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See detailAttention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial
Heathcote, Lauren C; Jacobs, Conrad; van Ryckeghem, Dimitri UL et al

in Pain (in press)

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See detailPain and Attention: Towards a Motivational Account
van Ryckeghem, Dimitri UL; Crombez, Geert

Book published by Oxford University Press (in press)

Attention plays a pivotal role in the experience of pain and its impact upon daily activities. Accordingly, research on the interplay between attention and pain has a long scientific history. Within this ... [more ▼]

Attention plays a pivotal role in the experience of pain and its impact upon daily activities. Accordingly, research on the interplay between attention and pain has a long scientific history. Within this chapter, we discuss the theoretical frameworks that aim to explain the relationship between attention and pain. We argue for a motivational perspective on pain that highlights the critical role of cognitive, affective and contextual factors in explaining the interplay between attention and pain. To substantiate this argument, we provide an overview of available research addressing the bottom-up capture of attention by pain and the top-down modulation (both inhibition and facilitation) of attention for pain. We conclude this chapter with guidelines and suggestions for future research and discuss clinical implications of adopting a motivational perspective on pain. [less ▲]

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See detailDo tonic itch and pain stimuli draw attention towards their location?
Van Laarhoven, Antoinette; Van Damme, , Dimitri Marcel Leon Van Ryckeghem, G Crombez, and Andrea Evers, Stefaan; Lavrijsen, A. P. et al

in BioMed Research International (in press)

Background: Although itch and pain are distinct experiences, both are unpleasant, and may demand attention and interfere with daily activities. Research investigating the role of attention in tonic itch ... [more ▼]

Background: Although itch and pain are distinct experiences, both are unpleasant, and may demand attention and interfere with daily activities. Research investigating the role of attention in tonic itch and pain stimuli, particularly whether attention is drawn to the stimulus location, is scarce. Methods: In the somatosensory attention task, fifty-three healthy participants were exposed to 35-seconds electrical itch or pain stimuli on either the left or right wrist. Participants responded as quickly as possible to visual targets appearing at the stimulated location (ipsilateral trials) or at the arm without stimulation (contralateral trials). During control blocks, participants performed the visual task without stimulation. Attention allocation at the itch and pain location is inferred when responses are faster ipsilaterally than contralaterally. Results: Results did not indicate that attention was directed towards or away from the itch and pain location. Notwithstanding, participants were slower during itch and pain than during control blocks. Conclusions: In contrast with our hypotheses, no indications were found for spatial attention allocation towards the somatosensory stimuli. This may relate to dynamic shifts in attention over the time course of the tonic sensations. Our secondary finding that itch and pain interfere with task performance is in line with attention theories of bodily perception. [less ▲]

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See detailThe efficacy of attentional distraction and sensory monitoring in chronic pain patients: A meta-analysis
van Ryckeghem, Dimitri UL; Van Damme, Stefaan; Eccleston, Chris et al

in Clinical Psychology Review (in press)

Attentional strategies, such as distraction and sensory monitoring, are often offered to reduce pain and pain-related distress. However, evidence for their efficacy in chronic pain patients is equivocal ... [more ▼]

Attentional strategies, such as distraction and sensory monitoring, are often offered to reduce pain and pain-related distress. However, evidence for their efficacy in chronic pain patients is equivocal. We report a meta-analysis on the efficacy of distraction and sensory monitoring in chronic pain patients, and explore possible methodological and theoretical moderators. The scientific literature was searched for relevant articles, which were coded for methodological quality and several theoretical and methodological moderator variables. Only 10 articles fulfilled the search criteria. Eight studies allowed us to compare distraction with a control condition, two studies to compare sensory monitoring with a control condition, and four studies to compare the effect of distraction with the effect of sensory monitoring. Overall, results indicate that distraction did not differ from control in altering pain experience (k=8; Hedges’ g=0.10, ns) and distress (k=2; Hedges’ g=0.549). Sensory monitoring did also not alter pain experience (k=2; Hedges’ g=-.21, ns) and distress (k=1; Hedges’ g=-0.191, ns). We found no evidence to support the superiority of distraction or sensory monitoring in altering pain compared to control conditions. We offer guidance for future theory-driven research to investigate distraction and sensory monitoring in this largely unexplored field, albeit one replete with methodological difficulties. [less ▲]

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See detailThe interference of pain with task performance: Increasing ecological validity in research
van Ryckeghem, Dimitri UL

in Scandinavian Journal of Pain (2017), 16

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See detailAttentional processing of itch
van Laarhoven, Antoinette; van Damme, Stefaan; Lavrijsen et al

in Psychological Research (2017)

Itch is a prevalent somatosensory symptom thatcan be highly disabling , because it is likely to drawattention and, as a resu lt, may interfere with the perfor-mance of daily activities. Yet, research ... [more ▼]

Itch is a prevalent somatosensory symptom thatcan be highly disabling , because it is likely to drawattention and, as a resu lt, may interfere with the perfor-mance of daily activities. Yet, research experimentallyinvestigating attention to itch is lacking. In this study weaimed to investigate attentional processing of itch usingmultiple behavioral attention tasks. Forty-one healthyparticipants performed (1) a modified Stroop task with itch-related words, (2) a dot-probe task with itch-related pic-tures, and (3) a rece ntly developed somatosensory attentiontask in which the effect of experimentally induced itch onthe localization of visual targets was examined. Addition-ally, a number of self-report questionnaires related tosomatosensory attentional processing were administered.Results indicated that participants’ attention was biasedtoward itch-related words and pictures assessed by meansof the dot- probe and modified Stroop task, respectively. Forthe somatosensory attention task, results showed that itchdid not significantly influence the allocation of attention.However, when taking into account the time course ofattention during the itch stimulus, data suggested thatparticipants tended to disengage attention away during theitch stimulus. This is the first study that indicates anattentional bias for itch, using methods that have previouslybeen validated for other sensations such as pain. In addi-tion, the newly developed somatosensory attention taskmay reflect the time course of attention toward a tonic itchstimulus. [less ▲]

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See detailGeneralized hypervigilance in fibromyalgia: normal interoceptive accuracy, but reduced self-regulatory capacity
Rost, Silke UL; van Ryckeghem, Dimitri UL; Schulz, André UL et al

in Journal of Psychosomatic Research (2017), 93(2), 48-54

Objective: The factors underlying the aetiology of fibromyalgia (FM) are largely unknown. According to the generalized hypervigilance hypothesis (GHH), FM patients show excessive attention towards pain ... [more ▼]

Objective: The factors underlying the aetiology of fibromyalgia (FM) are largely unknown. According to the generalized hypervigilance hypothesis (GHH), FM patients show excessive attention towards pain stimuli and other sensory events, thereby increasing pain perception and dysfunctional behaviour. We tested this notion by assessing interoceptive accuracy (IA) in FM patients and matched healthy controls. We also tested the hypothesis that FM is characterized by reduced self-regulatory capacity as indexed by heart rate variability (HRV). Methods: 47 FM patients (Mage = 45.5, 39 females) and 45 healthy controls (Mage = 44.9, 37 females) completed several self-report scales (Body Vigilance Scale, Depression Anxiety Stress Scales, Pain Catastrophizing Scale). To derive HRV, heart rate was monitored under resting conditions; for the assessment of IA participants performed a heartbeat tracking task in which they were asked to silently count their heartbeats. Results: FM patients reported higher body vigilance than healthy controls, but there were no group differences in IA. FM patients had lower HRV compared with healthy controls. HRV did not predictor IA. Conclusion: In conclusion, our findings do not support the hypothesis of generalized hypervigilance in FM patients. Patients reported a heightened focus on bodily sensations, which was not reflected in IA. It may be that hypervigilance is not a general and stable characteristic but is rather context dependent and modality-specific. [less ▲]

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See detailTowards an integrative view of cognitive biases in pain.
van Ryckeghem, Dimitri UL; Vervoort, Tine

in European journal of pain (London, England) (2016), 20(8), 1201-2

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See detailPerceived injustice explains pain intensity over and above attentional bias.
Bell, T.; Trost, Z.; van Ryckeghem, Dimitri UL et al

in Journal of Pain (2016), 17(4, 1), 32

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See detailATTENTIONAL BIASES IN PAIN: A META-ANALYSIS OF DOT PROBE RESEARCH
Todd, J.; Sharpe, L.; van Ryckeghem, Dimitri UL et al

in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE (2016), 23(1), 119

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See detailA componential emotion approach for the assessment of emotional awareness in youth.
Veirman, Elke; Fontaine, Johnny R. J.; van Ryckeghem, Dimitri UL

in Psychological assessment (2016), 28(11), 1416-1426

The Levels of Emotional Awareness Scale for Children (LEAS-C) is a performance-based instrument that assesses emotional awareness in the structure of written responses to a set of real-life scenarios ... [more ▼]

The Levels of Emotional Awareness Scale for Children (LEAS-C) is a performance-based instrument that assesses emotional awareness in the structure of written responses to a set of real-life scenarios. While it is theoretically expected that emotional awareness develops with age, virtually no age differences have been established with the LEAS-C. The present study investigated whether an adaptation of the instructions and scoring procedure on the basis of the componential emotion approach could improve the validity of the LEAS-C and reveal the theoretically expected age differences. An adapted LEAS-C was administered to a sample of 574 children and adolescents and scored with the original and a new componential scoring procedure. An acceptable reliability for the original and a good reliability and a high interrater reliability for the componential scoring procedure were observed. Multigroup confirmatory factor analyses showed measurement invariance of factor loadings and intercepts across children (8 to 12 years) and adolescents (13 to 16 years) for all tested models, for both scoring procedures. A one-factor model fitted well for the total scores and self and other scores for both scoring procedures. The pattern of relationships with alexithymia, emotional intelligence, intelligence, personality, and social and emotional impairment as well as gender differences were comparable with prior research. Furthermore, the expected relationship with age was found, with stronger correlations for the componential than the original scoring procedure. In conclusion, analyses of the reliability, internal structure, and nomological network supported the adaptations of the LEAS-C on the basis of the componential emotion approach. (PsycINFO Database Record [less ▲]

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See detailThe Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample.
Trost, Zina; van Ryckeghem, Dimitri UL; Scott, Whitney et al

in The journal of pain (2016), 17(11), 1207-1216

The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and ... [more ▼]

The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and difficulty of a standardized set of common physical activities. A pictorial dot-probe task assessed AB toward pain stimuli (ie, pain faces cueing pain), after which participants performed the physical tasks. Participants also rated face stimuli in terms of pain, sadness, and anger expression. As hypothesized, perceived injustice was positively associated with AB toward pain stimuli; additionally, perceived injustice and AB were positively associated with appraisals of pain and difficulty. Counter to expectations, AB did not mediate the relationship between perceived injustice and task appraisals, suggesting that AB is insufficient to explain this relationship. Exploratory analyses indicated that participants with higher levels of perceived injustice rated stimulus faces as sadder and angrier; no such differences emerged for pain ratings. To our knowledge, this is the first study to examine the association between perceived injustice and AB toward pain, as well as perceived injustice and in vivo appraisals of common physical activity. Results extend existing literature and suggest that attentional and potential interpretive bias should be considered in future research. PERSPECTIVE: This article identifies significant associations between perceived injustice, biased attention to pain, and appraisals of common physical activities among individuals with chronic low back pain. These findings suggest targets for intervention as well as directions for future research regarding individuals with high perceptions of injustice related to pain. [less ▲]

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See detailA Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games.
DeSmet, Ann; Shegog, Ross; van Ryckeghem, Dimitri UL et al

in Games for health journal (2015), 4(2), 78-90

OBJECTIVE: Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to ... [more ▼]

OBJECTIVE: Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games. MATERIALS AND METHODS: A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included. RESULTS: Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback. CONCLUSIONS: The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants. [less ▲]

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See detailThe relationship between adolescents' pain catastrophizing and attention bias to pain faces is moderated by attention control.
Heathcote, Lauren C.; Vervoort, Tine; Eccleston, Christopher et al

in Pain (2015), 156(7), 1334-41

This study considered the attentional functioning of adolescents with varying levels of pain catastrophizing. Specifically, we investigated the relationship between pain catastrophizing and attention bias ... [more ▼]

This study considered the attentional functioning of adolescents with varying levels of pain catastrophizing. Specifically, we investigated the relationship between pain catastrophizing and attention bias to pain facial expressions. Furthermore, drawing on dual process models in the context of pain, we investigated the moderating role of attention control on this relationship. Adolescents (N = 73; age, 16-18 years) performed a dot-probe task in which facial expressions of pain and neutral expressions were presented for 100 milliseconds and 1250 milliseconds. Participants also completed self-report pain catastrophizing and attention control measures. We found that although there was no main effect of pain catastrophizing on attention bias towards pain faces, attention control did significantly moderate this relationship. Further analysis revealed that lower levels of attention control were significantly associated with increasing attentional vigilance towards pain faces only within high catastrophizing adolescents. In addition, we found that poorer attention control was related to increased attention bias for pain faces (regardless of pain catastrophizing level) when these faces were presented for relatively longer durations (ie, 1250 milliseconds) but not for short durations (ie, 100 milliseconds). This study supports a dual process model of attentional processes in pain, thus replicating previous findings within the psychopathology literature but extending them to the study of pain. Theoretical and clinical implications of our findings are discussed. [less ▲]

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See detailGeneral hypervigilance in fibromyalgia: one swallow does not make a summer.
van Ryckeghem, Dimitri UL; Crombez, Geert

in European journal of pain (London, England) (2015), 19(4), 447-8

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See detailThe Experience of Cognitive Intrusion of Pain: scale development and validation.
Attridge, Nina; Crombez, Geert; van Ryckeghem, Dimitri UL et al

in Pain (2015), 156(10), 1978-90

Patients with chronic pain often report their cognition to be impaired by pain, and this observation has been supported by numerous studies measuring the effects of pain on cognitive task performance ... [more ▼]

Patients with chronic pain often report their cognition to be impaired by pain, and this observation has been supported by numerous studies measuring the effects of pain on cognitive task performance. Furthermore, cognitive intrusion by pain has been identified as one of 3 components of pain anxiety, alongside general distress and fear of pain. Although cognitive intrusion is a critical characteristic of pain, no specific measure designed to capture its effects exists. In 3 studies, we describe the initial development and validation of a new measure of pain interruption: the Experience of Cognitive Intrusion of Pain (ECIP) scale. In study 1, the ECIP scale was administered to a general population sample to assess its structure and construct validity. In study 2, the factor structure of the ECIP scale was confirmed in a large general population sample experiencing no pain, acute pain, or chronic pain. In study 3, we examined the predictive value of the ECIP scale in pain-related disability in fibromyalgia patients. The ECIP scale scores followed a normal distribution with good variance in a general population sample. The scale had high internal reliability and a clear 1-component structure. It differentiated between chronic pain and control groups, and it was a significant predictor of pain-related disability over and above pain intensity. Repairing attentional interruption from pain may become a novel target for pain management interventions, both pharmacologic and nonpharmacologic. [less ▲]

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See detailA meta-analysis of serious digital games for healthy lifestyle promotion.
DeSmet, Ann; van Ryckeghem, Dimitri UL; Compernolle, Sofie et al

in Preventive medicine (2014), 69

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies ... [more ▼]

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed. [less ▲]

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See detailThe frequency of acute medication intake relates to its perceived effectiveness in chronic headache patients
van Ryckeghem, Dimitri UL; Wens, T.; Paemeleire, K. et al

in JOURNAL OF HEADACHE AND PAIN (2014), 15(1),

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See detailAttentional bias and chronic pain: where to go from here?
van Ryckeghem, Dimitri UL; Crombez, Geert

in Pain (2014), 155(1), 6-7

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See detailKeeping pain out of your mind: the role of attentional set in pain.
van Ryckeghem, Dimitri UL; Crombez, G.; Eccleston, C. et al

in European journal of pain (London, England) (2013), 17(3), 402-11

BACKGROUND: The involuntary capture of attention by pain may, to some extent, be controlled by psychological variables. In this paper, we investigated the effect of attentional set (i.e., the collection ... [more ▼]

BACKGROUND: The involuntary capture of attention by pain may, to some extent, be controlled by psychological variables. In this paper, we investigated the effect of attentional set (i.e., the collection of task-related features that a person is monitoring in order to successfully pursue a goal) on pain. METHODS: Two experiments are reported in which the task relevance of the modality and spatial location of a target stimulus was manipulated. In both experiments, somatosensory and auditory stimuli were presented on each trial. In experiment 1, 29 participants were cued on each trial to localize either a somatosensory or an auditory target. In experiment 2, 37 participants were cued on each trial to identify either a somatosensory or an auditory target at a particular location. RESULTS: In experiment 1, self-reported pain intensity and unpleasantness were reduced when participants had to localize the auditory target. The location of the painful stimulus relative to the location of the auditory target did not affect pain. In experiment 2, again, pain intensity and unpleasantness ratings were reduced when participants identified the auditory target. Now, the location of the painful stimulus relative to the location of the auditory target moderated the effect. Pain intensity was less when the painful stimulus was at a different location than the auditory target. CONCLUSIONS: Results are discussed in terms of the attentional set hypothesis, and we argue that the effectiveness of distraction tasks depends on the degree to which the task-relevant features of the distraction task are distinct from pain-related features. [less ▲]

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