Periodic Reporting for period 1 - PainDynamics (PainDynamics: Research on the dynamics of attention bias for pain in daily life.)
Période du rapport: 2016-09-01 au 2018-08-31
Chronic pain is a major health care problem in Europe which results in huge societal and economic costs. It is furthermore estimated that these cost will only increase with an aging European population. Available cognitive-affective accounts of pain, distress and disability suggest that attention plays a pivotal role in the development and maintenance of pain problems. In particular, the presence of an attention bias towards pain information (AB) is thought to initiate or exacerbate pain problems in chronic pain patients. Despite the intuitive appeal of this idea, findings are inconsistent.
In current project it is argued that inconsistent findings in AB research are due to both conceptual and methodological limitations of the available research. From a conceptual point of view, it is argued that the presence of inconsistent findings is owe to the conceptualization of AB as a stable trait-like or habit-like process. Instead, we propose to conceptualize AB as a temporally dynamic, fluctuating and enfolding phenomenon that varies over time and across contexts. From a methodological standpoint, we furthermore argue that varying empirical support may also partly be due to low ecological validity in AB research. It is proposed that the ecological validity could be increased by using actual pain stimuli instead of symbolic stimuli and by investigating AB for pain-related information and key variables in everyday situations instead of in a single laboratory session.
In the current project, these conceptual and methodological challenges will be addressed via (1) the development of a novel theoretical framework incorporating the dynamic nature of attention bias and explaining the impact of contextual and motivational variables on the presence and/or absence of attention bias in people experiencing acute or chronic pain, (2) the development and validation of a novel ecologically valid paradigm to assess AB, which overcomes limitations of previous reaction time measures, and (3) the investigation of key hypotheses concerning the role of AB in acute and chronic pain using a novel ecologically valid approach.
In current project it is argued that inconsistent findings in AB research are due to both conceptual and methodological limitations of the available research. From a conceptual point of view, it is argued that the presence of inconsistent findings is owe to the conceptualization of AB as a stable trait-like or habit-like process. Instead, we propose to conceptualize AB as a temporally dynamic, fluctuating and enfolding phenomenon that varies over time and across contexts. From a methodological standpoint, we furthermore argue that varying empirical support may also partly be due to low ecological validity in AB research. It is proposed that the ecological validity could be increased by using actual pain stimuli instead of symbolic stimuli and by investigating AB for pain-related information and key variables in everyday situations instead of in a single laboratory session.
In the current project, these conceptual and methodological challenges will be addressed via (1) the development of a novel theoretical framework incorporating the dynamic nature of attention bias and explaining the impact of contextual and motivational variables on the presence and/or absence of attention bias in people experiencing acute or chronic pain, (2) the development and validation of a novel ecologically valid paradigm to assess AB, which overcomes limitations of previous reaction time measures, and (3) the investigation of key hypotheses concerning the role of AB in acute and chronic pain using a novel ecologically valid approach.
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.
This project furthers current understanding of how attention and pain are intertwined. The development of the integrated functional-contextual framework is expected to guide future research investigating the role of cognitive biases. Within this project, we have furthermore set the stage for the development of the paradigms that allow the investigation of AB for pain information in daily life and validated EMA items to assess pain-relevant and contextual information which can be used for future research in this area. In doing so, we aim for a better theoretical understanding of the role of AB for pain information and its impact upon the experience and chronification of pain. Finally, better understanding on the role of cognitive biases in the perception and chronification of pain may help to create standalone interventions that reduce attention bias for pain or improve currently available therapies that target (chronic) pain and its impact upon the daily life of pain patients and his/her environment. In doing so, this project may contribute to reduction of the enormous individual, societal and economic costs of (chronic) pain.