Fear of progression, depression, and sleep difficulties in people experiencing endometriosis-pain: A cross-sectional study.

OBJECTIVE: Endometriosis is a chronic condition generally characterised by severe pain. Recent findings demonstrate disproportionately elevated rates of insomnia and fatigue among people with endometriosis, particularly among those with associated pain. Yet there is little understanding of the psychological factors that might contribute to these sleep and fatigue related difficulties. We investigated whether fear of progression and depression interacted with pain to influence fatigue and insomnia among people with endometriosis-related pain. METHODS: A total of 206 individuals with endometriosis were included in this cross-sectional, online survey in January 2022. Participants provided relevant demographics and endometriosis characteristics. The BPI-SF, FoP-Q-SF, DASS-21, CFS and ISI were used to assess pain intensity, fear of progression, depression, fatigue, and insomnia symptoms, respectively. Associations between key variables were assessed with correlations. A path analysis determined whether the relationships between pain and fatigue, and pain and insomnia, depended on levels of fear of progression and depression. RESULTS: Controlling for age, fear of progression was uniquely associated with worse fatigue (ß = 0.348, p < .001) and insomnia (ß = 0.389, p < .001), and moderated the relationship between pain and fatigue (ß = 0.155, p = .009). Specifically, with increasing pain severity, the effects of fear of progression on fatigue were exacerbated. Depression was uniquely associated with fatigue (ß = 0.360, p < .001), but did not elicit any moderation effects. CONCLUSION: These results highlight the role of fear of progression and depression in endometriosis-related fatigue and insomnia, paving the way for future interventions targeting these constructs to be tested.

Interpretation bias and the transition from acute to chronic pain.

ABSTRACT: Most theories of pain emphasize cognitive factors in the development of chronicity, but they have rarely been studied in the context of the transition from acute to chronic pain. The aim of the present study was to assess the role of interpretation bias, pain anxiety, and pain avoidance in acute and chronic pain and the transition from acute to chronic pain. Study 1 recruited a sample of N = 85 adults with chronic pain. Study 2 recruited a sample of N = 254 adults with acute pain and followed them up 3 months later. Both studies assessed interpretation bias with the word association task, as well as measuring pain-related anxiety, pain avoidance, pain severity, and pain interference. In study 2, pain outcomes at 3 months were also assessed. Across both acute and chronic pain samples, interpretation bias was associated with pain interference, but not pain severity. Path analysis mediation models for study 2 showed that interpretation bias was associated with increased pain anxiety, which predicted both pain severity and pain interference 3 months later. Pain anxiety was also associated with pain avoidance, but pain avoidance did not predict pain outcomes. This research provides further insight into the transition from acute to chronic pain, suggesting that interpretation bias in acute pain may play a role in pain-related anxiety that drives pain interference, thus maintaining chronic pain. These findings hold promise for further research into potential large-scale preventative interventions targeting interpretation bias and pain anxiety in acute pain.

Fear of progression, imagery, interpretation bias, and their relationship with endometriosis pain.

ABSTRACT: Endometriosis is a chronic gynaecological condition, of which pain is both the most common and most debilitating symptom. As with other forms of pain, there is increasing recognition of the role of psychological processes in bridging the gap between pain and pain impact, and yet these processes are not well understood in endometriosis. The aim of this study was to investigate the relevance of fear of progression, imagery, and interpretation bias in endometriosis, and their contribution to pain interference. A total of 221 participants (mean age = 38 years, SD = 7.8) with endometriosis were recruited from Endometriosis Australia. This cross-sectional study included relevant demographics and endometriosis characteristics; questionnaires to measure fear of progression, imagery, interpretation bias, and pain; and the word association task to measure interpretation bias. Participants reported high scores on the Fear of Progression Questionnaire (M = 38/60), higher than that has been found in cancer. Controlling for age and pain intensity, we found that imagery, interpretation bias, and their interaction were associated with increased fear of progression and that fear of progression was associated with greater pain-related interference. In exploratory analysis, we also found that the frequency and distress of endometriosis-related intrusive imagery were associated with greater fear of progression and pain interference, after controlling for age and pain intensity. These findings provide the first support of the importance of fear of progression in people with endometriosis and suggest possible pathways for causal investigation.

Interpretation bias in endometriosis-related pain.

ABSTRACT: Endometriosis-related pain has been predominantly medically managed, which has hindered understanding of psychological factors involved in these pain experiences. Models of chronic pain highlight the biased interpretation of ambiguous information as health threat related (interpretation bias) as an important process in the development and maintenance of chronic pain. Whether interpretation bias may also be similarly implicated in endometriosis-related pain is unclear. The current study aimed to address this gap in the literature by (1) comparing interpretation biases between a sample of participants with endometriosis and a control sample of participants without medical conditions and pain, (2) exploring relationships between interpretation bias and endometriosis-related pain outcomes, and (3) exploring whether interpretation bias moderated the relationship between endometriosis-related pain severity and pain interference. The endometriosis and healthy control samples comprised 873 and 197 participants, respectively. Participants completed online surveys assessing demographics, interpretation bias, and pain-related outcomes. Analyses revealed that interpretation bias was significantly stronger among individuals with endometriosis relative to controls, with a large effect size. Within the endometriosis sample, interpretation bias was significantly associated with increases in pain-related interference, however, interpretation bias was not associated with any other pain outcomes and did not moderate the relationship between pain severity and pain interference. This study is the first to evidence biased interpretation styles among individuals with endometriosis and to show this bias is associated with pain interference. Whether interpretation bias varies over time and whether this bias can be modified through scalable and accessible interventions to alleviate pain-related interference are avenues for future research.

Peer-to-peer: The Social Transmission of Symptoms Online.

BACKGROUND: Social learning can be highly adaptive-for example, avoiding a hotplate your friend just burnt themselves on-but it has also been implicated in symptom transmission. Social learning is particularly pertinent given the rapid increase in the use of online mediums for social interaction. Yet, little is known about the social transmission of symptoms online or social chains extending further than a single model-observer interaction. PURPOSE: To explore whether socially induced symptoms could be propagated through a three-generation social transmission chain in an online setting. METHODS: We explored the social transmission of cybersickness following a virtual reality (VR) experience through online webcam interactions. One hundred and seventy-seven adults viewed a VR video in one of four links along a social transmission chain, after: viewing an actor model cybersickness to the VR video (First-Generation); viewing the First-Generation participant undergo VR (Second-Generation); viewing the Second-Generation participant undergo VR (Third-Generation); or naïve (Control). RESULTS: Cybersickness was strongest in First-Generation participants, indicating social transmission from the model. This was mediated by expectancy and anxiety. Whether or not subsequent generations experienced cybersickness depended on what the observed participant verbally reported, which is consistent with social transmission. CONCLUSIONS: Results demonstrate that symptoms can be readily transmitted online, and that expectancy and anxiety are involved. Although it is inconclusive as to whether symptoms can propagate along a social transmission chain, there is some evidence of protection from symptoms when a model who does not report any symptoms is observed. As such, this research highlights the role of social transmission in the modulation of symptoms through virtual mediums.

Social learning is a ubiquitous cognitive process whereby our own behaviors and experiences are influenced by observing others. Occasionally, this can involve the observation of an individual experiencing negative outcomes (e.g., pain or symptoms) following exposure to a treatment or intervention (e.g., consumption of medicine). Previous research has found that individuals may experience an increase in symptoms due to this social learning, even when their treatment has no active components. While research has primarily explored situations in which there is one model and one observer, it was of interest as to whether these socially induced symptoms can be transmitted beyond the first observer. Moreover, with social interaction through online mediums such as social media and video conferencing becoming more common, it was also of interest as to whether these symptoms can be transmitted online. The present findings highlight the significant role of social learning in symptom transmission, even when interactions occur online. With expectancy and anxiety being key features of this social transmission, this study highlights important implications for understanding how individuals can learn about their own future experiences through the observation of others.