Abstract
Expecting pain can be perceived as a threat may involve recruitment of cognitive strategies (such as attentional avoidance) which might help the person to reduce distress. The ecological validity of the paradigms aiming to study the attentional biases toward or away from threatening stimuli by manipulating the perception of threat in experimental settings has been questioned. Therefore, the current study aims to investigate the attentional bias toward or away from the threat when a confrontation with a real threatening and painful condition would be expected (i.e., dental treatment). One hundred and twenty-seven patients referred to three dentistry clinics for a dental treatment (experiment participants) and 30 individuals with no dental complaints (control participants) completed this study. Patients were randomly allocated to a high pain expectancy (HPE: n = 65) or a low pain expectancy (LPE: n = 62) expectancy condition. All participants completed questionnaires of distress, fear of pain, and fear of dental pain. Furthermore, they participated in a dot-probe task that assessed their attention to painful faces, dental pictures, and happy faces. In addition, before the treatment, participants reported their anticipated pain intensity and after the treatment, they reported the pain intensity that they perceived during the treatment using two separate visual analog scales. Patients in the HPE group showed a bias away from dental pictures compared to LPE and control group participants. HPE group patients also reported greater pain intensity during the treatment compared to LPE patients. Greater attentional bias away from dental pictures among HPE patients was associated with higher levels of fear of pain, fear of dental pain, and stress. Avoidance of highly salient threatening images can be seen as an unhelpful emotion-regulation strategy that individuals use to manage their fears. However, in this study, avoidance was associated with poorer outcomes.
Highlights
Cognitive-affective models consider attentional biases including attending to, sustaining attention, and attending away from threatening and distressing stimuli as detrimental components of many psychopathologies (Pine et al, 2005; Bar-Haim et al, 2007)
We expected to observe a difference between the participants in the two pain expectancy groups in the level of pain that they perceived during the dental treatment
Our results showed that the pain expectancy manipulation was effective in creating a small, but significant difference in pain expectation level between the high pain expectancy (HPE) and the low pain expectancy (LPE) groups
Summary
Cognitive-affective models consider attentional biases including attending to, sustaining attention, and attending away from threatening and distressing stimuli as detrimental components of many psychopathologies (Pine et al, 2005; Bar-Haim et al, 2007). Studies have shown that individuals with anxiety disorders are prone to exhibit attentional biases to threat-related stimuli (Bar-Haim et al, 2007; Barry et al, 2015). Researchers have found attentional biases to pain-related information among individuals with chronic pain and those with acute pain (e.g., (Haggman et al, 2010; Schoth and Liossi, 2010). Some recent studies observed the existence of these biases among parents, partners, and other family members of individuals with chronic pain (Vervoort et al, 2011, 2013b; Mohammadi et al, 2012, 2015). Some studies have demonstrated that individuals experiencing pain and anxiety disorders tend to avoid pain and threat-related information (e.g., Lautenbacher et al, 2010; Sharpe et al, 2014)
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