You eye what you eat: BMI, consumption patterns, and dieting status predict temporal attentional bias to food-associated images.

People know that overconsumption of high-fat high-sugar (HFHS) foods have negative consequences for physical and cognitive wellbeing but continue to consume these foods in excess, leading to recent proposals to model obesity as an addiction disorder. The current experiment tested, in a large undergraduate sample (N = 306), the hypothesis that obesity and overconsumption is linked with an oversensitivity to rewards that drives attentional biases towards foods and food-associated cues. Using a modified emotion-induced blindness task with food-related distractors, we examined the extent to which attentional biases to images of HFHS foods were accounted for by BMI, HFHS food intake, self-reported hunger, time since last meal, diet status, food preferences, and attentional control. We also examined whether the same individual differences predicted attentional priority to cues that have a learned association with HFHS foods (i.e., images of food logos). Contrary to our predictions, higher BMI predicted less attentional priority for images of food and food logos. At the same time, increased consumption of HFHS foods predicted increased attentional priority for food images, whereas dieting predicted increased attentional priority for food logo images. Our results suggest that different people may preferentially attend to food versus food logo imagery based on their relationships with food. More broadly, our results support the theoretical perspective that attentional biases to food-associated stimuli can be affected by various competing, state-related factors.

Characteristics of attentional bias in meditators: An ERP study.

Attentional bias is closely related to individual mental health. To explore the effect of mindfulness meditation on attentional bias, we use the dot-probe task to measure and compare the attentional bias of 16 Shaolin monks with meditation experience (meditator group) and 18 ordinary people without meditation experience (control group). The results were as follows: (1) The control group showed attentional bias to anger stimuli, while the meditator group did not show attentional bias; (2) The P1 amplitude induced by emotion stimuli was significantly less in the meditator group than in the control group; (3) When the control group observed angry-neutral faces, the P2 amplitude was greater than when they saw neutral-neutral faces. In comparison, there was no significant difference in P2 amplitude when the meditator group viewed faces with different emotions. This leads us to contend that people highly practiced in meditation can reduce their attentional bias to negative information, and show the cognitive characteristics of "impartial" treatment to external information.

Modulation of attentional bias by hypnotic suggestion: experimental evidence from an emotional Stroop task.

Hypnosis is considered a unique tool capable of modulating cognitive processes. The extent to which hypnotic suggestions intervenes is still under debate. This study was designed to provide a new insight into this issue, by focusing on an unintentional emotional process: attentional bias. In Experiment 1, highly suggestible participants performed three sessions of an emotional Stroop task where hypnotic suggestions aiming to increase and decrease emotional reactivity towards emotional stimuli were administered within an intra-individual design. Compared to a baseline condition (without hypnotic suggestion), a significant increase in attentional bias was found when a hypnotic suggestion to increase emotional reactivity was administered. In contrast, the bias was eliminated when a suggestion to decrease emotional reactivity was administered. Experiment 2 investigated the effect of session repetition on attentional bias across three successive experimental sessions without hypnosis, and showed that the emotional Stroop effect did not vary across sessions. Hence, session repetition could not account for part of the modulation of attentional bias in Experiment 1. Taken together, the results suggest that specific hypnotic suggestions can influence elicitation of unintentional emotional processing. The implications are discussed regarding the locus of intervention of hypnotic suggestion in cognitive and emotional processes.

Using Neurofeedback from Steady-State Visual Evoked Potentials to Target Affect-Biased Attention in Augmented Reality.

Biases in attention to emotional stimuli (i.e., affect-biased attention) contribute to the development and mainte-nance of depression and anxiety and may be a promising target for intervention. Past attempts to therapeutically modify affect-biased attention have been unsatisfactory due to issues with reliability and precision. Electroencephalogram (EEG)-derived steady-state visual evoked potentials (SSVEPS) provide a temporally-sensitive biological index of attention to competing visual stimuli at the level of neuronal populations in the visual cortex. SSVEPS can potentially be used to quantify whether affective distractors vs. task-relevant stimuli have "won" the competition for attention at a trial-by-trial level during neuro-feedback sessions. This study piloted a protocol for a SSVEP-based neurofeedback training to modify affect-biased attention using a portable augmented-reality (AR) EEG interface. During neurofeedback sessions with five healthy participants, signifi-cantly greater attention was given to the task-relevant stimulus (a Gabor patch) than to affective distractors (negative emotional expressions) across SSVEP indices (p<0.000l). SSVEP indices exhibited excellent internal consistency as evidenced by a maximum Guttman split-half coefficient of 0.97 when comparing even to odd trials. Further testing is required, but findings suggest several SSVEP neurofeedback calculation methods most deserving of additional investigation and support ongoing efforts to develop and implement a SSVEP-guided AR-based neurofeedback training to modify affect-biased attention in adolescent girls at high risk for depression.

Four-week Tai Chi intervention decreases attention bias to drug cues in individuals with methamphetamine use disorder.

Background: Mind-body exercise is used for the rehabilitation of individuals with methamphetamine use disorder (MUD). Attention bias to substances is an important index of MUD. However, whether a mind-body exercise intervention can decrease attention bias is unclear.Objective: This study aimed to test the effect of a four-week Tai Chi (a Chinese traditional mind-body exercise) exercise program on the attention bias of individuals with MUD.Methods: Thirty-two men with MUD and without Tai Chi practice experience were recruited and randomly assigned to either a Tai Chi exercise group or a control group. The Tai Chi group received four-week Tai Chi training, while the control group engaged in daily exercise (including radio gymnastics and Jianxincao, two kinds of free-hand exercises). During a drug-related Stroop task, participants were instructed to respond to the color of the word ignoring the word type (drug-related or neutral words). The reaction time and d' (the index of sensitivity) were measured.Results: The participants showed attention bias to substance cues; the reaction time was slower for drug-related words than for neutral words (p < .05). After the Tai Chi intervention, the Tai Chi group showed a faster reaction time (ps < .05) and a smaller d' (ps < .05) than the baseline across all the word types. In contrast, the control group showed no differences (ps > .05).Conclusion: Four-week Tai Chi intervention reduced sensitivity and attentional bias to drug-related cues in individuals with MUD, suggesting that mind-body exercise might enhance recovery from MUD via attention control.

Effectiveness of attentional bias modification training as add-on to regular treatment in alcohol and cannabis use disorder: A multicenter randomized control trial.

BACKGROUND: Attentional bias for substance-relevant cues has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, increase positive treatment outcome and reduce relapse rates. The current study investigated the effectiveness of a newly developed home-delivered, multi-session, internet-based ABM intervention, the Bouncing Image Training Task (BITT), as an add-on to treatment as usual (TAU). METHODS: Participants (N = 169), diagnosed with alcohol or cannabis use disorder, were randomly assigned to one of two conditions: the experimental ABM group (50%; TAU+ABM); or the control group (50%; split in two subgroups the TAU+placebo group and TAU-only group, 25% each). Participants completed baseline, post-test, and 6 and 12 months follow-up measures of substance use and craving allowing to assess long-term treatment success and relapse rates. In addition, attentional bias (both engagement and disengagement), as well as secondary physical and psychological complaints (depression, anxiety, and stress) were assessed. RESULTS: No significant differences were found between conditions with regard to substance use, craving, relapse rates, attentional bias, or physical and psychological complaints. CONCLUSIONS: The findings may reflect unsuccessful modification of attentional bias, the BITT not targeting the relevant process (engagement vs. disengagement bias), or may relate to the diverse treatment goals of the current sample (i.e., moderation or abstinence). The current findings provide no support for the efficacy of this ABM approach as an add-on to TAU in alcohol or cannabis use disorder. Future studies need to delineate the role of engagement and disengagement bias in the persistence of addiction, and the role of treatment goal in the effectiveness of ABM interventions.

Supplementation of Lactobacillus early in life alters attention bias to threat in piglets.

Gut microbes play an important role in regulating brain processes and influence behaviour, cognition and emotional states in humans and rodents. Nevertheless, it is not known how ingestion of beneficial microbes modulates emotional states in piglets and whether it can improve welfare. Here we use an attention bias task to assess the effects of Lactobacillus reuteri ATCC-PTA-6475 and Lactobacillus plantarum L1-6 supplementation early in life on emotional states in 33 piglets compared to 31 placebo supplemented piglets. We hypothesized that Lactobacillus supplementation would reduce vigilance behaviour (head at shoulder height or higher) and attention (head oriented towards the threat) in response to an auditory threat. The results showed that the control group increased vigilance behaviour in response to the threat, but there was no increase in the probiotics group. Despite the increased vigilance, the control group paid less attention to the threat. One explanation may be that control piglets avoided looking in the direction of the threat just because they perceived it as more threatening, but further research is necessary to confirm this. In conclusion, Lactobacillus supplementation may be a suitable tool to reduce anxiety, promote a more appropriate response to a challenge and so improve welfare.

Cloud-Based Functional Magnetic Resonance Imaging Neurofeedback to Reduce the Negative Attentional Bias in Depression: A Proof-of-Concept Study.

Individuals with depression show an attentional bias toward negatively valenced stimuli and thoughts. In this proof-of-concept study, we present a novel closed-loop neurofeedback procedure intended to remediate this bias. Internal attentional states were detected in real time by applying machine learning techniques to functional magnetic resonance imaging data on a cloud server; these attentional states were externalized using a visual stimulus that the participant could learn to control. We trained 15 participants with major depressive disorder and 12 healthy control participants over 3 functional magnetic resonance imaging sessions. Exploratory analysis showed that participants with major depressive disorder were initially more likely than healthy control participants to get stuck in negative attentional states, but this diminished with neurofeedback training relative to controls. Depression severity also decreased from pre- to posttraining. These results demonstrate that our method is sensitive to the negative attentional bias in major depressive disorder and showcase the potential of this novel technique as a treatment that can be evaluated in future clinical trials.

A randomized controlled trial of gaze-contingent music reward therapy for major depressive disorder.

BACKGROUND: Heightened attention allocation toward negative-valanced information and reduced attention allocation toward positive-valanced information represent viable targets for attention bias modification in major depressive disorder. Accordingly, we conducted a randomized controlled trial testing the efficacy of a novel gaze-contingent attention bias modification procedure for major depressive disorder. METHOD: Sixty patients with major depressive disorder were randomly assigned to either eight training sessions of feedback-based gaze-contingent music reward therapy designed to divert patients' gaze toward positive over sad stimuli, or to a control condition which entailed eight sessions of gaze-noncontingent music. Clinician-rated and self-reported measures of depression, and proportion of dwell-time on sad faces, were assessed pretreatment, posttreatment, and at a 3-month follow-up. RESULTS: Gaze-contingent music reward therapy produced a greater reduction in dwell-time on sad faces compared with the control condition, but it failed to generalize to novel faces. Both groups manifested similarly significant reductions in depression symptoms from pre- to posttreatment that were maintained at follow-up. Exploratory analyses suggest that first-episode patients may benefit more from this therapy than patients with a history of multiple episodes. CONCLUSIONS: Gaze-contingent music reward therapy can modify attention biases in depression, but clear differential clinical effects did not emerge. Theoretical and practical implications are discussed.

Behavioral inhibition system sensitivity moderates audio-visual neutral information processing.

BACKGROUND AND OBJECTIVES: Misperception of other people's intention and emotions could cause and worsen interpersonal problems, thereby increasing the likelihood of developing depression and anxiety disorders among individuals who are already at risk for those conditions. Although multisensory emotional information is ubiquitous in the real world, most previous research focused exclusively on processing facial expressions. Addressing this gap, the current study examined the association between behavioral inhibition system (BIS) sensitivity and audio-visual emotional information processing. Sensitive BIS suggests heightened sensitivity to anxiety provoking stimuli and is a known risk factor for developing emotional disorders. We hypothesized that higher BIS levels would be associated with inefficient multisensory emotional processing, which might be pronounced for neutral stimuli. METHODS: Seventy-six undergraduates (40 women) completed a task while target faces (disgusted, happy, and neutral) were rendered invisible, and a voice (disgusted, happy, and neutral) or no voice was presented simultaneously. Participants' reaction times to indicate the location of the interocularly suppressed faces were measured. RESULTS: Individuals with lower BIS levels detected neutral faces faster when accompanied by neutral voices than by no voice; individuals with higher BIS levels, however, did not benefit from congruent auditory information when processing neutral faces. LIMITATIONS: The current study cannot address whether the finding is due to attentional biases, interpretation biases, or both in individuals who are prone to become anxious. CONCLUSION: Multisensory processing of neutral information is modulated by individuals' propensity to become anxious.

The interrelation between interpretation biases, threat expectancies and pain-related attentional processing.

BACKGROUND: Few studies examining the effect of pain-related threat on eye movements have incorporated a measure of interpretation bias. However, theories suggest that interpretation biases also play an important role in the anticipation of harm in situations where pain could be imminent. The current study investigates the association between interpretation biases and pain-related threat expectancies and their associations with eye movements to pain-related imagery. METHODS: Healthy adults' (N = 91) fear of pain, emotional functioning and interpretation biases were assessed prior to a threat manipulation where they were given either threatening or reassuring information about an upcoming cold pressor task. Participants were then asked to freely view scene images that were either pain-related or neutral. RESULTS: We used a data-driven machine learning method to analyse eye movements. We identified an explorative (i.e. greater dispersal of eye fixations) and a focused eye movement pattern subgroup (i.e. mainly focusing on foreground information) for scene viewing in the sample. Participants with more negative interpretation biases expected that the cold pressor task would be more harmful, and those with higher levels of anticipated harm used a more explorative strategy when viewing injury scene images. Subsequent analysis confirmed an indirect effect of interpretation biases on eye movements through expected bodily harm. No difference in eye movements was found between participants given threatening and reassuring information. CONCLUSIONS: Interpretation biases may play a prominent role in threat-related attentional processing. By adopting a novel eye movement analysis approach, our results revealed interesting associations among interpretations, threat expectancies and eye movements. SIGNIFICANCE: Negative interpretation biases may be associated with greater threat expectancies for an upcoming experimental pain task. Anticipation of bodily harm may induce a stimulus non-specific hypervigilant style of scanning of pain-related scenes.

Selective attention to sound features mediates cross-modal activation of visual cortices.

Contemporary schemas of brain organization now include multisensory processes both in low-level cortices as well as at early stages of stimulus processing. Evidence has also accumulated showing that unisensory stimulus processing can result in cross-modal effects. For example, task-irrelevant and lateralised sounds can activate visual cortices; a phenomenon referred to as the auditory-evoked contralateral occipital positivity (ACOP). Some claim this is an example of automatic attentional capture in visual cortices. Other results, however, indicate that context may play a determinant role. Here, we investigated whether selective attention to spatial features of sounds is a determining factor in eliciting the ACOP. We recorded high-density auditory evoked potentials (AEPs) while participants selectively attended and discriminated sounds according to four possible stimulus attributes: location, pitch, speaker identity or syllable. Sound acoustics were held constant, and their location was always equiprobable (50% left, 50% right). The only manipulation was to which sound dimension participants attended. We analysed the AEP data from healthy participants within an electrical neuroimaging framework. The presence of sound-elicited activations of visual cortices depended on the to-be-discriminated, goal-based dimension. The ACOP was elicited only when participants were required to discriminate sound location, but not when they attended to any of the non-spatial features. These results provide a further indication that the ACOP is not automatic. Moreover, our findings showcase the interplay between task-relevance and spatial (un)predictability in determining the presence of the cross-modal activation of visual cortices.

Effects of combined coffee and alcohol use over cigarette demand among treatment-seeking smokers.

OBJECTIVE: This study is aimed at comparing the relative reinforcing efficacy (RRE) of nicotine though CPT performance in function of alcohol and coffee consumption of treatment-seeking smokers. MATERIAL AND METHODS: A total of 88 treatment-seeking smokers (60.2 % female) completed the CPT. A multivariate analysis of variance (MANOVA) was used to compare alcohol (consumers and abstainers of alcohol) and coffee intake (high coffee consumers and low coffee consumers) on CPT indices. RESULTS: Univariate effects of coffee × alcohol use interaction were significant for elasticity [F (1, 83) = 4.9435, p = .038, η2 = .051] and intensity [F (1, 83) = 6.972, p = .01, η2 = .077]. CONCLUSIONS: Alcohol and coffee use is associated with an elevated cigarette demand among treatment-seeking smokers. This finding suggests the need for specific interventions to reduce alcohol and coffee use in order to increase the effectiveness of treatments for smoking cessation.

Study protocol of a randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity.

BACKGROUND: Obesity is a highly prevalent condition with multiple adverse health consequences. Widely available first-line treatments for obesity, such as dietary and other lifestyle interventions, typically have only short-term effects. Thus, new treatment approaches are needed. Novel interventions such as Attention Bias Modification Training (ABMT) and mindfulness-based interventions focus on modifying different maladaptive cognitive patterns typically present in people with obesity (e.g. attention bias to food cues); however, their mechanisms of action remain largely unknown. We describe the theoretical basis and the rationale for a study protocol of a feasibility randomised controlled trial (RCT) comparing two attention trainings (ABMT vs Mindfulness Training [MT]) in people with overweight or obesity. The aim of this study is to inform the development of a large-scale RCT in relation to acceptability and attendance rates and to identify preliminary evidence for the interventions' clinical efficacy and potential underlying mechanisms. DESIGN: Forty-five adults who are either overweight or obese (minimum body mass index of 25 kg/m2) will be randomly allocated to receive eight sessions over eight weeks of either computerised ABMT or MT or be on a waiting list. Clinical and cognitive outcomes will be assessed at baseline, post-treatment (8 weeks) and follow-up (12 weeks post-randomisation). These include mood, body composition and attention biases. Credibility and acceptability of the trainings will be assessed using questionnaires, and recruitment and retention rates will be recorded. DISCUSSION: Findings will inform the feasibility of developing a large-scale RCT that takes into consideration effect sizes for primary outcome measures and the acceptability of the design. The study will also provide preliminary evidence on the clinical efficacy of two different attention trainings for people with obesity and associated underlying mechanisms. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.

A plea for more attention to mental representations.

In this invited essay I plead for a renewed attention to mental representations in research into psychopathology and its treatment. With the cognitive revolution in the second half of the previous century most psychological models of psychopathology were based on people's capacity to form mental representations of the world. However, much research effort was put into investigating cognitive biases instead of investigating mental representations, and attention shifted towards such biases, including claims that they are causal in psychopathology. Similar claims were made about emotion regulation difficulties. Moreover, in many treatment models that were developed the focus was more on cognitive biases and emotion regulation, than on underlying representations. In this essay I argue that the causal status of cognitive biases, emotion regulation, and similar phenomena is overestimated, and that in clinical reality such phenomena can be best conceptualized as output of activated mental representations. Moreover, I argue that the disappointing effectiveness and protection to relapse of many current psychological treatments are related to not addressing the underlying mental representation. Next I discuss aspects of mental representations that are important for understanding and treating psychopathology, after which I discuss the clinical implications. I sketch how better understanding the specificities of mental representations can help us to improve psychological treatments, and I make some suggestions for future research.

Reactions to ideal body shapes.

Difficult-to-attain beauty standards that are promulgated by the media could contribute to body dissatisfaction, but their potential impact upon body image remains unclear. The present study examined reactions to thin-ideal and muscular-ideal images, and examined the effects of ideal image exposure on preferred body shape and time spent deliberating about ideal shape. In a 2 × 2 experimental design, 200 Internet users completed the Kessler psychological distress scale (K10) and were randomly assigned to view idealistic body images or houses (and rated them on semantic differential dimensions). Females viewed thin ideal images and males viewed muscular ideal images, while the control groups viewed images of houses. Between group measures analysis of variance revealed women reacted negatively to thinspirational images. Women were more driven for thinness and idealized a thinner shape for the female body than men. Psychologically distressed participants had a stronger drive for thinness and greater body dissatisfaction compared to low-distress participants. In addition, although beauty ideal imagery had no significant impact on males, females spent more time in choosing ideal body figure. Viewing thin bodies for females created a trend toward desiring a slimmer figure, as well as increased preoccupation with size as they spent more time deliberating over a photorealistic figure rating scale. Therefore, exposure to thinspiration promotes dissatisfaction with self and leads women to dwell more upon their body image.

The neural chronometry of threat-related attentional bias: Event-related potential (ERP) evidence for early and late stages of selective attentional processing.

Rapid and accurate detection of threat is adaptive. Yet, threat-related attentional biases, including hypervigilance, avoidance, and attentional disengagement delays, may contribute to the etiology and maintenance of anxiety disorders. Behavioral measures of attentional bias generally indicate that threat demands more attentional resources; however, indices exploring differential allocation of attention using reaction time fail to clarify the time course by which attention is deployed under threatening circumstances in healthy and anxious populations. In this review, we conduct an interpretive synthesis of 28 attentional bias studies focusing on event-related potentials (ERPs) as a primary outcome to inform an ERP model of the neural chronometry of attentional bias in healthy and anxious populations. The model posits that both healthy and anxious populations display modulations of early ERP components, including the P1, N170, P2, and N2pc, in response to threatening and emotional stimuli, suggesting that both typical and abnormal patterns of attentional bias are characterized by enhanced allocation of attention to threat and emotion at earlier stages of processing. Compared to anxious populations, healthy populations more clearly demonstrate modulations of later components, such as the P3, indexing conscious and evaluative processing of threat and emotion and disengagement difficulties at later stages of processing. Findings from the interpretive synthesis, existing bias models, and extant neural literature on attentional systems are then integrated to inform a conceptual model of the processes and substrates underlying threat appraisal and resource allocation in healthy and anxious populations. To conclude, we discuss therapeutic interventions for attentional bias and future directions.

Attentional bias in depression: understanding mechanisms to improve training and treatment.

One of the most common symptoms of depression is the tendency to attend to negative stimuli in the world and negative thoughts in mind. This symptom is especially nefarious because it is also a cause - biasing processing to negatively valenced information, thus worsening mood, and exacerbating the condition. Here we attempt to systematize the diverse body of recent research on the negative attentional bias from across cognitive and clinical psychology in order to identify recurring themes and devise potential mechanistic explanations. We leverage theoretical progress in our understanding of healthy attention systems in terms of internal versus external components. With this lens, we review approaches to training attention that might reduce the negative attentional bias, including behavioral interventions and real-time neurofeedback. Although extant findings are somewhat mixed, these approaches provide hope and clues for the next generation of treatments.

Feasibility and dissemination of a computerized home-based treatment for Generalized Anxiety Disorder: A randomized clinical trial.

Generalized Anxiety Disorder (GAD) is a prevalent, impairing, and undertreated psychiatric disorder. We examined if a home-based computerized treatment program can feasibly be delivered and successfully treat GAD symptoms. Using a randomized control trial, we compared three active groups receiving computerized sequenced Attention Bias Modification (ABM) followed by Applied Relaxation psychoeducation (AR-pe), the reversed sequence of AR-pe and ABM, and a simultaneous ABM and AR-pe group to an assessment only control group. The participants comprised 169 adults with a diagnosis of GAD. We asked participants to complete as many as twenty-four 30-min sessions of an at-home computerized treatment program over 12 weeks. The control group received 24 brief assessment questionnaires as well as assessments of attention bias. Results from intent-to-treat analyses show faster rate of improvement for symptoms of anxiety as measured by the Hamilton Anxiety Rating Scale (HAM-A) over time in groups that received active training in contrast to the clinical monitoring (CM) control group. Follow-up analyses revealed that both sequenced groups improved in anxiety when compared to the control group, while the simultaneous group did not outperform the control group. Results suggest that sequenced delivery of ABM and AR, may be a viable home-based treatment option for individuals with GAD who have limited access to resources or are otherwise unable to seek available treatments that require engagement outside of the home. TRIAL REGISTRATION: clinicaltrial. gov Identifier: NCT00602563.

Mapping the Affective Dimension of Embodiment With the Sensation Manikin: Validation Among Chronic Pain Patients and Modification by Mindfulness-Oriented Recovery Enhancement.

OBJECTIVE: Mindfulness-based interventions target novel pain relief mechanisms not captured by legacy pain scales, including 1) cultivating awareness of pleasant and neutral sensations proximal to unpleasant sensations and 2) interoceptively mapping sensation location and spatial distribution. METHODS: We created a digital sensation manikin (SM) by overlaying a human figure silhouette with a grid of 469 "sensation" pixels. A series of five research questions examined the SM's discriminant validity, construct validity, incremental validity, convergence with an objective measure of pain attentional bias, and sensitivity to a mindfulness-based psychological treatment, Mindfulness-Oriented Recovery Enhancement (MORE). A sample of opioid treated chronic pain patients (n = 108; age, 53.79 (12.94) years; female, 65%) was recruited to answer research questions 1 to 5, and a sample of healthy controls (n = 91; age, 36.47 (13.50) years; female, 55%) was recruited as the comparison group for research question 1. RESULTS: Chronic pain patients reported significantly more unpleasant sensations than did healthy controls (p < .001, d = 1.23) and significantly fewer pleasant sensations (p = .001, d = 0.50). The SM also evidenced expected relationships with multiple measures of pain (r = 0.26-0.29) and well-being (r = -0.21 to 0.28), uniquely predicted pain interference (ß = -0.18), and exhibited a significant association with pain attentional bias (r = 0.25). Finally, mindfulness-based intervention via MORE significantly increased the ratio of pleasant to unpleasant sensations reported by chronic pain patients relative to an active control condition (p = .036, d = 0.51). CONCLUSIONS: This study supports the SM's validity and indicates that assessing both pleasant and unpleasant sensations broadens the scope of pain measurement. Although the SM would benefit from further optimization, its continued use is likely to contribute to improved assessment and treatment options for chronic pain patients.