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See detailClinical relevance of attentional biases in pediatric chronic pain: an eye-tracking study
Soltani, Sabine; van Ryckeghem, Dimitri UL; Vervoort, Tine et al

in Pain (in press)

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical ... [more ▼]

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical prominence, a comprehensive understanding of the nature of biased attentional processing in chronic pain and its relationship to theorized antecedents and clinical outcomes is lacking, particularly in youth. This study used eye-tracking to assess attentional bias for painful facial expressions and its relationship to theorized antecedents of chronic pain and clinical outcomes. Youth with chronic pain (n = 125) and without chronic pain (n = 52) viewed face images of varying levels of pain expressiveness while their eye gaze was tracked and recorded. At baseline, youth completed questionnaires to assess pain characteristics, theorized antecedents (pain catastrophizing, fear of pain, and anxiety sensitivity), and clinical outcomes (pain intensity, interference, anxiety, depression, and posttraumatic stress). For youth with chronic pain, clinical outcomes were reassessed at 3 months to assess for relationships with attentional bias while controlling for baseline symptoms. In both groups, youth exhibited an attentional bias for painful facial expressions. For youth with chronic pain, attentional bias was not significantly associated with theorized antecedents or clinical outcomes at baseline or 3-month follow-up. These findings call into question the posited relationships between attentional bias and clinical outcomes. Additional studies using more comprehensive and contextual paradigms for the assessment of attentional bias are required to clarify the ways in which such biases may manifest and relate to clinical outcomes. [less ▲]

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See detailThe Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain
Wauters, Aline; Noel, Melanie; van Ryckeghem, Dimitri UL et al

in Journal of Pain (2021), 22(10), 1303-1314

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing ... [more ▼]

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PERSPECTIVE: This article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain. [less ▲]

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See detailAttentional biases in pediatric chronic pain : an eye-tracking study assessing the nature of the bias and its relation to attentional control
Soltani, Sabine; van Ryckeghem, Dimitri UL; Vervoort, Tine et al

in PAIN (2020), 161(10), 2263--2273

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings, and few studies have ... [more ▼]

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings, and few studies have examined attentional biases in pediatric samples. This study used eye-gaze tracking to examine attentional biases to pain-related stimuli in a clinical sample of youth with chronic pain and pain-free controls. The moderating role of attentional control was also examined. Youth with chronic pain (n = 102) and pain-free controls (n = 53) viewed images of children depicting varying levels of pain expressiveness paired with neutral faces while their eye gaze was recorded. Attentional control was assessed using both a questionnaire and a behavioural task. Both groups were more likely to first fixate on high pain faces but showed no such orienting bias for moderate or low pain faces. Youth with chronic pain fixated longer on all pain faces than neutral faces, whereas youth in the control group exhibited a total fixation bias only for high and moderate pain faces. Attentional control did not moderate attentional biases between or within groups. The results lend support to theoretical models positing the presence of attentional biases in youth with chronic pain. Further research is required to clarify the nature of attentional biases and their relationship to clinical outcomes. [less ▲]

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See detailParental (non-)pain attending verbalizations moderate the relationship between child attention and memory bias for pain
Wauters, Aline; Noel, Melanie; van Ryckeghem, Dimitri UL et al

in EUROPEAN JOURNAL OF PAIN (2020), 24(9), 1797--1811

Background: Children's negatively biased pain‐related memories (i.e. recalling pain as being more intense or fearful than initially reported) have been recognized as a key factor in explaining child pain ... [more ▼]

Background: Children's negatively biased pain‐related memories (i.e. recalling pain as being more intense or fearful than initially reported) have been recognized as a key factor in explaining child pain development. While mechanisms underlying children's pain memory development remain poorly understood, attention biases and parent language have been implicated in conceptual models. This study examined the association between child pain‐related attention and memory biases and the moderating role of parental pain and non‐pain attending verbalizations. Methods: Participants were 51 school children and one of their parents. Probability of initial fixation and gaze duration to pain were assessed using eye tracking methodology. Children performed a cold pressor task (CPT) and reported on experienced pain intensity and pain‐related fear. A 3‐minute parent–child interaction upon CPT completion allowed measurement of parental pain and non‐pain attending verbalizations. Children's pain‐related memories were elicited 2 weeks later. Results: Findings indicated that the relationship between maintained attention to pain and fear memory bias was moderated by parental non‐pain attending verbalizations such that higher gaze duration bias was positively associated with fear memory bias but only among children whose parents demonstrated low levels of non‐pain attending verbalizations. The opposite pattern was observed for children whose parents showed high levels of non‐pain attending verbalizations. No such effects were observed for child initial attention bias to pain, memory bias for pain and parental pain attending verbalizations. Conclusions: Findings highlight the importance of parental and child pain‐related variables as well as their interaction in understanding negatively biased pain‐related memories. Significance: This study on child pain memories is the first to highlight that characteristics of the social context, such as parental (non‐)pain‐related verbalizations, as well as factors related to the intra‐individual experience of pain, such as child attention bias to pain, should be studied jointly, as they interact with each other in their effect on the emergence of negatively biased memories of painful events. [less ▲]

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See detailCognitive biases in pain: An integrated functional-contextual framework
Van Ryckeghem, Dimitri UL; Noel, Melanie; Sharpe, Louise et al

in Pain (2019)

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