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

疼痛是一种常见的全球性健康问题。疼痛不仅仅是躯体的：例如，80%的背痛病例不存在躯体原因。因此，重要的是要看看心理因素，如认知和情绪，这在疼痛的发展和维持中起着重要作用。影响疼痛的认知因素是对疼痛的关注，与疼痛强度、疼痛相关的痛苦和残疾呈正相关。将注意力优先分配给疼痛，而不是环境中的其他信息，这被称为与疼痛相关的注意力偏差，并与残疾和慢性疼痛的发展有关。目前尚不清楚如何最佳地减轻疼痛相关的注意力偏差，尽管对焦虑症的研究表明，它可以受到认知控制策略的影响。然而，到目前为止，还没有研究在疼痛领域的这一关键问题。拟议的项目旨在阐明这种影响的认知疼痛控制策略对疼痛的注意偏向。该实验将包括两种策略的操作，用于在疼痛刺激期间控制疼痛：思想抑制和集中注意力分散。根本问题是：不去想疼痛是否更好（思想抑制-不去想疼痛！），或者去想一个具体的其他想法（集中注意力--想想夏威夷的海滩！）？这是一个微妙但重要的区别。在思维压制中，有反弹效果，使得被压制的思维比之前更强。思维抑制和注意力偏差在焦虑症中被联合研究，表明存在因果关系。在集中注意力的分散中没有这样的效应。这项研究是将这些发现应用于疼痛领域的第一次尝试，将指导健康受试者在冷痛诱导过程中使用这两种策略。疼痛后，它是测试与点探测任务是否有两个疼痛控制策略不同的影响对疼痛的注意偏向。焦虑被认为是这一关系的协变量和潜在调节因子，预期的结果具有理论和实际的用途：首先，它们可以阐明注意和疼痛共同作用的机制。第二，如果思维抑制导致了对疼痛的注意偏向，而集中注意力分散则可以防止这种偏向，那么他们可以简化疼痛治疗。思维抑制通常是患者自发使用的，而在治疗中学习集中注意力分散将是一种更简单、更有效的控制疼痛的策略。它可以作为治疗的一部分，也可以作为等待名单上的病人的初步措施。

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.