias in this effect.
Abstract: People are frequently challenged by goals that demand effort and persistence. As a consequence, philosophers, psychologists, economists, and others have studied the factors that enhance task motivation. Using a sample of undergraduate students and a sample of working adults, we demonstrate that the manner in which an incentive is framed has implications for individuals' task motivation. In both samples we find that individuals are less motivated when an incentive is framed as a means to accrue a gain (positive framing) as compared with when the same incentive is framed as a means to avoid a loss (negative framing). Further, we provide evidence for the role of the negativity bias in this effect, and highlight specific populations for whom positive framing may be least motivating. Interestingly, we find that people's intuitions about when they will be more motivated show the opposite pattern, with people predicting that positively framed incentives will be more motivating than negatively framed incentives. We identify a lay belief in the positive correlation between enjoyment and task motivation as one possible factor contributing to the disparity between predicted and actual motivation as a result of the framing of the incentive. We conclude with a discussion of the managerial implications for these findings. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

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01 Jan 2010-Pain
TL;DR: An emerging and intriguing question is whether cognitive-behavioral therapies aimed at the reevaluation of major life goals and at the resolution of enduring goal conflicts help to counter fear-driven and disabling avoidance behavior.
Abstract: Cognitive-behavioral treatment programs have been developed to give patients with chronic pain the opportunity to reassess their beliefs about the relationship between pain and functioning and to experience that spontaneous safety behaviors – which may be adaptive in acute episodes of pain – are no longer functional when pain lasts for extended periods of time [5]. These treatment programs appear to be useful. Indeed, a recent meta-analysis of randomized controlled trials of these treatments in adults concluded that these treatments have beneficial effects on pain and mood, but also that there is ample room for improvement [3]. It is, for example, recommended that extensive and multimodal programs be replaced by a more targeted approach that focuses on specific treatments for specific outcomes – as has been done in exposurebased techniques targeting pain-related fear [2]. In addition, it is expected that treatments would have stronger effects when treatment content, dose, timing etc. are based on explicit theoretical models. In line with these ideas, a number of authors have recently called for an expanded affective-motivational approach with a prominent focus on behavior in the context of multiple goals [9,10]. In their attempt to resume daily life activities, pain patients engage in several goals, some of which are directly related to dealing with pain (e.g., to avoid further injury, take less medication, increase physical capacity), whereas others are not pain-related (e.g., being professionally successful, meeting other people, losing weight). Interrelations among these multiple goals – either conflicting or facilitating – may have implications for the initiation and maintenance of the intended goal [6]. A particularly stressful situation, for instance, occurs when the goal to satisfy others by resuming work-related activities holds the risk of increasing pain and re-injury. In contrast, the goal to protect bodily integrity by staying home may lead to social rejection. Such a conflict between two avoidance goals is much more difficult to handle than choosing between two attractive options. This situation may result in indecision and oscillation between the two goals, as is often seen in chronic pain patients. Unfortunately, unresolved pain-related goal conflicts may fuel fear [4]. An emerging and intriguing question is whether cognitive-behavioral therapies aimed at the reevaluation of major life goals and at the resolution of enduring goal conflicts help to counter fear-driven and disabling avoidance behavior [9,10]. In line with this novel treatment approach, Christiansen and colleagues (this issue) have developed and evaluated a brief goalpursuit intervention to improve physical capacity through exercising in chronic back pain patients [1]. In order to facilitate the realization of this intended goal, the following strategies were added to a standard back pain treatment (exercise therapy): (1) mental contrasting to increase the patient’s expectations about achieving the promoted goal, (2) problem solving techniques to help the patient

24 citations

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TL;DR: The impact of attempts to control pain on somatosensory processing at the pain location is investigated, providing further insight into the motivational mechanisms of pain-related attention and points to the negative consequences of trying to control uncontrollable pain.

22 citations

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TL;DR: Experimental evidence for the differential effects of various goal conflicts on pain-related fear and decision-making is provided to improve the understanding of patients' behavior when experiencing goal conflict and may contribute to improving treatments by addressing multiple goals patients are pursuing, and not just pain avoidance/reduction.

16 citations

Journal ArticleDOI
01 Jun 2012-Pain
TL;DR: The study by Schrooten and colleagues in this issue of PAIN uses an innovative approach to address the question of whether directing attention to pain-related stimuli is dependent, at least in part, on motivation to pursue non-pain goals, and calls into question the stability with which pain is deemed threatening.
Abstract: A number of recent commentaries in PAIN have addressed the issue of attentional biases for pain-related stimuli [8,9]. This attention reflects favorably on the importance that researchers and clinicians place on this line of inquiry for advancing understanding of cognitive mechanisms of chronic pain and associated treatments. Why is the investigation of attentional biases for pain important? Attentional capture of stimuli with high threat value, including acute pain, can serve to motivate action that promotes the goal of survival [6]. However, sustained attention to stimuli that are not necessarily indicative of threat to survival can negatively impact the effectiveness with which one pursues other goals. In this context, sustained attention to pain-related somatosensory and environmental stimuli might become maladaptive and associated with functional limitations. Research on attentional biases for pain has been informed by similar research conducted on anxiety and its disorders (see, for example, [4]). Unlike the generally consistent pattern of findings that has emerged from studies on anxiety, findings regarding attentional biases for pain in clinical and nonclinical samples are mixed. Meta-analyses of findings from studies of pain-related attentional biases [11,12] suggest that, overall, patients with chronic pain are more biased toward pain threat (i.e., pain words, pictures of faces in pain) than are healthy control participants, and that biases occur in the latter stages of attention as opposed to initial orienting of attention to threat. On the other hand, there are a number of studies in which patients with chronic pain have not shown attentional biases toward pain-related stimuli (e.g., [1,10]). There are several possible explanations for these mixed findings, including between-study differences in specific methods used to assess attentional bias, differences in sample characteristics and size, and consideration of potentially important individual difference factors that might influence the threat value attributed to pain (e.g., fear of pain). Interestingly, the findings regarding the impact of fear of pain on pain-related attentional biases have also been mixed. This is true for both healthy participants and those with chronic pain (e.g., [2,7]). These findings collectively call into question the stability with which pain, or at least pain-related stimuli, is deemed threatening. In short, do pain and pain-related stimuli always have sufficient threat value to motivate actions to satisfy the goal of survival? Fear-avoidance perspectives on chronic pain suggest this should be the case, at least for those with high fear of pain [3,14]. The study by Schrooten and colleagues [13] in this issue of PAIN uses an innovative approach to address the question of whether directing attention to pain-related stimuli is dependent, at least in part, on motivation to pursue non-pain goals. Healthy partici-

11 citations