Attention to pain: Does it help to think about Hawaii?- How pain control strategies shape attentional biases towards pain

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Pain is a common, worldwide health problem. Pain is not merely somatic: 80% of back pain cases, for example, do not present with a somatic cause. Therefore, it is important to look at psychological factors, such as cognition and emotion, which play important roles in pain development and maintenance. A cognitive factor influencing pain, positively correlated with pain intensity, pain-related distress and disability, is attention towards pain. A preferential allocation of attention towards pain, to the cost of other information in the environment, is called a pain-related attentional bias, and is linked to the development of disability and chronic pain. It is currently unclear how a pain-related attentional bias can be optimally mitigated, although studies on anxiety disorders suggest that it can be influenced by cognitive control strategies. However, to date no studies have examined this key issue in the field of pain.The proposed project aims to elucidate this influence of cognitive pain control strategies on attentional biases towards pain. The experiment will include a manipulation of two strategies, employed to control pain during a painful stimulation: thought suppression and focused distraction. The essential question is: Is it better to just not think about pain (thought suppression - Do not think about the pain!), or to think a concrete other thought instead (focused distraction - Think about a Hawaiian beach!)? This is a subtle but important difference. In thought suppression, there is a rebound effect, causing the suppressed thoughts to resurface stronger than before. Thought suppression and attentional biases have been jointly studied in anxiety disorders, suggesting a causal relationship. No such effects are known in focused distraction. The proposed study is the first endeavour to translate these findings into the field of pain.Healthy subjects will be instructed to employ the two strategies during a cold pain induction. After the pain, it is tested with a dot-probe task whether the two pain control strategies differently influence an attentional bias towards pain. Anxiety is assessed as a covariate and a potential moderator of this relationship.The expected results have both theoretical and practical use: First, they could clarify the mechanisms with which attention and pain work together. Second, they could simplify pain treatment, if thought suppression causes an attentional bias towards pain, while focused distraction prevents it. Thought suppression is often spontaneously employed by the patients, while learning focused distraction in treatment would then be a much simpler and more effective strategy to control pain. It could be employed as a part of treatment as well as a preliminary measure for patients on the wait list.