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Neurocognitive mechanisms underlying attention bias towards pain: evidence from a drift-diffusion model and event-related potentials


      • Neurocognitive process of pain-related attention bias was depicted by DDM and ERPs
      • Facilitated attention engagement to pain was indexed by DDM-derived non-decision time
      • Facilitated attention engagement to pain was driven by cue-evoked N1 amplitudes
      • Retarded attention disengagement from pain was indexed by DDM-derived drift rate
      • Retarded attention disengagement from pain was driven by target-evoked N2 amplitudes


      Although combining computational modeling with event-related potentials (ERPs) can precisely characterize neurocognitive processes involved in attention bias, it has yet to be applied in the context of pain. Here, a hierarchical drift-diffusion model (DDM) along with ERPs was used to characterize the neurocognitive mechanisms underlying attention bias towards pain. A spatial cueing paradigm was adopted, in which the locations of targets were either validly or invalidly predicted by spatial cues related to pain or non-pain signals. DDM-derived non-decision time was shorter for targets validly cued by pain signals than by non-pain signals, thus indicating speeded attention engagement towards pain; drift rate was slower for targets invalidly cued by pain signals than by non-pain signals, reflecting slower attention disengagement from pain. The facilitated engagement towards pain was partially mediated by the enhanced lateralization of cue-evoked N1 amplitudes, which relate to the bottom-up, stimulus-driven processes of detecting threatening signals. On the other hand, the retarded disengagement from pain was partially mediated by the enhanced target-evoked anterior N2 amplitudes, which relate to the top-down, goal-driven processes of conflict monitoring and behavior regulating. These results demonstrated that engagement and disengagement components of pain-related attention bias are governed by distinct neurocognitive mechanisms. However, it remains possible that the findings are not pain-specific, but rather, are related to threat or aversiveness in general. This deserves to be further examined by adding a control stimulus modality.
      Perspective: This study characterized the neurocognitive processes involved in attention bias towards pain through combining a hierarchical drift-diffusion model and event-related potentials. Our results revealed distinctive neurocognitive mechanisms underlying engagement and disengagement components of attention bias. Future studies are warranted to examine whether our findings are pain-specific or not.


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        • Baik SY
        • Jeong M
        • Kim HS
        • Lee SH
        ERP investigation of attentional disengagement from suicide-relevant information in patients with major depressive disorder.
        J Affective Disord. 2018; 225: 357-364
        • Bisley JW
        • Goldberg ME
        Attention, intention, and priority in the parietal lobe.
        Annu Rev Neurosci. 2010; 33: 1-21
        • Carlson JM
        A systematic review of event-related potentials as outcome measures of attention bias modification.
        Psychophysiology. 2021; 58: e13801
        • Chan FH
        • Suen H
        • Jackson T
        • Vlaeyen JW
        • Barry TJ
        Pain-related attentional processes: A systematic review of eye-tracking research.
        Clin Psychol Rev. 2020; 80101884
        • Cisler JM
        • Koster EH
        Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review.
        Clin Psychol Rev. 2010; 30: 203-216
        • Cisler JM
        • Olatunji BO
        Components of attentional biases in contamination fear: Evidence for difficulty in disengagement.
        Behav Res Ther. 2010; 48: 74-78
        • Crombez G
        • Van Ryckeghem DM
        • Eccleston C
        • Van Damme S
        Attentional bias to pain-related information: A meta-analysis.
        Pain. 2013; 154: 497-510
        • De Sanctis P
        • Katz R
        • Wylie GR
        • Sehatpour P
        • Alexopoulos GS
        • Foxe JJ
        Enhanced and bilateralized visual sensory processing in the ventral stream may be a feature of normal aging.
        Neurobiol Aging. 2008; 29: 1576-1586
        • Dear BF
        • Sharpe L
        • Nicholas MK
        • Refshauge K
        The psychometric properties of the dot-probe paradigm when used in pain-related attentional bias research.
        J Pain. 2011; 12: 1247-1254
        • Delorme A
        • Makeig S
        EEGLAB: An open source toolbox for analysis of single-trial EEG dynamics including independent component analysis.
        J Nurosci Meth. 2004; 134: 9-21
      1. Diamond A: Executive functions.
        Annu Rev Psychol. 2013; 64: 135-168
        • Eccleston C
        • Crombez G
        Pain demands attention: A cognitive–affective model of the interruptive function of pain.
        Psychol Bull. 1999; 125: 356-366
        • Eldar S
        • Bar-Haim Y
        Neural plasticity in response to attention training in anxiety.
        Psychol Med. 2010; 40: 667-677
        • Fichtenholtz HM
        • Hopfinger JB
        • Graham R
        • Detwiler JM
        • LaBar KS
        Happy and fearful emotion in cues and targets modulate event-related potential indices of gaze-directed attentional orienting.
        Soc Cogn Affect Neurosci. 2007; 2: 323-333
        • Folstein JR
        • Van Petten C
        Influence of cognitive control and mismatch on the N2 component of the ERP: A review.
        Psychophysiology. 2008; 45: 152-170
        • Forstmann BU
        • Ratcliff R
        • Wagenmakers EJ
        Sequential sampling models in cognitive neuroscience: Advantages, applications, and extensions.
        Annu Rev Psychol. 2016; 67: 641-666
        • Fox E
        • Russo R
        • Bowles R
        • Dutton K
        Do threatening stimuli draw or hold visual attention in subclinical anxiety?.
        J Exp Psychol Gen. 2001; 130: 681-700
        • Fu S
        • Zinni M
        • Squire PN
        • Kumar R
        • Caggiano DM
        • Parasuraman R
        When and where perceptual load interacts with voluntary visuospatial attention: An event-related potential and dipole modeling study.
        Neuroimage. 2008; 39: 1345-1355
        • Fu X
        • Taber-Thomas BC
        • Pérez-Edgar K
        Frontolimbic functioning during threat-related attention: Relations to early behavioral inhibition and anxiety in children.
        Biol Psychol. 2017; 122: 98-109
        • Gao T
        • Han X
        • Bang D
        • Han S
        Cultural differences in neurocognitive mechanisms underlying believing.
        NeuroImage. 2022; 250118954
        • Gottlieb J
        From thought to action: The parietal cortex as a bridge between perception, action, and cognition.
        Neuron. 2007; 53: 9-16
        • Gupta RS
        • Kujawa A
        • Vago DR
        The neural chronometry of threat-related attentional bias: Event-related potential (ERP) evidence for early and late stages of selective attentional processing.
        Int J Psychophysiol. 2019; 146: 20-42
        • Hauser TU
        • Iannaccone R
        • Stämpfli P
        • Drechsler R
        • Brandeis D
        • Walitza S
        • Brem S
        The feedback-related negativity (FRN) revisited: New insights into the localization, meaning and network organization.
        Neuroimage. 2014; 84: 159-168
        • Jackson T
        • Yang Z
        • Su L
        Pain-related gaze biases and later functioning among adults with chronic pain: A longitudinal eye-tracking study.
        Pain. 2019; 160: 2221-2228
        • Jones EB
        • Sharpe L
        • Andrews S
        • Colagiuri B
        • Dudeney J
        • Fox E
        • Heathcote LC
        • Lau JY
        • Todd J
        • Van Damme S
        The time course of attentional biases in pain: A meta-analysis of eye-tracking studies.
        Pain. 2021; 162: 687-701
        • Kim KH
        • Kim JH
        • Yoon J
        • Jung KY
        Influence of task difficulty on the features of event-related potential during visual oddball task.
        Neurosci Lett. 2008; 445: 179-183
        • Kok A
        On the utility of P3 amplitude as a measure of processing capacity.
        Psychophysiology. 2001; 38: 557-577
        • Koster EH
        • Crombez G
        • Verschuere B
        • Van Damme S
        • Wiersema JR
        Components of attentional bias to threat in high trait anxiety: Facilitated engagement, impaired disengagement, and attentional avoidance.
        Behav Res Ther. 2006; 44: 1757-1771
        • Legrain V
        • Damme SV
        • Eccleston C
        • Davis KD
        • Seminowicz DA
        • Crombez G
        A neurocognitive model of attention to pain: Behavioral and neuroimaging evidence.
        Pain. 2009; 144: 230-232
        • Li X
        • Li J
        • Hu B
        • Zhu J
        • Zhang X
        • Wei L
        • Zhong N
        • Li M
        • Ding Z
        • Yang J
        • Zhang L
        Attentional bias in MDD: ERP components analysis and classification using a dot-probe task.
        Comput Meth Programs Biomed. 2018; 164: 169-179
        • Liu T
        • Wang D
        • Wang C
        • Xiao T
        • Shi J
        The influence of reward anticipation on conflict control in children and adolescents: Evidences from hierarchical drift-diffusion model and event-related potentials.
        Dev Cogn Neurosci. 2022 May 24; ([Epub ahead of print])
        • Luck SJ
        Multiple mechanisms of visual-spatial attention: Recent evidence from human electrophysiology.
        Behav Brain Res. 1995; 71: 113-123
        • Luck SJ
        • Woodman GF
        • Vogel EK
        Event-related potential studies of attention.
        TRENDS COGN SCI. 2000; 4: 432-440
        • Mangun GR
        Neural mechanisms of visual selective attention.
        Psychophysiology. 1995; 32: 4-18
        • Mangun GR
        • Hillyard S
        Allocation of visual attention to spatial locations: Tradeoff functions for event-related brain potentials and detection performance.
        Percept Psychophys. 1990; 47: 532-550
        • Massar SA
        • Mol NM
        • Kenemans JL
        • Baas JM
        Attentional bias in high-and low-anxious individuals: Evidence for threat-induced effects on engagement and disengagement.
        Cogn Emot. 2011; 25: 805-817
        • Mittner M
        • Boekel W
        • Tucker AM
        • Turner BM
        • Heathcote A
        • Forstmann BU
        When the brain takes a break: A model-based analysis of mind wandering.
        J Neurosci. 2014; 34: 16286-16295
        • Mogg K
        • Holmes A
        • Garner M
        • Bradley BP
        Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals.
        Behav Res Ther. 2008; 46: 656-667
        • Montoya AK
        • Hayes AF
        Two-condition within-participant statistical mediation analysis: A path-analytic framework.
        Psychol Methods. 2017; 22: 6-27
        • Mulckhuyse M
        • Crombez G
        Disentangling attention from action in the emotional spatial cueing task.
        Cogn Emot. 2014; 28: 1223-1241
        • Naim R
        • Haller SP
        • Linke JO
        • Jaffe A
        • Stoddard J
        • Jones M
        • Harrewijn A
        • Kircanski K
        • Bar-Haim Y
        • Brotman MA
        Context-dependent amygdala–prefrontal connectivity during the dot-probe task varies by irritability and attention bias to angry faces.
        Neuropsychopharmacology. 2022 Jun 1; ([Epub ahead of print])
        • Nieuwenhuis S
        • Yeung N
        • Van Den Wildenberg W
        • Ridderinkhof KR
        Electrophysiological correlates of anterior cingulate function in a go/no-go task: Effects of response conflict and trial type frequency.
        Cogn Affect Behav Neurosci. 2003; 3: 17-26
        • Nunez MD
        • Vandekerckhove J
        • Srinivasan R
        How attention influences perceptual decision making: Single-trial EEG correlates of drift-diffusion model parameters.
        J Math Psychol. 2017; 76: 117-130
        • O'Connell RG
        • Schneider D
        • Hester R
        • Mattingley JB
        • Bellgrove MA
        Attentional load asymmetrically affects early electrophysiological indices of visual orienting.
        Cereb Cortex. 2011; 21: 1056-1065
        • Ong G
        • Sewell DK
        • Weekes B
        • McKague M
        • Abutalebi J
        A diffusion model approach to analysing the bilingual advantage for the Flanker task: The role of attentional control processes.
        J Neurolinguist. 2017; 43: 28-38
        • Pincus T
        • Morley S
        Cognitive-processing bias in chronic pain: A review and integration.
        Psychol bull. 2001; 127: 599-617
        • Polich J
        Updating P300: An integrative theory of P3a and P3b.
        Clin Neurophysiol. 2007; 118: 2128-2148
        • Price RB
        • Brown V
        • Siegle GJ
        Computational modeling applied to the dot-probe task yields improved reliability and mechanistic insights.
        Biol Psychiatry. 2019; 85: 606-612
        • Price RB
        • Siegle GJ
        • Silk JS
        • Ladouceur CD
        • McFarland A
        • Dahl RE
        • Ryan ND
        Looking under the hood of the dot-probe task: An fMRI study in anxious youth.
        Depress Anxiety. 2014; 31: 178-187
        • Ratcliff R
        A theory of memory retrieval.
        Psychol Rev. 1978; 85: 59-108
        • Ratcliff R
        • McKoon G
        The diffusion decision model: Theory and data for two-choice decision tasks.
        Neural Comput. 2008; 20: 873-922
        • Ratcliff R
        • Smith PL
        • Brown SD
        • McKoon G
        Diffusion Decision Model: Current Issues and History.
        TRENDS COGN SCI. 2016; 20: 260-281
        • Sawaki R
        • Ji Katayama
        Difficulty of discrimination modulates attentional capture for deviant information.
        Psychophysiology. 2007; 44: 374-382
        • 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: 13-25
        • Slagter HA
        • Prinssen S
        • Reteig LC
        • Mazaheri A
        Facilitation and inhibition in attention: Functional dissociation of pre-stimulus alpha activity, P1, and N1 components.
        NeuroImage. 2016; 125: 25-35
        • Stevens ES
        • Weinberg A
        • Nelson BD
        • Meissel EE
        • Shankman SA
        The effect of panic disorder versus anxiety sensitivity on event-related potentials during anticipation of threat.
        J Anxiety Disord. 2018; 54: 1-10
        • Thai N
        • Taber-Thomas BC
        • Pérez-Edgar KE
        Neural correlates of attention biases, behavioral inhibition, and social anxiety in children: An ERP study.
        Dev Cogn Neurosci. 2016; 19: 200-210
        • Thompson A
        • Steinbeis N
        Computational modelling of attentional bias towards threat in paediatric anxiety.
        Dev Sci. 2021; 24: e13055
        • Todd J
        • Sharpe L
        • Johnson A
        • Perry KN
        • Colagiuri B
        • Dear BF
        Towards a new model of attentional biases in the development, maintenance, and management of pain.
        Pain. 2015; 156: 1589-1600
        • Todd J
        • van Ryckeghem DM
        • Sharpe L
        • Crombez G
        Attentional bias to pain-related information: A meta-analysis of dot-probe studies.
        Health Psychol Rev. 2018; 12: 419-436
        • Torrence RD
        • Troup LJ
        Event-related potentials of attentional bias toward faces in the dot-probe task: A systematic review.
        Psychophysiology. 2018; 55: e13051
        • Van Damme S
        • Crombez G
        • Eccleston C
        The anticipation of pain modulates spatial attention: Evidence for pain-specificity in high-pain catastrophizers.
        Pain. 2004; 111: 392-399
        • Van Damme S
        • Crombez G
        • Eccleston C
        • Koster EH
        Hypervigilance to learned pain signals: A componential analysis.
        J Pain. 2006; 7: 346-357
        • Van Damme S
        • Crombez G
        • Hermans D
        • Koster EH
        • Eccleston C
        The role of extinction and reinstatement in attentional bias to threat: A conditioning approach.
        Behav Res Ther. 2006; 44: 1555-1563
        • Van Damme S
        • Lorenz J
        • Eccleston C
        • Koster EH
        • De Clercq A
        • Crombez G
        Fear-conditioned cues of impending pain facilitate attentional engagement.
        Neurophysiol Clin. 2004; 34: 33-39
      2. Van Ryckeghem D Crombez G Pain and attention: Toward a motivational account. Oxford University Press, New York2018
        • Van Ryckeghem DM
        • Crombez G
        • Goubert L
        • De Houwer J
        • Onraedt T
        • Van Damme S
        The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study.
        Pain. 2013; 154: 468-475
        • Van Ryckeghem DM
        • Crombez G
        • Van Hulle L
        • Van Damme S
        Attentional bias towards pain-related information diminishes the efficacy of distraction.
        Pain. 2012; 153: 2345-2351
        • Van Veen V
        • Carter CS
        The anterior cingulate as a conflict monitor: fMRI and ERP studies.
        Physiol Behav. 2002; 77: 477-482
        • Vandekerckhove J
        • Tuerlinckx F
        • Lee MD
        Hierarchical diffusion models for two-choice response times.
        Psychol Methods. 2011; 16: 44-62
        • Vanlessen N
        • Rossi V
        • De Raedt R
        • Pourtois G
        Positive emotion broadens attention focus through decreased position-specific spatial encoding in early visual cortex: Evidence from ERPs.
        Cogn Affect Behav Neurosci. 2013; 13: 60-79
        • Veen VV
        • Carter CS
        The timing of action-monitoring processes in the anterior cingulate cortex.
        J Cogn Neurosci. 2002; 14: 593-602
        • Verleger R
        • Zurawska Vel Grajewska B
        • Jaśkowski P
        Time-course of hemispheric preference for processing contralateral relevant shapes: P1pc, N1pc, N2pc, N3pc.
        Adv Cogn Psychol. 2012; 8: 19-28
        • Voss A
        • Nagler M
        • Lerche V
        Diffusion models in experimental psychology: A practical introduction.
        Exp Psychol. 2013; 60: 385-402
        • Voss A
        • Rothermund K
        • Voss J
        Interpreting the parameters of the diffusion model: An empirical validation.
        Mem Cogn. 2004; 32: 1206-1220
        • Wascher E
        • Hoffmann S
        • Sänger J
        • Grosjean M
        Visuo-spatial processing and the N1 component of the ERP.
        Psychophysiology. 2009; 46: 1270-1277
        • Weigard A
        • Huang-Pollock C
        • Brown S
        Evaluating the consequences of impaired monitoring of learned behavior in ADHD using a Bayesian hierarchical model of choice response time.
        Neuropsychology. 2016; 30: 502-515
        • Wiecki T
        • Sofer I
        • Frank M
        HDDM: Hierarchical Bayesian estimation of the Drift-Diffusion Model in Python.
        Front Neuroinformatics. 2013; 7: 1-10
        • Woldorff M
        • Liotti M
        • Seabolt M
        • Busse L
        • Lancaster J
        • Fox P
        The temporal dynamics of the effects in occipital cortex of visual-spatial selective attention.
        Cognit Brain Res. 2002; 15: 1-15