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Comparing the Effects of Thought Suppression and Focused Distraction on Pain-Related Attentional Biases in Men and Women

      Highlights

      • Effects of 2 cognitive strategies on attentional biases were compared.
      • Thought suppression reduced cold pressor pain intensity.
      • No difference in pain biases between thought suppression or focused distraction.
      • Cognitive strategy type and gender had a non-pain-related effect on temporal bias.
      • No differences were found on a spatial (dot-probe) task.

      Abstract

      Increasing attentional focus away from pain can affect pain experience, suggesting that cognitive strategies that move attentional allocation may be a moderator of pain. In a pre-post-design, the present study examined the effects of 2 cognitive strategies used in pain contexts, thought suppression and focused distraction, on subsequent pain-related attention. Thought suppression was hypothesized to increase pain-related attention, whereas focused distraction was expected to reduce it. Influences of both anxiety and sex were also considered, as secondary questions. 139 (86 women, 53 men) healthy, pain-free participants were randomly assigned to use either thought suppression or focused distraction during a mild cold pressor test (CPT). Pain-related attention was examined using a dot-probe and an attentional blink task, pre-and post-CPT. Questionnaires about relevant cognitive and emotional aspects, demographics, and pain were completed. Results showed no difference in the effect of the 2 pain inhibition strategies on pain-related attention. The hypothesized rebound effect in thought suppression on pain-related attention did not emerge. However, thought suppression showed a short-term benefit in comparison to focused distraction regarding reported pain and perceived threat during the cold pressor test. Few sex differences were found. Thus, the cognitive strategies affected pain outcomes, but did not influence pain-related attention.

      Perspective

      Cognitive strategies could help with pain through changing attention allocation. In this study, the effects of the 2 cognitive strategies thought suppression and focused distraction on pain-related attention in men and women were examined. Elucidating mechanisms that lie behind pain strategies that focus on changing attention may help improve treatments.

      Key Words

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      References

        • Abramowitz JS
        • Tolin DF
        • Street GP
        Paradoxical effects of thought suppression: A meta-analysis of controlled studies.
        Clin Psychol Rev. 2001; 21: 683-703
        • Agoston AM
        • Sieberg CB
        Nonpharmacologic treatment of pain.
        Semin Pediatr Neurol. 2016; 23: 220-223https://doi.org/10.1016/j.spen.2016.10.005
        • Attridge N
        • Crombez G
        • Van Ryckeghem D
        • Keogh E
        • Eccleston C
        The experience of cognitive intrusion of pain: Scale development and validation.
        Pain. 2015; 156: 1978-1990https://doi.org/10.1097/j.pain.0000000000000257
        • Baum C
        • Schneider R
        • Keogh E
        • Lautenbacher S
        Different stages in attentional processing of facial expressions of pain: A dot-probe task modification.
        J Pain. 2013; 14: 223-232https://doi.org/10.1016/j.jpain.2012.11.001
        • Burns JW
        The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: Evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients.
        Emotion. 2006; 6: 180-192
        • Carr AR
        • Scully A
        • Webb M
        • Felmingham KL
        Gender differences in salivary alpha-amylase and attentional bias towards negative facial expressions following acute stress induction.
        Cogn Emot. 2016; 30: 315-324https://doi.org/10.1080/02699931.2014.999748
        • Cioffi D
        • Holloway J
        Delayed costs of suppressed pain.
        J Pers Soc Psychol. 1993; 64: 274-282
        • Clark DM
        • Winton E
        • Thynn L
        A further experimental investigation of thought suppression.
        Behav Res Ther. 1993; 31: 207-210
        • Crombez G
        • Van Ryckeghem DM
        • Eccleston C
        • Van Damme S
        Attentional bias to pain-related information: A meta-analysis.
        Pain. 2013; 154: 497-510https://doi.org/10.1016/j.pain.2012.11.013
        • Dehghani M
        • Sharpe L
        • Nicholas MK
        Modification of attentional biases in chronic pain patients: A preliminary study.
        Eur J Pain. 2012; 8: 585-594
        • Dux PE
        • Marois R
        The attentional blink: A review of data and theory.
        Atten Percept Psychophys. 2009; 71: 1683-1700https://doi.org/10.3758/APP.71.8.1683
        • Eccleston C
        • Crombez G
        Pain demands attention: A cognitive-affective model of the interruptive function of pain.
        Psychol Bull. 1999; 125: 356-366
        • Fawzy TI
        • Hecker JE
        • Clark J
        The relationship between cognitive avoidance and attentional bias for snake-related thoughts.
        J Anxiety Disord. 2006; 20: 1103-1117
        • Goubert L
        • Crombez G
        • Eccleston C
        • Devulder J
        Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain.
        Pain. 2004; 110: 220-227
        • Hasenbring M
        Endurance strategies – a neglected phenomenon in the research and therapy of chronic pain?.
        Der Schmerz. 1993; 52 (in German): 304-313
        • Hasenbring M
        • Chehadi O
        • Titze C
        • Kreddig N
        Fear and anxiety in the transition from acute to chronic pain: There is evidence for endurance besides avoidance.
        Pain Manag. 2014; 4: 363-374https://doi.org/10.2217/pmt.14.36
        • Hasenbring M
        • Hallner D
        • Klasen B
        • Streitlein-Böhme I
        • Willburger R
        • Rusche H
        Pain-related avoidance versus endurance in primary care patients with subacute back pain: Psychological characteristics and outcome at a 6-month follow-up.
        Pain. 2012; 52: 211-217https://doi.org/10.1016/j.pain.2011.10.019
        • Hasenbring M
        • Hallner D
        • Rusu AC
        Fear-avoidance- and endurance-related responses to pain: Development and validation of the Avoidance-Endurance Questionnaire (AEQ).
        Eur J Pain. 2009; 52: 620-628https://doi.org/10.1016/j.ejpain.2008.11.001
        • Henry JD
        • Crawford JR
        The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample.
        Br J Clin Psychol. 2005; 44: 227-239
        • Hirsh AT
        • George SZ
        • Bialosky JE
        • Robinson ME
        Fear of pain, pain catastrophizing, and acute pain perception: Relative prediction and timing of assessment.
        J Pain. 2008; 9: 806-812
        • Hülsebusch J
        • Hasenbring M
        • Rusu AC
        Understanding pain and depression in back pain: The role of catastrophizing, help-/hopelessness, and thought suppression as potential mediators.
        Int J Behav Med. 2015; 23: 251-259https://doi.org/10.1007/s12529-015-9522-y
        • Hunt C
        • Keogh E
        • French CC
        Anxiety sensitivity: The role of conscious awareness and selective attentional bias to physical threat.
        Emotion. 2006; 6: 418-428
        • Johnson MH
        How does distraction work in the management of pain?.
        Curr Pain Headache Rep. 2005; 9: 90-95
        • Jolicoeur P
        Restricted attentional capacity between sensory modalities.
        Psychol Bull Rev. 1999; 6: 87-92
        • Keogh E
        • Attridge N
        • Walsh J
        • Bartlett J
        • Francis R
        • Bultitude JH
        • Eccleston C
        Attentional biases towards body expressions of pain in men and women.
        J Pain. 2021; 22: 1696-1708https://doi.org/10.1016/j.jpain.2021.06.003
        • Keogh E
        • Bond FW
        • Hanmer R
        • Tilston J
        Comparing acceptance- and control-based coping instructions on the cold-pressor pain experiences of healthy men and women.
        Eur J Pain. 2005; 9: 591-598https://doi.org/10.1016/j.ejpain.2004.12.005
        • Keogh E
        • Cheng F
        • Wang S
        Exploring attentional biases towards facial expressions of pain in men and women.
        Eur J Pain. 2018; 22: 1617-1627https://doi.org/10.1002/ejp.1244
        • Walsh J
        • Eccleston C
        • Keogh E
        Gender differences in attention to pain body postures in a social context: a novel use of the bodies in the crowd task.
        Pain. 2020; 161: 1776-1786https://doi.org/10.1097/j.pain.0000000000001873
        • Keogh E
        • Ellery D
        • Hunt C
        • Hannent I
        Selective attentional bias for pain-related stimuli amongst pain fearful individuals.
        Pain. 2001; 91: 91-100
        • Keogh E
        • Hatton K
        • Ellery D
        Avoidance versus focused attention and the perception of pain: differential effects for men and women.
        Pain. 2000; 85: 225-230
        • Keogh E
        • Herdenfeldt M
        Gender, coping and the perception of pain.
        Pain. 2002; 97: 195-201https://doi.org/10.1016/S0304-3959(01)00427-4
        • Keogh E
        • Thompson T
        • Hannent I
        Selective attentional bias, conscious awareness and the fear of pain.
        Pain. 2003; 104: 85-91https://doi.org/10.1016/s0304-3959(02)00468-2
        • Keuleers E
        • Brysbaert M
        Wuggy: a multilingual pseudoword generator.
        Behav Res Methods. 2010; 42: 627-633https://doi.org/10.3758/BRM.42.3.627
        • Klasen BW
        • Bruggert J
        • Hasenbring M
        Role of cognitive pain coping strategies for depression in chronic back pain. Path analysis of patients in primary care.
        Der Schmerz. 2006; 52 (404-6 passim (in German)): 400-402
        • Komiyama O
        • Wang K
        • Svensson P
        • Arendt-Nielsen L
        • Kawara M
        • De Laat
        A: The influence of psychological state on the masseteric exteroceptive suppression reflex and somatosensory function.
        Clin Neurophysiol. 2008; 119: 2321-2328https://doi.org/10.1016/j.clinph.2008.07.004
        • Koster EH
        • De Raedt R
        • Verschuere B
        • Tibboel H
        • De Jong PJ
        Negative information enhances the attentional blink in dysphoria.
        Depress Anxiety. 2009; 26: E16-E22https://doi.org/10.1002/da.20420
        • Lambert AE
        • Hu Y
        • Magee JC
        • Beadel JR
        • Teachman BA
        Thought suppression across time: Change in frequency and duration of thought recurrence.
        J Obsessive Compuls Relat Disord. 2014; 3: 21-28
        • Lin YJ
        • Wicker FW
        A comparison of the effects of thought suppression, distraction, and concentration.
        Behav Res Ther. 2007; 45: 2924-2937
        • MacLean MH
        • Arnell KM
        A conceptual and methodological framework for measuring and modulating the attentional blink.
        Atten Percept Psychophysiol. 2012; 74: 1080-1097https://doi.org/10.3758/s13414-012-0338-4
        • MacLeod C
        • Grafton B
        • Notebaert L
        Anxiety-Linked Attentional Bias: Is It Reliable?.
        Annu Rev Clin Psychol. 2019; 15: 529-554https://doi.org/10.1146/annurev-clinpsy-050718-095505
        • MacLeod C
        • Mathews A
        • Tata P
        Attentional bias in emotional disorders.
        J Abnorm Psychol. 1986; 95: 15-20https://doi.org/10.1037//0021-843x.95.1.15
        • Martens S
        • Wyble B
        The attentional blink: past, present, and future of a blind spot in perceptual awareness.
        Neurosci Biobehav Rev. 2009; 34: 947-957https://doi.org/10.1016/j.neubiorev.2009.12.005
        • Mathewson KJ
        • Arnell KM
        • Mansfield CA
        Capturing and holding attention: the impact of emotional words in rapid serial visual presentation.
        Mem Cognit. 2008; 36: 182-200https://doi.org/10.3758/mc.36.1.182
        • McCracken LM
        • Dhingra L
        A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity.
        Pain Res Manag. 2002; 7: 45-50https://doi.org/10.1155/2002/517163
        • McCracken LM
        • Zayfert C
        • Gross RT
        The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain.
        Pain. 1992; 50: 67-73https://doi.org/10.1016/0304-3959(92)90113-p
        • McNally RJ
        Attentional bias for threat: Crisis or opportunity?.
        Clin Psychol Rev. 2019; 69: 4-13https://doi.org/10.1016/j.cpr.2018.05.005
        • Mitchell LA
        • MacDonald RA
        • Brodie EE
        Temperature and the cold pressor test.
        J Pain. 2004; 5: 233-237https://doi.org/10.1016/j.jpain.2004.03.004
        • Najmi S
        • Riemann BC
        • Wegner DM
        Managing unwanted intrusive thoughts in obsessive-compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance.
        Behav Res Ther. 2009; 47: 494-503https://doi.org/10.1016/j.brat.2009.02.015
        • Nixon RD
        • Cain N
        • Nehmy T
        • Seymour M
        The influence of thought suppression and cognitive load on intrusions and memory processes following an analogue stressor.
        Behav Ther. 2009; 40: 368-379
        • Nixon RD
        • Cain N
        • Nehmy T
        • Seymour M
        Does post-event cognitive load undermine thought suppression and increase intrusive memories after exposure to an analogue stressor?.
        Memory. 2009; 17: 245-255https://doi.org/10.1080/09658210802592353
        • Nixon RD
        • Rackebrandt J
        Cognitive load undermines thought suppression in acute stress disorder.
        Behav Ther. 2016; 47: 388-403https://doi.org/10.1016/j.beth.2016.02.010
        • Ocanez KLS
        • McHugh RK
        • Otto MW
        A meta-analytic review of the association between anxiety sensitivity and pain.
        Depress Anxiety. 2010; 27: 760-767https://doi.org/10.1002/da.20681
        • Pintzinger NM
        • Pfabigan DM
        • Tran US
        • Kryspin-Exner I
        • Lamm C
        Attentional biases in healthy adults: Exploring the impact of temperament and gender.
        J Behav Ther Exp Psychiatry. 2016; 52: 29-37https://doi.org/10.1016/j.jbtep.2016.02.003
        • Pool E
        • Brosch T
        • Delplanque S
        • Sander D
        Attentional bias for positive emotional stimuli: A meta-analytic investigation.
        Psychol Bull. 2016; 142: 79-106https://doi.org/10.1037/bul0000026
        • Raymond JE
        • Shapiro KL
        • Arnell KM
        Temporary suppression of visual processing in an RSVP task: An attentional blink?.
        J Exp Psychol: Hum Percept Perform. 1992; 18: 849-860https://doi.org/10.1037//0096-1523.18.3.849
        • Reicherts P
        • Wiemer J
        • Gerdes ABM
        • Schulz SM
        • Pauli P
        • Wieser MJ
        Anxious anticipation and pain: The influence of instructed vs conditioned threat on pain.
        Soc Cogn Affect Neurosci. 2017; 12: 544-554https://doi.org/10.1093/scan/nsw181
        • Roelofs J
        • Peters ML
        • Patijn J
        • Schouten EGW
        • Vlaeyen JWS
        An electronic diary assessment of the effects of distraction and attentional focusing on pain intensity in chronic low back pain patients.
        Br J Health Psychol. 2006; 11: 595-606https://doi.org/10.1348/135910705X74819
        • Schoth DE
        • Liossi C
        Specificity and time-course of attentional bias in chronic headache: A visual-probe investigation.
        Clin J Pain. 2013; 29: 583-590https://doi.org/10.1097/AJP.0b013e31826b4849
        • Schoth DE
        • Nunes VD
        • Liossi C
        Attentional bias towards pain-related information in chronic pain: A meta-analysis of visual-probe investigations.
        Clin Psychol Rev. 2012; 32: 13-25https://doi.org/10.1016/j.cpr.2011.09.004
        • Schoth DE
        • Yu K
        • Liossi C
        The role of threat expectancy in attentional bias and thermal pain perception in healthy individuals.
        J Health Psychol. 2014; 19: 653-663https://doi.org/10.1177/1359105313476976
        • Schwabe L
        • Wolf OT
        Emotional modulation of the attentional blink: Is there an effect of stress?.
        Emotion. 2010; 10: 283-288https://doi.org/10.1037/a0017751
        • Sharpe L
        • Ianiello M
        • Dear BF
        • Nicholson Perry K
        • Refshauge K
        • Nicholas MK
        Is there a potential role for attention bias modification in pain patients? Results of 2 randomized, controlled trials.
        Pain. 2012; 153: 722-731https://doi.org/10.1016/j.pain.2011.12.014
        • Skinner HK
        • Ferguson H
        The attentional blink paradigm in individuals with high and low levels of depression and anxiety.
        J Eur Psychol Stud. 2014; 5: 89-99
        • Smeets E
        • Roefs A
        • Jansen A
        Experimentally induced chocolate craving leads to an attentional bias in increased distraction but not in speeded detection.
        Appetite. 2009; 53: 370-375https://doi.org/10.1016/j.appet.2009.07.020
        • Sullivan MJL
        • Rouse D
        • Bishop S
        • Johnston S
        Thought suppression, catastrophizing and pain.
        Cognit Ther Res. 1997; 21: 555-568
        • Thompson T
        • Keogh E
        • Chen MJ
        • French CC
        Emotion-focused coping and distraction: Sex differences in the influence of anxiety sensitivity during noxious heat stimulation.
        Eur J Pain. 2012; 16 (10.1002): 410-420
        • Thompson T
        • Keogh E
        • French CC
        • Davis R
        Anxiety sensitivity and pain: Generalizability across noxious stimuli.
        Pain. 2008; 134: 187-196https://doi.org/10.1016/j.pain.2007.04.018
        • Thompson T
        • Keogh E
        • French CC
        Sensory focusing versus distraction and pain: Moderating effects of anxiety sensitivity in males and females.
        J Pain. 2011; 12: 849-858https://doi.org/10.1016/j.jpain.2011.01.004
        • Todd J
        • Sharpe L
        • Johnson A
        • Nicholson Perry K
        • Colagiuri B
        • Dear BF
        Towards a new model of attentional biases in the development, maintenance, and management of pain.
        Pain. 2015; 156: 1589-1600https://doi.org/10.1097/j.pain.0000000000000214
        • Todd J
        • van Ryckeghem D
        • Sharpe L
        • Crombez G
        Attentional bias to pain-related information: A meta-analysis of dot-probe studies.
        Health Psychol Rev. 2018; 12: 419-436https://doi.org/10.1080/17437199.2018.1521729
        • Vaegter HB
        • Fehrmann E
        • Gajsar H
        • Kreddig N
        Endogenous modulation of pain: The role of exercise, stress and cognitions in humans.
        Clin J Pain. 2020; 36: 150-161https://doi.org/10.1097/AJP.0000000000000788
        • Van Ryckeghem D
        • Noel M
        • Sharpe L
        • Pincus T
        • Van Damme S
        Cognitive biases in pain: An integrated functional-contextual framework.
        Pain. 2019; 160: 1489-1493https://doi.org/10.1097/j.pain.0000000000001508
        • Van Ryckeghem DM
        • Van Damme S
        • Eccleston C
        • Crombez G
        The efficacy of attentional distraction and sensory monitoring in chronic pain patients: A meta-analysis.
        Clin Psychol Rev. 2018; 59: 16-29https://doi.org/10.1016/j.cpr.2017.10.008
        • Verhoeven K
        • Crombez G
        • Eccleston C
        • Van Ryckeghem DM
        • Morley S
        • Van Damme S
        The role of motivation in distracting attention away from pain: an experimental study.
        Pain. 2010; 149: 229-234https://doi.org/10.1016/j.pain.2010.01.019
        • Vickers AJ
        • Altman DG
        Statistics notes: Analyzing controlled trials with baseline and follow up measurements.
        BMJ. 2001; 323: 1123-1124https://doi.org/10.1136/bmj.323.7321.1123
        • Wegner DM
        Ironic processes of mental control.
        Psychol Rev. 1994; 101: 34-52https://doi.org/10.1037/0033-295x.101.1.34
        • Wegner DM
        How to think, say, or do precisely the worst thing for any occasion.
        Science. 2009; 3: 48-50https://doi.org/10.1126/science.1167346
        • Wegner DM
        Setting free the bears: Escape from thought suppression.
        Am Psychol. 2011; 66: 671-680https://doi.org/10.1037/a0024985
        • Wegner DM
        • Erber R
        The hyper accessibility of suppressed thoughts.
        J Per Soc Psychol. 1992; 63: 903-912
        • Wegner DM
        • Schneider DJ
        • Carter SR
        • White TL
        Paradoxical effects of thought suppression.
        J Pers Soc Psychol. 1987; 53: 5-13https://doi.org/10.1037//0022-3514.53.1.5
        • Wegner DM
        • Zanakos S
        Chronic thought suppression.
        J Pers. 1994; 62: 616-639https://doi.org/10.1111/j.1467-6494.1994.tb00311.x
        • Wenzel A
        • Barth TC
        • Holt CS
        Thought suppression in spider-fearful and nonfearful individuals.
        J Gen Psychol. 2003; 130: 191-205https://doi.org/10.1080/00221300309601284
        • Wenzlaff RM
        • Bates DE
        The relative efficacy of concentration and suppression strategies of mental control.
        Pers Soc Psychol Bull. 2000; 26: 1200-1212