Interpretation bias in the face of pain: a discriminatory fear conditioning approach

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)383-395
Number of pages13
JournalSCANDINAVIAN JOURNAL OF PAIN
Volume19
Issue number2
DOIs
Publication statusPublished - Apr 2019

Keywords

  • interpretation bias
  • pain threat
  • acute pain
  • startle response
  • pain expectancy
  • ILLNESS/INJURY SENSITIVITY INDEX
  • NEGATIVE INTERPRETATION BIAS
  • ANXIETY SENSITIVITY
  • INJURY/ILLNESS SENSITIVITY
  • CATASTROPHIZING SCALE
  • ATTENTIONAL BIAS
  • QUESTIONNAIRE
  • THREAT
  • ACQUISITION
  • MODEL

Cite this

@article{fa597a1a1bfb4d7fb955426f191b385a,
title = "Interpretation bias in the face of pain: a discriminatory fear conditioning approach",
abstract = "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.",
keywords = "interpretation bias, pain threat, acute pain, startle response, pain expectancy, ILLNESS/INJURY SENSITIVITY INDEX, NEGATIVE INTERPRETATION BIAS, ANXIETY SENSITIVITY, INJURY/ILLNESS SENSITIVITY, CATASTROPHIZING SCALE, ATTENTIONAL BIAS, QUESTIONNAIRE, THREAT, ACQUISITION, MODEL",
author = "Juliane Traxler and Schrooten, {Martien G S} and Pauline Dibbets and {van Cleef}, {Linda M.G.}",
year = "2019",
month = "4",
doi = "10.1515/sjpain-2018-0112",
language = "English",
volume = "19",
pages = "383--395",
journal = "SCANDINAVIAN JOURNAL OF PAIN",
issn = "1877-8860",
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Interpretation bias in the face of pain : a discriminatory fear conditioning approach. / Traxler, Juliane; Schrooten, Martien G S; Dibbets, Pauline; van Cleef, Linda M.G.

In: SCANDINAVIAN JOURNAL OF PAIN, Vol. 19, No. 2, 04.2019, p. 383-395.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Interpretation bias in the face of pain

T2 - a discriminatory fear conditioning approach

AU - Traxler, Juliane

AU - Schrooten, Martien G S

AU - Dibbets, Pauline

AU - van Cleef, Linda M.G.

PY - 2019/4

Y1 - 2019/4

N2 - 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.

AB - 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.

KW - interpretation bias

KW - pain threat

KW - acute pain

KW - startle response

KW - pain expectancy

KW - ILLNESS/INJURY SENSITIVITY INDEX

KW - NEGATIVE INTERPRETATION BIAS

KW - ANXIETY SENSITIVITY

KW - INJURY/ILLNESS SENSITIVITY

KW - CATASTROPHIZING SCALE

KW - ATTENTIONAL BIAS

KW - QUESTIONNAIRE

KW - THREAT

KW - ACQUISITION

KW - MODEL

U2 - 10.1515/sjpain-2018-0112

DO - 10.1515/sjpain-2018-0112

M3 - Article

VL - 19

SP - 383

EP - 395

JO - SCANDINAVIAN JOURNAL OF PAIN

JF - SCANDINAVIAN JOURNAL OF PAIN

SN - 1877-8860

IS - 2

ER -