Exploring Cognitive Biases in Pain: Investigating Attention, Interpretation and Memory Bias..

Cognitive-affective models posit that cognitive biases contribute to the aetiology and maintenance of chronic pain. In chronic pain, it is argued that cognitive biases encapsulate interpretation bias, attentional bias, and memory bias. These biases are suggested to exert their influence through the preferential processing of information pertaining to pain, bodily-threat, and harm. Research exploring multiple cognitive biases within the context of a single study is limited. Thus, the role, nature and interaction of these cognitive biases remains poorly understood. This programme of research aimed to address these limitations. Studies 1 and 2 progressed the development and validation of stimulus sets suitable for measuring pain-related attention and interpretation biases in adults. Study 3 then investigated whether a single experience of pain influences cognitive biases in a pain-free sample subjected to acute pain; and study 4 investigated the measurement of cognitive biases, in a chronic pain (vs. non-pain control) sample. Study 1 resulted in the development of two stimulus sets categorised via varying degrees of pain intensity (neutral, low, high) and threat (low, medium, high) to enable rigorous investigation of attentional bias. Study 2 resulted in the development and validation of two ambiguous scenario stimulus sets to enable rigorous investigation of interpretation (and subsequently memory) bias utilising i) forced-choice and ii) free-response paradigms. Supplementary analyses indicated that recent pain experiences positively correlated with the endorsement of pain/pain-illness interpretations of the ambiguous scenarios. Study 3 revealed that a single acute pain experience was not sufficient to influence cognitive biases. However, individuals subjected to a warm water control (as opposed to a cold-pressor task) showed increased attention towards pain-related information, increased recall of pain words immediately following the warm water control, and greater recognition of non-pain words. Additionally, in the acute pain group, measures of pain threshold and tolerance were associated with attention, interpretation, and memory biases. These results indicate a potentially pleasant experience can bias attention toward pain stimulus processing and the importance of pain sensitivity as an influencing cognitive bias factor. Consistent with Study 3, Study 4 provided no evidence of pain-related interpretation or recall biases. However, the chronic pain group exhibited poorer overall recognition performance, compared to their pain-free counterparts. Cross-bias correlations further revealed that as the number of ambiguous scenarios interpreted as pain/pain-illness related increased, so too did the number of pain/pain-illness solutions correctly recalled, irrespective of pain experience. However, correlations between cognitive biases for the non-pain/non-pain illness stimuli were exclusive to the pain-free group. This indicates that the chronic pain group processed scenarios interpreted in a pain/pain-illness manner differently than those they interpreted in a non-pain/non-pain illness manner. Overarching conclusions indicate that individuals with lower pain thresholds and tolerance are more likely to display biased attention, interpretation, and memory favouring pain/pain-illness information; and that individuals with chronic pain display impaired recognition for pain/pain-illness related information. A detailed discussion of these findings is presented in the final chapter, including the proposition of a Pain Sensitivity Model in understanding the role of cognitive biases in pain