Pain-Related Attentional Biases: The Importance of the Personal Relevance and Ecological Validity of Stimuli

Published:February 11, 2011DOI:


      The literature regarding pain-related attentional biases is currently marked by considerable inconsistency. The primary aim of the present study was to examine whether 2 stimulus-related factors may be important to the detection of pain-related attentional biases: 1) the personal relevance of stimuli; and 2) their ecological validity. To do this, the present research compared the ability of a word-based dot-probe task (ie, lower ecological validity) and picture-based dot-probe task (ie, higher ecological validity) to detect attentional biases using generally selected (ie, lower personal relevance) and idiosyncratically selected stimuli (ie, higher personal relevance). To do this, the present study used a large sample of chronic pain patients and matched pain-free individuals. Attentional biases were found among both chronic pain patients and pain-free individuals for idiosyncratically selected pictorial stimuli (ie, highest ecological validity and personal relevance) but not for generally selected pictorial stimuli or for pain-related word stimuli, irrespective of whether they were idiosyncratically or generally selected. These biases were found to stem from vigilance for pain-related stimuli. Overall, the findings of the present study suggest that similar pain-related attentional biases can be found among both pain-free individuals and chronic pain patients and that stimulus-related factors may be important to the detection of those biases.


      To date, research examining pain-related attentional biases has yielded inconsistent results. The present study sought to examine 2 stimulus-related factors often identified for their potential to influence the consistency of findings. The findings of this study highlight the importance of considering stimulus-related factors when designing and interpreting pain-related dot-probe research.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Andersson G.
        • Haldrup D.
        Personalized pain words and Stroop interference in chronic pain patients.
        Euro J Pain. 2003; 7: 431-438
        • Asmundson G.J.G.
        • Carleton R.N.
        • Ekong J.
        Dot-probe evaluation of selective attentional processing of pain cues in patients with chronic headaches.
        Pain. 2005; 114: 250-256
        • Asmundson G.J.G.
        • Kuperos J.L.
        • Norton G.R.
        Do patients with chronic pain selectively attend to pain-related information? Preliminary evidence for the mediating role of fear.
        Pain. 1997; 72: 27-32
        • Asmundson G.J.G.
        • Wright K.D.
        • Hadjistavropoulos H.D.
        Hypervigilance and attentional fixedness in chronic musculoskeletal pain: Consistency of findings across modified stroop and dot-probe tasks.
        J Pain. 2005; 8: 479-506
        • Bradley B.P.
        • Mogg K.
        • Falla S.J.
        • Hamilton L.R.
        Attentional bias for threatening facial expressions in anxiety: Manipulation of stimulus duration.
        Cognition Emotion. 1998; 12: 737-753
        • Boston A.
        • Sharpe L.
        The role of threat-expectancy in acute pain: Effects on attentional bias, coping strategy effectiveness and response to pain.
        Pain. 2005; 119: 168-175
        • Crombez G.
        • Hermans D.
        • Adriaensen G.
        The emotional stroop task and chronic pain: What is threatening for chronic pain sufferers?.
        Euro J Pain. 2000; 4: 37-44
        • Dehghani M.
        • Sharpe L.
        • Nicholas M.K.
        Selective attention to pain-related information in chronic musculoskeletal pain patients.
        Pain. 2003; 105: 37-46
        • Dehghani M.
        • Sharpe L.
        • Nicholas M.K.
        Modification of attentional biases in chronic pain patients: A preliminary study.
        Euro J Pain. 2004; 8: 585-594
        • Haggman S.
        • Sharpe L.
        • Nicholas M.K.
        • Refshauge K.M.
        Attentional biases toward sensory pain words in acute and chronic pain patients.
        J Pain. 2010; 11: 1129-1135
        • International Association for the Study of Pain
        Classification of chronic pain: Descriptions of chronic pain syndromes and definition of pain terms.
        Pain. 1986; 26: 1-222
        • Keogh E.
        • Cochrane M.
        Anxiety sensitivity, cognitive biases, and the experience of pain.
        J Pain. 2002; 3: 320-329
        • Keogh E.
        • Ellery D.
        • Hunt C.
        • Hannent I.
        Selective attentional bias for pain-related stimuli among pain fearful individuals.
        Pain. 2001; 91: 91-100
        • Keogh E.
        • Thompson T.
        • Hannent I.
        Selective attentional bias, conscious awareness and the fear of pain.
        Pain. 2003; 104: 85-91
        • Khatibi A.
        • Dehghani M.
        • Sharpe L.
        • Asmundson G.J.G.
        • Pouretemad H.
        Selective attention towards painful faces among chronic pain patients: Evidence from a modified version of the dot-probe.
        Pain. 2009; 142: 42-47
        • Korri S.H.
        • Miller R.P.
        • Todd D.D.
        • Kinesiophobia
        A new view of chronic pain behaviour.
        Pain Manag. 1990; 3: 25-43
        • Koster E.H.W.
        • Crombez G.
        • Verscuere B.
        • De Houwer J.
        Selective attention to threat in the dot probe paradigm: Differentiating vigilance and difficulty to disengage.
        Behav Res Ther. 2004; 42: 1183-1192
        • Koster E.H.W.
        • Crombez G.
        • Verschuere B.
        • De Houwer J.
        Attention to threat in anxiety-prone individuals: Mechanisms underlying attentional bias.
        Cogn Ther Res. 2006; 30: 635-643
        • Kugler K.
        • Wijn J.
        • Geilen M.
        • De Jong J.
        • Vlaeyen J.W.S.
        The Photograph Series of Daily Activities (PHODA): CD-Rom version 1.0.
        Institute for Rehabilitation Research and School for Physiotherapy, Heerlen, Netherlands1999
        • Lang P.J.
        • Bradley M.M.
        • Cuthbert B.N.
        International affective picture system (IAPS): Affective ratings of pictures and instructional manual.
        Technical Report A-6, University of Florida, Gainesville, FL2005
        • Liossi C.
        • Schoth D.E.
        • Bradley B.P.
        • Mogg K.
        Time-course of attentional bias for pain-related cues in chronic daily headache sufferers.
        Euro J Pain. 2009; 13: 963-969
        • Lovibond S.H.
        • Lovibond P.F.
        Manual for the Depression Anxiety Stress Scales.
        1st ed. Psychology Foundation, Sydney, NSW1995
        • McGowan N.
        • Sharpe L.
        • Refshauge K.
        • Nicholas M.K.
        The effect of attentional re-training and threat expectancy in response to acute pain.
        Pain. 2009; 142: 101-107
        • McNeil D.W.
        • Rainwater A.J.
        Development of the Fear of Pain Questionnaire III.
        J Behav Med. 1998; 21: 389-410
        • Mogg K.
        • Bradley B.P.
        Some methodological issues in assessing attentional biases for threatening faces in anxiety: A replication study using a modified version of the probe detection task.
        Behav Res Ther. 1999; 37: 595-604
        • Nicholas M.K.
        • Asghari A.
        • Blyth F.M.
        What do the numbers mean? Normative data in chronic pain measures.
        Pain. 2008; 134: 158-173
        • Pincus T.
        • Morley S.
        Cognitive processing bias in chronic pain: A review and integration.
        Psychol Bull. 2001; 127: 599-617
        • Riemann B.C.
        • McNally R.J.
        Cognitive processing of personally relevant information.
        Cognition Emotion. 1995; 9: 325-340
        • Roelofs J.
        • Peters M.L.
        • Fassaert T.
        • Vlaeyen J.W.S.
        The role of fear of movement and injury in selective attentional processing in patients with chronic low back pain: A dot-probe evaluation.
        J Pain. 2005; 6: 294-300
        • Roelofs J.
        • Peters M.L.
        • van der Zijden M.
        • Thielen F.G.J.M.
        • Vlaeyen J.W.S.
        Selective attention and avoidance of pain-related stimuli: A dot-probe evaluation in a pain-free population.
        J Pain. 2003; 4: 322-328
        • Roland M.
        • Morris S.
        A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain.
        Spine. 1983; 8: 141-144
        • Sharpe L.
        • Dear B.
        • Shrieber L.
        Attentional biases in chronic pain associated with rheumatoid arthritis: Hypervigilance or difficulties disengaging?.
        J Pain. 2009; 10: 329-335
        • Vlaeyen J.W.S.
        • Kole-Snijders A.M.J.
        • Boeren R.G.B.
        • van Eek H.
        Fear of movement/(re)injury in chronic low back pain and its relation to behavioural performance.
        Pain. 1995; 62: 363-372
        • Vlaeyen J.W.S.
        • Linton S.J.
        Fear avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332