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This study aimed to determine the causal role of insomnia-consistent interpretation bias within the cognitive model of insomnia, by modifying this bias in students experiencing subclinical levels of insomnia and assessing subsequent effects on sleep parameters. A sample of 128 students underwent randomization to receive either a single session of online Cognitive Bias Modification-Interpretation (CBM-I) or a sham training. Participants then tracked their pre-sleep worry and sleep parameters for seven consecutive days. Interpretation bias was assessed using an encoding-recognition task specifically designed for insomnia-related interpretation bias. The CBM-I manipulation utilized ambiguous scenarios to redirect participants away from making insomnia-related interpretations. Results revealed that CBM-I effectively decreased insomnia-consistent interpretation bias compared to the sham treatment, with interpretation bias being absent post-training in the CBM-I group. This reduction did not lead to improvements in pre-sleep worry or any sleep parameters. This study has been the first to investigate the causal role of interpretation bias on symptoms of insomnia. Although results indicated this bias to be modifiable, its causality within the cognitive model proves to be more complicated. Future research focusing on optimization of cognitive bias modifications could shed more light on the effects of biased cognitions on insomnia symptoms.
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Background: Attentional processing of pain has been theorized to play a key role in the severity of pain and associated disability. In particular attentional bias towards pain information, resulting in poor pain outcomes, has been extensively researched. Recently, the idea was put forward that attention bias malleability (AM), i.e., the readiness to acquire an attentional bias irrespective of its direction, may be key in predicting poor pain outcomes. We tested this hypothesis in two studies. Methods: In Study 1, 55 healthy participants completed an AM paradigm, followed by an experimental heat pain paradigm probing pain experience and pain-related task interference. In Study 2, 71 people with chronic pain completed an AM paradigm and questionnaires probing pain experience and associated disability. Results: In Study 1, including healthy participants, no relationship was found between AM indices and experimental pain outcomes. In Study 2, including chronic pain patients, results indicated that higher levels of overall AM were related to higher levels of pain experience and disability. Conclusion: This study partially supports the hypotheses that the degree to which individuals can adapt their attentional preference in line with changing environmental conditions is associated with poor pain outcomes. However, future research is needed to clarify inconsistent findings between healthy volunteers and chronic pain patients as well as to determine the causal status of AM in poor pain outcomes.
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Viés de Atenção , Dor Crônica , Humanos , Feminino , Masculino , Adulto , Viés de Atenção/fisiologia , Dor Crônica/psicologia , Dor Crônica/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor/métodos , Inquéritos e Questionários , Adulto Jovem , Pessoas com Deficiência/psicologia , AtençãoRESUMO
The attentional bias literature has consistently failed to take context into account. We developed a novel paradigm in immersive virtual reality (VR) with pain stimuli where it would be adaptive or nonadaptive to attend to the stimuli. Participants had to indicate the location of the stimuli. Seventy participants were recruited. The VR-attention task assessed overall attentional bias (the tendency to prioritize pain compared with nonpain stimuli) and attentional alignment (the tendency to attend to pain more in adaptive than nonadaptive situations). Pain tolerance and threshold were measured using electrocutaneous stimulation and thermal pain. We conducted 2 (context: adaptive vs nonadaptive) × 2 (congruence: congruent vs incongruent) Analysis of Covariance, controlling for threat. Participants responded to pain probes more quickly in adaptive than nonadaptive contexts. There was an overall bias away from pain-related stimuli (avoidance) in reaction time to the target. There was also an interaction where avoidance was greater in nonadaptive contexts, indicative of attentional alignment. For gaze behavior, both attentional alignment and attentional bias were observed for latency to first fixation on the target, such that participants showed vigilance for pain particularly in the adaptive context. Attentional alignment was correlated with threshold and tolerance from electrocutaneous stimulation but not thermal pain. In conclusion, we found overall attentional biases indicating vigilance (latency to first fixation) and avoidance (response to target). We also found that participants evidenced a pattern of attention favoring adaptive over nonadaptive contexts (attentional alignment). It was attentional alignment, but not overall attentional bias, that predicted pain tolerance and threshold. PERSPECTIVE: The study explored attentional processes in pain through a novel paradigm designed in VR. The results found that positive attentional alignment, or the tendency to attend to pain more in adaptive contexts rather than nonadaptive contexts, predicted pain outcomes.
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BACKGROUND AND OBJECTIVES: Resilience refers to the process through which individuals show better outcomes than what would be expected based on the adversity they experienced. Several theories have proposed that variation in resilience is underpinned by cognitive flexibility, however, no study has investigated this using an outcome-based measure of resilience. DESIGN: We used a residual-based approach to index resilience, which regresses a measure of mental health difficulties onto a measure of adversity experienced. The residuals obtained from this regression constitute how much better or worse someone is functioning relative to what is predicted by the adversity they have experienced. METHODS: A total of 463 undergraduate participants completed questionnaires of mental health difficulties and adversity, as well as a number-letter task-switching task to assess cognitive flexibility. RESULTS: Multiple regression analyses showed that better cognitive flexibility was not associated with greater resilience. CONCLUSIONS: Our findings do not support theoretical models that propose the existence of a relationship between cognitive flexibility and resilience. Future research may serve to refine the residual-based approach to measure resilience, as well as investigate the contribution of "hot" rather than "cold" cognitive flexibility to individual differences in resilience.
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Attention biases towards disease-relevant cues have been implicated in numerous disorders and health conditions, such as anxiety, cancer, drug-use disorders, and chronic pain. Attention bias modification (ABM) has shown that changing attention biases can change related emotional processes. ABM most commonly uses a modified dot-probe task, which has received increasing criticism regarding its reliability and inconsistent findings. The purpose of the present review was thus to systematically review and meta-analyse alternative tasks used in ABM research. We sought to examine whether alternative tasks significantly changed attention biases and emotional outcomes, and critically examined whether relevant sample, task and intervention characteristics moderated each of these effect sizes. Seventy-four (completer n = 15,294) study level comparisons were included in the meta-analysis. Overall, alternative ABM designs had a medium effect on changing biases (g = 0.488), and a small, but significant effect on improving clinical outcomes (g = 0.117). We found this effect to be significantly larger for studies which successfully changed biases compared to those that did not. Across all tasks, it appeared that targeting engagement biases results in the largest change to attention biases. Importantly, we found tasks incorporating gaze-contingency - encouraging engagement with non-biased stimuli - show the most promise for improving emotional outcomes.
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Viés de Atenção , Humanos , Viés de Atenção/fisiologiaRESUMO
The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear.
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Viés de Atenção , COVID-19 , Humanos , Viés de Atenção/fisiologia , Pandemias , Medo/psicologia , Tempo de ReaçãoRESUMO
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.
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Endometriose , Distúrbios do Início e da Manutenção do Sono , Feminino , Humanos , Endometriose/complicações , Endometriose/psicologia , Estudos Transversais , Distúrbios do Início e da Manutenção do Sono/complicações , Depressão/etiologia , Depressão/psicologia , Dor/complicações , Medo , Fadiga/complicaçõesRESUMO
Nocebo effects in pain (nocebo hyperalgesia) have been thoroughly researched, and negative expectancies have been proposed as a key factor in causing nocebo hyperalgesia. However, little is known about the psychological mechanisms by which expectations exacerbate the perception of pain. A potential mechanism that has been proposed within wider pain research is pain-related attention. The aim of the present study was thus to explore whether attention bias (AB) to pain influenced nocebo hyperalgesia. One-hundred and thirty-four healthy participants were randomized in a 2 (AB training: towards vs away from pain) × 2 (nocebo condition: nocebo vs control) design. Pain-related AB was manipulated through a novel, partially gaze-contingent dot-probe task. Participants then completed either a nocebo instruction and conditioning paradigm or a matched control condition. Primary outcomes were measures of expectancy, anticipatory anxiety, and pain intensity completed during a nocebo test phase. Results showed that the AB manipulation was unsuccessful in inducing ABs either toward or away from pain. The nocebo paradigm induced significantly greater expectancy, anticipatory anxiety, and pain intensity for the nocebo groups compared to the control groups. In a posthoc analysis of participants with correctly induced ABs, AB towards pain amplified nocebo hyperalgesia, expectancy, and anticipatory anxiety relative to AB away from pain. The results are consistent with the expectancy model of nocebo effects and additionally identify anticipatory anxiety as an additional factor. Regarding AB, research is needed to develop reliable means to change attention sample-wide to corroborate the present findings. PERSPECTIVE: This article explores the role of AB, expectancy, and anticipatory anxiety in nocebo hyperalgesia. The study shows that expectancy can trigger anticipatory anxiety that exacerbates nocebo hyperalgesia. Further, successful AB training towards pain heightens nocebo hyperalgesia. These findings identify candidate psychological factors to target in minimizing nocebo hyperalgesia.
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Hiperalgesia , Efeito Nocebo , Humanos , Hiperalgesia/etiologia , Dor/psicologia , Ansiedade/etiologia , Medição da Dor/métodosRESUMO
OBJECTIVES: Worry about recurrence or progression is a common concern among people with chronic physical illnesses. Although there are options to measure the fear of cancer recurrence and other illness-specific measures, there is only one transdiagnostic measure of fear of progression, which does not assess the fear of recurrence or relapse. DESIGN: A multi-phase study outlining the development and validation of a novel transdiagnostic measure of fear of recurrence or progression, the Worries About Recurrence and Progression Scale (WARPS). METHOD: From a prior systematic review, we used quotes from people with lived experience to generate 55 items. Next, we piloted the items with 10 people with a range of chronic conditions, leading to a final total of 57 items. We then recruited four groups of people with cardiac disease, rheumatic disease, diabetes and respiratory disease (n = 804). An exploratory factor analysis in a randomly split sample resulted in an 18 item, single factor scale. We then performed confirmatory factor analysis on these 18 items in the remaining sample. RESULTS: The 18-item WARPS demonstrated good construct validity, internal consistency and test-retest reliability. Specifically, the WARPS was strongly correlated with the Fear of Progression Questionnaire, and with illness-specific fears. Significant, moderate correlations were observed with depression, anxiety, stress, and death anxiety. The WARPS demonstrated the validity and reliability amongst people with four of the most common chronic conditions and the factor structure was invariant across genders. CONCLUSION: The WARPS is a valid and reliable tool to measure transdiagnostic worries about recurrence and progression.
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Ansiedade , Medo , Humanos , Masculino , Feminino , Reprodutibilidade dos Testes , Psicometria , Doença Crônica , Inquéritos e QuestionáriosRESUMO
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.
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Dor Aguda , Viés de Atenção , Dor Crônica , Adulto , Humanos , Dor Crônica/psicologia , Ansiedade/psicologia , Transtornos de Ansiedade , ViésRESUMO
Chronic pain and insomnia symptoms are highly comorbid; however, the psychological mechanisms driving this comorbidity are not well understood. The aim of the present study was to assess whether 2 cognitive biases that occur separately in chronic pain and insomnia, that is, interpretation bias and attentional bias, are heightened in people with comorbid chronic pain and elevated insomnia symptoms. A final sample of N = 109 people with chronic pain and N = 79 people without pain who varied in insomnia symptoms were recruited through Prolific Academic to complete this cross-sectional study. Participants completed measures of sleep and pain-related interpretation bias (ambiguous sentences task) and attentional bias (dot-probe task), as well as questionnaires assessing insomnia symptoms, pain symptoms, and general psychological symptoms. We found an interaction between pain status and insomnia symptoms for sleep-related interpretation bias. That is, people with chronic pain showed greater sleep-related interpretation bias than those without pain, but only when insomnia symptoms were also elevated. This interaction did not extend to pain interpretation bias or attentional bias, although we did find an elevated pain interpretation bias in people with chronic pain compared to pain-free individuals. We also found that both pain and sleep-related interpretation bias were associated with depression symptoms, suggesting that interpretation bias could potentially drive a trimorbidity of chronic pain, insomnia, and depression. Taken together, these findings suggest promise for the role of interpretation bias in the mutual maintenance of chronic pain and insomnia symptoms and the importance of also considering depression. PERSPECTIVE: This article presents data on the cognitive biases that are present in chronic pain, and that are associated with increased insomnia symptoms. Identifying such cognitive biases could help in explaining the high comorbidity between chronic pain and insomnia, leading to more effective and targeted treatments.
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Viés de Atenção , Dor Crônica , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Dor Crônica/psicologia , Dor Crônica/epidemiologia , Dor Crônica/complicações , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Viés de Atenção/fisiologia , Comorbidade , Depressão/epidemiologia , Adulto Jovem , IdosoRESUMO
OBJECTIVE: The nocebo effect represents a growing concern in clinical settings. Nocebo effects occur when the treatment context generates negative expectancies that trigger the experience or worsening of negative symptoms beyond any effects attributable to the treatment itself. Despite being identified in a range of outcomes and conditions, from pain to Parkinson's disease, there has not been an attempt to systematically quantify the nocebo effects across health outcomes. The purpose of the present review was thus to systematically review and meta-analyze the nocebo literature to quantify the size of the nocebo effect across outcomes and examine which factors moderate the size of the nocebo effect, including process of induction, treatment type, or health outcome. METHOD: Systematic searches of PubMed, PychInfo, Medline, and Web of Science identified 130 (n = 8,219) independent eligible studies. To be included, studies had to include both a nocebo and control group/condition, which were compared to isolate the nocebo effect size. RESULTS: Overall, the magnitude of the nocebo effect was medium (g = 0.522) and highly heterogeneous. Two key moderators emerged: health outcome and process of induction. Here, the nocebo effect was medium for most somatic outcomes and affect, with no significant effect on worsening cognitive performance. Further, inducing nocebo effects through instruction in combination with conditioning produced larger nocebo effects. CONCLUSIONS: The present review suggests nocebo effects can be reliably induced across somatic health outcomes, and interventions that target the effect of instructions will be of critical importance to reducing the occurrence of nocebo effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Efeito Nocebo , Doença de Parkinson , Humanos , DorRESUMO
OBJECTIVES: People with rheumatoid arthritis (RA) have higher levels of fear of disease progression (FOP) than cancer survivors. In cancer, FOP is inextricably linked with existential concerns. However, this has not been investigated in people with RA. METHODS: We recruited 165 people with RA (96%F) who volunteered for a treatment trial of psychological intervention. Participants completed the Existential Concerns Questionnaire (ECQ) and questionnaires measuring constructs associated with FOP in cancer. We created groups of people with RA, with and without clinically significant levels of FOP (clinical and control groups) and compared their existential concerns. We hypothesized that existential concerns would add to the variance in FOP over and above pain, psychopathology, and disability. RESULTS: Nearly two-thirds of people with RA scored in the clinical range for FOP. The clinical group had higher levels of all existential concerns than the control group. When subscales of the ECQ were entered into a multiple regression with FOP as the dependent variable, death anxiety, meaninglessness and guilt domains accounted for significant variance in FOP. Moreover, when added to a regression equation controlling all other variables, existential concerns continued to account for unique variance in FOP (t = 2.712, p = 0.007). CONCLUSION: Existential concerns were strongly associated with FOP. While this cross-sectional study cannot determine whether existential concerns underlie FOP in RA, these results show robust relationships that warrant future investigation.
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Artrite Reumatoide , Neoplasias , Humanos , Estudos Transversais , Progressão da Doença , Medo/psicologia , Neoplasias/psicologia , Inquéritos e QuestionáriosRESUMO
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.
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Endometriose , Feminino , Humanos , Adulto , Endometriose/complicações , Estudos Transversais , Dor/complicações , Medo/psicologia , Inquéritos e QuestionáriosRESUMO
Climate change is a serious threat to human health and the awareness of this threat can elicit ecological anxiety (eco-anxiety), which could be considered a rational and potentially adaptive response. However, the experience of eco-anxiety does not always lead to adaptive behaviour. The present study investigated whether differential patterns of selective attention towards climate-related information, and variability in this attention, might explain this inconsistent relationship. Participants completed a dot-probe assessment of attentional bias to images of both climate change mitigation strategies and of climate change causes and consequences, and measures of eco-anxiety, climate change belief, environmental self-efficacy, and general psychological symptoms. Engagement in pro-environmental behaviours was measured using a daily behavioural diary. Eco-anxiety and attentional bias independently predicted behaviour, but did not interact. However, attentional bias variability moderated the relationship between eco-anxiety and behaviour, such that higher eco-anxiety predicted greater behavioural engagement, but only when attentional bias variability was low. This was the first known study to examine the potential moderating effect of attentional bias on the relationship between eco-anxiety and pro-environmental behaviours. This growing field of research can help in identifying how the rational response of eco-anxiety can be better harnessed to motivate an adaptive response to the climate crisis.
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Ansiedade , Viés de Atenção , Humanos , Ansiedade/psicologia , Atenção/fisiologia , Transtornos de Ansiedade , Viés de Atenção/fisiologia , Mudança ClimáticaRESUMO
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.
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Dor Crônica , Endometriose , Feminino , Humanos , Dor Crônica/psicologia , Endometriose/complicações , Medição da Dor , Inquéritos e Questionários , ViésRESUMO
BACKGROUND: The aim of the present review was to determine whether attentional bias variability (ABV) is causally implicated in emotional vulnerability. We consider evidence examining whether ABV precedes and predicts later psychopathology, and whether modifying ABV leads to changes in psychological symptoms following an intervention. METHODS: A systematic literature search located 15 studies that met the inclusion criteria (3 longitudinal, 12 intervention). Eligible intervention studies were also meta-analysed. RESULTS: Preliminary evidence suggests that ABV predicts later post-traumatic stress symptomatology in interaction with number of traumatic events. The few interventions designed to reduce ABV suggest promise for improving PTSD symptoms. However, these interventions did not consistently change ABV, and where it was tested, change in ABV did not correspond to change in symptoms. CONCLUSIONS: There is emerging evidence that ABV could represent a vulnerability factor for psychological symptoms, particularly for those exposed to trauma. This may indicate attentional control difficulties, although this remains to be tested. Conclusions regarding the causal status of ABV will depend on future high-quality randomised controlled trials.
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Viés de Atenção , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
ABSTRACT: Cognitive bias modification for interpretation (CBM-I) is an effective intervention for anxiety, but there is only a single trial in people with chronic pain. The aim of this randomized controlled trial was to test CBM-I with and without psychoeducation for people with chronic pain. We randomized 288 participants to 4 groups comprising treatment (CBM-I vs placebo) with or without psychoeducation. One hundred and eighty-three participants (64%) completed 4, 15-minute training sessions over 2 weeks. The coprimary outcomes were pain interference and pain intensity. We also measured interpretation bias, fear of movement, catastrophizing, depression, anxiety, and stress. Participants with more psychopathology at baseline were more likely to dropout, as were those allocated to psychoeducation. Intention-to-treat analyses using linear mixed models regression were conducted. Training effects of CBM-I were found on interpretation bias, but not a near-transfer task. Cognitive bias modification of interpretation improved both primary outcomes compared with placebo. For pain interference, there was also a main effect favoring psychoeducation. The CBM-I group improved significantly more than placebo for fear of movement, but not catastrophizing, depression, or anxiety. Cognitive bias modification of interpretation reduced stress but only for those who also received psychoeducation. This trial shows that CBM-I has promise in the management of pain, but there was limited evidence that psychoeducation improved the efficacy of CBM-I. Cognitive bias modification of interpretation was administered entirely remotely and is highly scalable, but future research should focus on paradigms that lead to better engagement of people with chronic pain with CBM-I.
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Dor Crônica , Humanos , Dor Crônica/terapia , Resultado do Tratamento , Transtornos de Ansiedade/psicologia , Ansiedade/etiologia , Ansiedade/terapia , Ansiedade/psicologia , Viés , CogniçãoRESUMO
Despite the theoretical prominence of expectancy and anxiety as potential mechanisms of the nocebo effect, not all studies measure expectancy and/or anxiety, and there are inconsistent findings among those that do. The present study sought to systematically review and meta-analyse available data to evaluate the relationship between expectancy, anxiety and the nocebo effect. The two key questions were: (1) whether nocebo manipulations influence expectancy and anxiety; and (2) whether expectancy and anxiety are associated with the subsequent nocebo effect. Fifty-nine independent studies (n = 3129) were identified via database searches to 1st August 2021. Nocebo manipulations reliably increased negative expectancy with a large effect (g = .837) and state anxiety with a small effect (g = .312). Changes in expectancy and state anxiety due to the nocebo manipulation were associated with larger nocebo effects (r = .376 and .234, respectively). However, there was no significant association between dispositional anxiety and the nocebo effect. These findings support theories that rely on situationally-induced expectancy and anxiety, but not dispositional anxiety, to explain nocebo effects. Importantly, being malleable, these findings suggest that interventions that target maladaptive negative expectancies and state anxiety could be beneficial for reducing the harm nocebo effects cause across health settings. Recommendations for future research are discussed.
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Efeito Nocebo , Efeito Placebo , Humanos , Ansiedade , Transtornos de AnsiedadeRESUMO
Contemporary cognitive theories of anxiety and attention processing propose that heightened levels of anxiety vulnerability are associated with a decreasing ability to inhibit the allocation of attention towards task-irrelevant information. Existing performance-based research has most often used eye-movement assessment variants of the antisaccade paradigm to demonstrate such effects. Critically, however, eye-movement assessment methods are limited by expense, the need for expert training in administration, and limited mobility and scalability. These barriers have likely led to researchers' use of suboptimal methods of assessing the relationship between attentional control and anxiety vulnerability. The present study examined the capacity for a non-eye-movement-based variant of the antisaccade task, the masked-target antisaccade task (Guitton et al., 1985), to detect anxiety-linked differences in attentional control. Participants (N = 342) completed an assessment of anxiety vulnerability and performed the masked-target antisaccade task in an online assessment session. Greater levels of anxiety vulnerability predicted poorer performance on the task, consistent with findings observed from eye-movement methods and with cognitive theories of anxiety and attention processing. Results also revealed the task to have high internal reliability. Our findings indicate that the masked-target antisaccade task provides a psychometrically reliable, low-cost, mobile, and scalable assessment of anxiety-linked differences in attentional control.