Cognitive bias in back pain patients attending osteopathy: testing the enmeshment model in reference to future thinking

Abstract

Background: Depressive symptoms are common in chronic pain. Previous research has found differences in information-processing biases in depressed pain patients and depressed people without pain. The schema enmeshment model of pain (SEMP) has been proposed to explain chronic pain patients’ information-processing biases. Negative future thinking is common in depression but has not been explored in relation to chronic pain and information-processing models. Objectives: The study aimed to test the SEMP with reference to future thinking. Methods: An information-processing paradigm compared endorsement and recall bias between depressed and non-depressed chronic low back pain patients and control participants. Twenty-five depressed and 35 non-depressed chronic low back pain patients and 25 control participants (student osteopaths) were recruited from an osteopathy practice. Participants were asked to endorse positive and negative ill-health, depression-related, and neutral (control) adjectives, encoded in reference to either current or future time-frame. Incidental recall of the adjectives was then tested. Results: While the expected hypothesis of a recall bias by depressed pain patients towards ill-health stimuli in the current condition was confirmed, the recall bias was not present in the future condition. Additionally, patterns of endorsement and recall bias differed. Discussion: Results extend understanding of future thinking in chronic pain within the context of the SEMP.