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Interpretation bias in the face of pain: a discriminatory fear conditioning approach
Department on Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Research Centre for Health Psychology, University of Leuven, Leuven, Belgium.
Örebro University, School of Law, Psychology and Social Work. Research Centre for Health Psychology, University of Leuven, Leuven, Belgium.ORCID iD: 0000-0002-9462-0256
Department on Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
Department on Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 2, p. 383-395Article in journal (Refereed) Published
Abstract [en]

Background and aims: Interpreting pain- and illness-related stimuli as health-threatening is common among chronic pain patients but also occurs in the general population. As interpretation bias (IB) may affect pain perception and might even play part in the development and maintenance of chronic pain, it is important to improve our understanding of this concept. Several studies suggest an association between IB and pain-related anxiety. However, those studies often rely on verbal and pictorial IB tasks that do not entail a threat of actual pain, therefore lacking personal relevance for healthy participants. The current study investigated whether healthy individuals show an IB towards ambiguous health-related stimuli in a context of actual pain threat, and explored whether this bias is associated to pain anxiety constructs.

Methods: Thirty-six healthy participants were conditioned to expect painful electrocutaneous shocks (unconditioned stimulus - US) after health-threat words (CS+) but not after neutral (non-health-threat) words (CS-) in order to establish fear of pain. Subsequently, they completed a verbal interpretation task that contained new CS+ and CS- stimuli as well as ambiguous non-reinforced health-threat and non-health-threat words. IB was assessed through shock expectancy ratings and startle responses to ambiguous and evident health threatening or neutral word stimuli. Pain-related anxiety was measured with validated questionnaires.

Results: The results show a general IB towards ambiguous health-related words on pain expectancies but not on startle response. An exploratory analysis suggests that this effect exists irrespective of pain-related anxiety levels which however may be due to a lack of power.

Conclusion: We present a novel experimental paradigm employing actual health threat that captures IB towards health-related stimuli in healthy individuals. Taken together, results provide evidence for the further consideration of IB as a latent vulnerability factor in the onset and maintenance of pain chronicity. In contrast to previous studies employing a safe, pain-free context, we found that healthy participants show an IB towards ambiguous health-related stimuli, when confronted with pain threat.

Implications: Like chronic pain patients, healthy individuals display an IB towards health-threat stimuli when these stimuli become personally relevant by carrying information about pending health threat. Therefore, the presented paradigm could be valuable for pain-related cognitive bias research in healthy participants as it may have a higher ecological validity than previous study designs. Future studies will have to elucidate the influence of anxiety constructs on IB in larger samples.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019. Vol. 19, no 2, p. 383-395
Keywords [en]
Acute pain, interpretation bias, pain expectancy, pain threat, startle response
National Category
Applied Psychology Neurology
Identifiers
URN: urn:nbn:se:oru:diva-69997DOI: 10.1515/sjpain-2018-0112ISI: 000463370000018PubMedID: 30379643Scopus ID: 2-s2.0-85056216116OAI: oai:DiVA.org:oru-69997DiVA, id: diva2:1261530
Note

Funding Agency:

Netherlands Organization for Scientific Research  NWO 016.105.211

Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2019-06-19Bibliographically approved

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Schrooten, Martien G. S.

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CiteExportLink to record
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