Within this project, I have developed a theoretical framework, i.e. the integrated functional-contextual framework, which offers a radical shift from the traditional view on cognitive bias in the context of pain and aims to increase current understanding of the role of cognitive biases, including attention bias, for pain information upon the experience of pain and related outcomes. Within this framework, we point at the dynamics of attention bias, and propose that attention bias is functional and influenced by context and motivational variables (Van Ryckeghem et al., Under review, Van Ryckeghem & Crombez, 2018). The corresponding need to shift away from the traditional perspective on AB as a stable phenomenon have been supported by (a) a state-of-the art review and (b) experimental studies. Within this review, we summarized research findings from studies using traditional paradigms to investigate AB for pain information. This review revealed only small effect sizes for an AB for pain information in chronic pain patients and people experiencing acute pain (Todd, Van Ryckeghem, Sharpe & Crombez, 2018). Within an experimental context we investigated the effect of training attention bias away from symbolic pain information on the experience of pain and task interference during pain. Results again showed that training attention away from pain without taking context and participants’ goals into account and overlooking the ecological validity of pain information is ineffective (Van Ryckeghem, Van Damme & Vervoort, 2018). To overcome these limitations, we developed a novel paradigm, i.e. the somatosensory detection paradigm (SDP), in which we investigate the impact of context upon participants’ threshold for innocuous tactile information. The SDP aims to assess increased attention for relevant bodily sensations at one body location (e.g. a threatened arm) versus another body location (e.g. an non-threatened arm). In doing so biased attention for pain information can be assessed with ecological valid and relevant stimuli and without using a reaction times. Two laboratory studies were performed to validate the SDP in a controlled environment. In a first study , we cued attention away from one body location towards another body location and found that attending away from a body location decreases the perceptual threshold for this body location. This was however unrelated to participants’ level of inhibitory control. In a second study, one hand of the participants was threatened by pain. Results showed that at the location threatened by pain, participants threshold for innocuous tactile sensations was decreased, suggesting biased attention towards the location of pain. After the validation within the lab, we aimed at investigating attention bias in daily life of people. Therefore, we developed a portable tactor system to provide tactile innocuous tactile stimuli at the shoulder location, allowing the use of the SDP in daily life context. To assess the outcome (pain experience, disability, …), antecedents (fear of pain, ….) and contextual information, an ecological momentary assessment (EMA) diary was developed and validated in healthy participants experiencing DOMS pain and chronic pain patients using the discriminant content validity method and cognitive interviewing techniques (Köckeritz, 2018). After validation of the EMA diary, attention bias was investigated in students' daily life environment while they experienced DOMS using the validated SDP paradigm (Fig1). Participants filled out an EMA for 9 days. In doing so this study was the first to investigate AB for pain information in daily life of people. Despite some limitations of the study, the first results confirm that AB for pain information can indeed be investigated in daily life contexts. Furthermore, results show large fluctuations in attention for bodily sensations over time and contexts. The outcome of this project was disseminated in manuscripts published in high impact journals and at national and international conferences. Furthermore, findings were shared with the broader public via social media and were disseminated during lectures for clinicians and students.
