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  • 1.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Ljótsson, Brjánn
    Deptartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Edebol-Carlman, Hanna
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences. Department of gastroenterology, Örebro university hospital, Örebro, Sweden.
    Exposure-based cognitive behavioral therapy for irritable bowel syndrome: A single-case experimental design across 13 subjects2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 6, p. 415-430Article in journal (Refereed)
    Abstract [en]

    Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

  • 2.
    Carstens, Johan K. P.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Effects of validating communication on recall during a pain-task in healthy participants2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 118-125, article id S1877-8860(17)30143-XArticle in journal (Refereed)
    Abstract [en]

    BACKGROUND: Increasing recall of instructions and advice in a pain consultation is important, since it is a prerequisite for adherence to treatment recommendations. However, interference due to pain-related distress may result in poor recall. Whereas there are some indications that recall can be increased by empathic communication that reduces interference, this interesting possibility remains largely untested experimentally. The current experiment aimed at studying effects of empathic communication, and more specifically validation, on recall during a pain test and possible mediators and moderators of this effect.

    METHOD: Participants received either validating (N=25) or invalidating responses (N=25) from the experimenter during a pain provoking task, followed by self-report measures of interference (affect, situational pain catastrophizing) and recall (accurate and false memories of words).

    RESULTS: As expected, the validated group exhibited higher accurate recall and less false memories following the pain test as compared to the invalidated group. This was partly due to the effect of interference being counteracted by moderating the relationship between pain catastrophizing and recall.

    CONCLUSION: These novel results suggest that validating communication can counteract interference due to pain catastrophizing on recall, at least in a controlled experimental setting.

    IMPLICATIONS: Good communication by health professionals is of utmost importance for adherence to pain management. The current results expand our knowledge on the effects of pain communication by establishing and explaining a clear link between empathic communication and recall, highlighting the role of pain catastrophizing.

  • 3.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Ljotsson, Brjann
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Repsilber, Dirk
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Brummer, Robert J.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms2017In: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, article id 8915872Article in journal (Refereed)
    Abstract [en]

    Irritable bowel syndrome (IBS) is a gastrointestinal disorder linked to disturbances in the gut-brain axis. Visceral hypersensitivity and pain are hallmarks of IBS and linked to the physiological and psychological burden and to the nonadaptive coping with stress. Cognitive-behavioral therapy (CBT) for IBS has proven effective in reducing gastrointestinal and psychiatric symptoms in IBS by means of coping with stress. The present pilot study evaluated for the first time whether CBT for IBS affected visceral sensitivity and pain. Individual CBT was performed for 12 weeks in 18 subjects with IBS and evaluated in terms of visceral sensitivity and pain during rectal distensions using the barostat method and self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms. Visceral discomfort, urge, and pain induced by the barostat were not affected by CBT but were stable across the study. However, the level of self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms decreased after the intervention. Central working mechanisms and increased ability to cope with IBS-symptoms are suggested to play a key role in the alleviation of IBS symptoms produced by CBT.

  • 4.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Ljóttson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology and Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, p. 81-91Article in journal (Refereed)
    Abstract [en]

    Background and aims: Irritable bowel syndrome (IBS), is a common multifactorial gastrointestinal disorder linked to disturbances in the microbe gut-brain axis. Cognitive behavioral therapy (CBT), in face-to-face format has showed promising results on IBS and its associated psychological symptoms. The present study explored for the first time if CBT for IBS affects the autonomic nervous system (ANS) during experimentally induced visceral pain and cognitive stress, respectively. The levels of state and trait anxiety, current and perceived stress were also evaluated.

    Methods: In this uncontrolled trial, individual CBT was performed in face-to-face format for 12 weeks in 18 subjects with IBS. Heart rate variability and skin conductance were measured during experimentally induced visceral pain and during a cognitive task (Stroop color-word test), before and after intervention. The levels of state and trait anxiety as well as self-rated current and perceived stress were also measured before and after the intervention.

    Results: CBT did not affect ANS activity during experimentally induced visceral pain and cognitive stress. The sympathetic activity was high, typical for IBS and triggered during both visceral pain and cognitive stress. The levels of state and trait anxiety significantly decreased after the intervention. No significant changes in self-rated current or perceived stress were found.

    Conclusions: Results suggest that face-to-face CBT for IBS improved anxiety- a key psychological mechanism for the IBS pathophysiology, rather than the autonomic stress response to experimentally induced visceral pain and cognitive stress, respectively.

  • 5.
    Gatzounis, R.
    et al.
    Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium; Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Crombez, G.
    Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
    Vlaeyen, J. W. S.
    Section Behavioral Medicine, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Forgetting to remember?: Prospective memory within the context of pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 3, p. 614-625Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

    METHODS: Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues.

    RESULTS: Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context.

    CONCLUSIONS: Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed.

    SIGNIFICANCE: This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.

  • 6.
    Gatzounis, Rena
    et al.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, University of Leuven, Leuven, Belgium.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vancleef, Linda M. G.
    Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Vlaeyen, Johan W S
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Taking a break in response to pain: An experimental investigation of the effects of interruptions by pain on subsequent activity resumption2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, p. 52-60, article id S1877-8860(17)30029-0Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Interrupting ongoing activities with the intention to resume them again later is a natural response to pain. However, such interruptions might have negative consequences for the subsequent resumption and performance of the interrupted activity. Activity interruptions by pain may be more impairing than interruptions by non-painful stimuli, and also be subjectively experienced as such. These effects might be more pronounced in people high in pain catastrophizing. These hypotheses were investigated in two experiments.

    METHODS: In Experiment 1, healthy volunteers (n=24) performed an ongoing task requiring a sequence of joystick movements. Occasionally, they received either a painful electrocutaneous or a non-painful vibrotactile stimulus, followed by suspension of the ongoing task and temporary engagement in a different task (interruption task). After performing the interruption task for 30s, participants resumed the ongoing task. As the ongoing task of Experiment 1 was rather simple, Experiment 2 (n=30) included a modified, somewhat more complex version of the task, in order to examine the effects of activity interruptions by pain.

    RESULTS: Participants made more errors and were slower to initiate movements (Experiment 1 & 2) and to complete movements (Experiment 2) when they resumed the ongoing task after an interruption, indicating that interruptions impaired subsequent performance. However, these impairments were not larger when the interruption was prompted by painful than by non-painful stimulation. Pain catastrophizing did not influence the results.

    CONCLUSIONS: Results indicate that activity interruptions by pain have negative consequences for the performance of an activity upon its resumption, but not more so than interruptions by non-painful stimuli. Potential explanations and avenues for future research are discussed.

    IMPLICATIONS: Interrupting ongoing activities is a common response to pain. In two experiments using a novel paradigm we showed that activity interruptions by pain impair subsequent activity resumption and performance. However, this effect seems to not be specific to pain.

  • 7.
    Gatzounis, Rena
    et al.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, University of Leuven, Leuven, Belgium.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vlaeyen, Johan
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Effects of activity interruptions by pain on pattern of activity performance: An experimental investigation2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, p. 109-119Article in journal (Refereed)
    Abstract [en]

    Background and aims: Suspending an ongoing activity with the intention to resume it again later is a natural response to pain. This response facilitates coping with the pain, but it may also have negative consequences for the resumption and performance of the activity. For example, people with pain problems are often forced to take a break from doing their household chores because of their pain. They might delay resuming their chore, eventually needing longer time to finish it. We investigated how activity interruptions by pain influence the pattern of subsequent activity performance. We expected that when an activity is interrupted by pain (compared to non-pain), people spend longer time away from the activity, need longer time to complete it, and are less motivated to perform it.

    Methods: Sixty healthy volunteers performed an ongoing task that required them to make joystick movements in different directions according to a specific rule. Occasionally, participants received either a painful electrocutaneous stimulus or a non-painful and non-aversive auditory stimulus (between-subjects) as an interruption cue. The interruption cue was followed by the temporary suspension of the ongoing task and the initiation of a different activity (interruption task). The latter required the categorization of cards and had a maximum duration, but participants could also stop it earlier by pressing a button. We measured time away from the (interrupted) ongoing task, total time to complete the ongoing task (including the interruptions) and self-reported motivation to perform both the ongoing as well as the interruption task.

    Results: Groups did not differ in the time away from the ongoing task, total time to complete the ongoing task, or self-reported motivation to perform the two tasks.

    Conclusions: Activity interruptions by pain did not impair the pattern of activity performance more than activity interruptions by non-pain. Potential explanations and suggestions for future research are discussed.

  • 8.
    Gatzounis, Rena
    et al.
    Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work. Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vlaeyen, Johan W. S.
    Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Activity interruptions by pain impair activity resumption, but not more than activity interruptions by other stimuli: an experimental investigation2018In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 159, no 2, p. 351-358Article in journal (Refereed)
    Abstract [en]

    Interrupting ongoing activities whilst intending to resume them later is a natural response to pain. Whereas this response facilitates pain management, at the same time it may also disrupt task performance. Previous research has shown that activity interruptions by pain impair subsequent resumption of the activity, but not more than pain-irrelevant interruptions. Ongoing task complexity and pain threat value might influence interruption effects. In this experiment, we adjusted a paradigm from outside the field of pain to investigate how activity interruptions by pain affect task performance. Healthy participants (n=69) were required to answer a series of questions, in a specific sequence, about presented letter-digit combinations. This ongoing task was occasionally interrupted by painful electrocutaneous or non-painful vibrotactile stimulation (between-subjects) followed by a typing task. Upon interruption completion, participants were required to resume the ongoing task at the next step of the question sequence. Results indicate impaired sequence accuracy (less frequent resumption at the correct step of the sequence) but preserved non-sequence accuracy (similarly frequent correct responses to question content) immediately after an interruption. Effects were not larger for interruptions by pain, compared to non-pain. Further, participants in the two conditions reported similar task experience, namely task motivation, perceived difficulty, and confidence to resume the interrupted task. Pain catastrophizing did not influence the results. As in previous studies, activity interruptions by pain were shown to impair the resumption of a task that requires keeping to a step sequence, but not more than interruptions by non-painful stimuli. Potential explanations are discussed.

  • 9.
    Gatzounis, Rena
    et al.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Schrooten, Martien G S
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, University of Leuven, Leuven, Belgium; Centre for Health and Medical Psychology, Örebro University, Örebro, Sweden.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vlaeyen, Johan W. S.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Interrupted by pain: an anatomy of pain-contingent activity interruptions2014In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 155, no 7, p. 1192-1195Article in journal (Refereed)
  • 10.
    Karsdorp, Petra A.
    et al.
    Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Department of Psychology, Utrecht University, Utrecht, The Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Geenen, Rinie
    Department of Psychology, Utrecht University, Utrecht, The Netherlands.
    Attentional control and the competition between nonpain goals and the threat of pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 1, p. 181-190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fully understanding attention to pain requires taking into account the motivational context. Both pain- and (nonpain) goal-related information attracts attention. An intriguing question is which attentional bias prevails when pain- and goal-related information co-occurs? Reduced attentional bias towards pain- and goal-related information was predicted when the other competing information was presented simultaneously. Moreover, trait attentional control was predicted to be associated with stronger attentional bias towards goal-related information particularly in the presence of pain-related information.

    METHODS: Attentional competition between pain- and (nonpain) goal-related information was measured in ninety participants using a dot-probe task presenting two stimuli (pain-related, goal-related or neutral) simultaneously. Reaction time was the dependent variable. Dot-probe trials alternated with goal trials to induce a temporary goal. Trait attentional control was measured with the attentional control scale.

    RESULTS: For pain-related neutral stimulus pairs, participants responded fastest when probes appeared on the same, compared to the opposite, location as the pain-related stimulus. For pain-goal-related stimulus pairs, responses were fastest when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Higher trait attentional control was associated with faster responding when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Unpredicted, this effect was irrespective of the co-occurring stimulus (neutral vs. pain-related).

    CONCLUSIONS: The findings suggest that the unintentional allocation of attention towards events related to a temporary (nonpain) goal prevails over attentional bias to events predicting pain. Trait attentional control predicts stronger attentional allocation towards events related to a temporary goal.

    SIGNIFICANCE: These findings indicate that treatment interventions facilitating goal pursuit in patients with chronic pain are beneficial in reducing attentional biases towards pain-related events.

  • 11.
    Khatibi, Ali
    et al.
    Research Group on Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Laboratory of Research on Neuropsychology of Pain, University of Montreal, Montréal QC, Canada.
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Bosmans, Katrien
    Department of Psychology, Vrije Universiteit Brussel, Brussels, Belgium.
    Volders, Stephanie
    Research Group on Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium.
    Vlaeyen, Johan W. S.
    Research Group on Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Van den Bussche, Eva
    Department of Psychology, Vrije Universiteit Brussel, Brussels, Belgium.
    Sub-optimal presentation of painful facial expressions enhances readiness for action and pain perception following electrocutaneous stimulation2015In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 6Article in journal (Refereed)
    Abstract [en]

    Observation of others' painful facial expressions has been shown to facilitate behavioral response tendencies and to increase pain perception in the observer. However, in previous studies, expressions were clearly visible to the observer and none of those studies investigated the effect of presence of peripheral stimulation on response tendencies. This study focuses on the effect of sub-optimal presentation of painful facial expressions in the presence and absence of an electrocutaneous stimulus. Twenty-two healthy individuals categorized arrow targets which were preceded by a sub-optimally presented facial expression (painful, happy, or neutral in different blocks). On half of the trials, aversive electrocutaneous stimulation was delivered to the wrist of the non-dominant hand between the presentation of facial expression and target (an arrow directing to right or left). Participants' task was to indicate direction of the arrow as soon as it appears on the screen by pressing the corresponding key on the keyboard and to rate their pain at the end of block. Analysis showed that responses were faster to targets preceded by aversive stimulation than to targets not preceded by stimulation, especially following painful expressions. Painfulness ratings were higher following painful expressions than following happy expressions. These findings suggest that sub-optimally presented painful expressions can enhance readiness to act to neutral, non-pain-related targets after aversive stimulation and can increase pain perception.

  • 12.
    Khatibi, Ali
    et al.
    Research Group on Health Psychology, Katholieke Univ Leuven, Leuven, Belgium.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work. Research Group on Health Psychology, Katholieke Univ Leuven, Leuven, Belgium.
    Vancleef, Linda M. G.
    Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Vlaeyen, Johan W. S.
    Research Group on Health Psychology, Katholieke Univ Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    An experimental examination of catastrophizing-related interpretation bias for ambiguous facial expressions of pain using an incidental learning task2014In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 5, p. 1002-Article in journal (Refereed)
    Abstract [en]

    Individuals with pain-related concerns are likely to interpret ambiguous pain-related information in a threatening manner. It is unknown whether this interpretation bias also occurs for ambiguous pain-related facial expressions. This study examined whether individuals who habitually attach a catastrophic meaning to pain are characterized by negative interpretation bias for ambiguous pain-related facial expressions. Sixty-four female undergraduates completed an incidental learning task during which pictures of faces were presented, each followed by a visual target at one of two locations. Participants indicated target location by pressing one of two response keys. During the learning phase, happy and painful facial expressions predicted target location. During two test phases, morphed facial expressions of pain and happiness were added, equally often followed by a target at either location. Faster responses following morphs to targets at the location predicted by painful expressions compared to targets at the location predicted by happy expressions were taken to reflect pain-related interpretation bias. During one test phase, faces were preceded by either a safe or threatening context cue. High, but not low, pain-catastrophizers responded faster following morphs to targets at the location predicted by painful expressions than to targets at the other location (when participants were aware of the contingency between expression type and target location). When context cues were presented, there was no indication of interpretation bias. Participants were also asked to directly classify the facial expressions that were presented during the incidental learning task. Participants classified morphs more often as happy than as painful, independent of their level of pain catastrophizing. This observation is discussed in terms of differences between indirect and direct measures of interpretation bias.

  • 13.
    Khatibi, Ali
    et al.
    Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium.
    Vachon-Presseau, Etienne
    Departement de Psychologie, Université de Montréal, Montréal, Quebec, Canada; Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Quebec, Canada.
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work. Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium.
    Vlaeyen, Johan
    Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Rainville, Pierre
    Departement de Psychologie, Université de Montréal, Montréal, Quebec, Canada; Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montréal, Quebec, Canada; Groupe de Recherche sur le Systeme Nerveux Central (GRSNC), Université de Montréal, Montréal, Quebec, Canada.
    Attention effects on vicarious modulation of nociception and pain2014In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 155, no 10, p. 2033-2039Article in journal (Refereed)
    Abstract [en]

    The observation of others' facial expressions of pain has been shown to facilitate the observer's nociceptive responses and to increase pain perception. We investigated how this vicarious facilitation effect is modulated by directing the observer's attention toward the meaning of pain expression or the facial movements. In separate trials, participants were instructed to assess the "intensity of the pain expression"(meaning) or to "discriminate the facial movements" in the upper vs lower part of the face shown in 1-second dynamic clips displaying mild, moderate, or strong pain expressions or a neutral control. In 50% of the trials, participants received a painful electrical stimulation to the sural nerve immediately after the presentation of the expression. Low-level nociceptive reactivity was measured with the RIII-response, and pain perception was assessed using pain ratings. Pain induced by the electrical stimulation increased after viewing stronger pain expressions in both tasks, but the RIII-response showed this vicarious facilitation effect only in the movement discrimination task at the strongest expression intensity. These findings are consistent with the notion that vicarious processes facilitate self-pain and may prime automatic nociceptive responses. However, this priming effect is influenced by top-down attentional processes. These results provide another case of dissociation between reflexive and perceptual processes, consistent with the involvement of partly separate brain networks in the regulation of cortical and lower-level nociceptive responses. Combined with previous results, these findings suggest that vicarious pain facilitation is an automatic process that may be diminished by top-down attentional processes directed at the meaning of the expression.

  • 14.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Wicksell, Rikard K.
    Behavior Medicine Pain Treatment Service, Karolinska University Hospital, Sweden.
    Understanding co-occuring emotion and pain: The role of context sensitivity from a transdiagnostic perspectiveIn: Journal of Contemporary Psychotherapy, ISSN 0022-0116, E-ISSN 1573-3564Article in journal (Refereed)
  • 15.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Wiksell, Rikard
    Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Understanding Co-occurring Emotion and Pain: The Role of Context Sensitivity from a Transdiagnostic Perspective2016In: Journal of Contemporary Psychotherapy, ISSN 0022-0116, E-ISSN 1573-3564, Vol. 46, no 3, p. 129-137Article in journal (Refereed)
    Abstract [en]

    Co-occurring emotional distress and chronic pain are a true challenge in the clinic. This combination of symptoms is quite common but associated with poor treatment results, frequent relapses and costly dysfunction. This paper describes a transdiagnostic approach to the problem by focusing on psychological processes that drive both the emotional as well as the pain problem. Avoidance and context (in)sensitivity are suggested as potential transdiagnostic factors that might be targeted in treatment. Since both pain and distress are aversive, they may be avoided. This may be helpful in the short-term, but paradoxically the avoidance maintains the problem in the long-term. Context sensitivity concerns how well our responses are in tune with the changing demands of the environment. We propose that context insensitivity may drive emotional distress and pain problems. We present data that show that disclosure of pain is important emotionally, but that it is also a challenge to respond in manner that is sensitive to the social context. Indeed, disclosing how we feel emotionally or concerning pain might be helpful in some situations, but enhance the problem in others. Finally, we outline a hybrid treatment that combines exposure for pain (feared movements) and emotions (disclosure) with context sensitivity training. While such new treatments are promising, there remains a dire need for more clinical research to test and improve treatments for co-occurring emotional distress and pain.

  • 16.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Lind, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Understanding co-occurring pain and emotion: a transdiagnostic approach to treatment2015In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 84, p. 45-46Article in journal (Other academic)
  • 17.
    Schrooten, Martien G S
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Karsdorp, P A
    University of Utrecht, Utrecht, The Netherlands.
    Vlaeyen, J W S
    University of Leuven, Leuven, Belgium.
    Pain catastrophizing moderates the effects of pain-contingent task interruptions2013In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, no 7, p. 1082-92Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A prominent behavioural consequence of pain is the temporary suspension of current activities with intent to resume them later. Little is known about the effects of such pain-contingent task interruptions. This experiment examines the influence of pain-contingent interruptions on the amount of time spent performing a cognitive achievement task: We expected that people would spend more time on task when task performance was interrupted in response to pain (vs. no interruption), and that negative mood and pain catastrophizing would enhance this negative impact.

    METHODS: Healthy volunteers read behaviour descriptions until they felt they could form a good impression. Before task performance, participants underwent a negative or positive mood induction. During the task, all participants expected painful stimulation. Half of the participants in each mood induction group received an acute (electrocutaneous) pain stimulus, resulting in a 2-min break from the task. The other participants received no sensory stimulation during task performance and their performance was not interrupted.

    RESULTS: Results revealed no effect of mood on task performance (i.e., total number of descriptions read). There was, however, a significant interaction between task interruption and pain catastrophizing, indicating that participants with low levels of catastrophizing tended to read more descriptions when performance was interrupted than when not, whereas participants reporting relatively high levels of catastrophizing showed the reverse behavioural pattern.

    CONCLUSIONS: The impact of pain-contingent task interruptions was reversed in participants reporting relatively high levels of pain catastrophizing. Results are discussed with regard to interruption management in the context of chronic pain.

  • 18.
    Schrooten, Martien G. S.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Changing pain expectations: the role of social context and communication2017In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 158, no 7, p. 1185-1186Article in journal (Other academic)
  • 19.
    Schrooten, Martien G. S.
    et al.
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium.
    Vancleef, L.
    Department of Clinical Psychological Science, Maastricht University,Maastricht, The Netherlands.
    Vlaeyen, J. W. S.
    Research Group Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Attention allocation to ambiguous health/somatic threat cues2015In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 7, p. 1002-1011Article in journal (Refereed)
    Abstract [en]

    Background: An influential idea is that attentional bias to information related to pain or pain-related negative affect underlies persistent pain problems. Such information is however often ambiguous. If ambiguous input is perceived as pain or threat related, attention to this stimulus would be enhanced compared with stimuli with no (dominant) pain-/threat-related meaning. Attentional bias to ambiguous stimuli related to somatic/health threat was expected to be more pronounced with higher levels of pain catastrophizing.

    Methods: University students performed a spatial cueing task including four types of word cues that were combinations of word content (somatic/health threat vs. non-threat), and word ambiguity (unambiguous vs. ambiguous), each presented for 500 or 750 ms. Attentional bias to somatic/health threat is reflected in larger cue validity effects for somatic/heath threat words than for non-threat words.

    Results: In the 500-ms condition, cue validity effects were larger for threat than for non-threat words in participants reporting low catastrophizing, but did not depend on word content in participants reporting higher catastrophizing. In the 750-ms condition, cue validity effects did not depend on pain catastrophizing or word content. Cue validity effects did not significantly differ between unambiguous words and ambiguous homographs.

    Conclusions: Low catastrophizers demonstrated attentional bias to threat content. Participants reporting higher catastrophizing showed overall enhanced attentional orienting. There was no evidence for differences in (biased) attention to unambiguous and ambiguous words. Further research is needed to determine attentional bias for ambiguous pain-/threat-related stimuli in the context of consistent attentional bias for unambiguous pain-/threat-related stimuli.

  • 20.
    Schrooten, Martien G. S.
    et al.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden; Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
    Wiech, Katja
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Nuffield Division Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Centre for Pain Research, University of Bath, Bath, United Kingdom.
    Vlaeyen, Johan W. S.
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    When pain meets...: pain-related choice behavior and pain perception in different goal conflict situations2014In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 15, no 11, p. 1166-1178Article in journal (Refereed)
    Abstract [en]

    Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation.

    Perspective: We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain treatment.

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