Examining the role and plasticity of cognitive biases in adolescent pain experiences

• Main Author: Heathcote, Lauren C.
• Other Authors: Lau, Jennifer
• Published: University of Oxford 2016
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.748659

Acute pain is a common experience in childhood and adolescence. However, a significant minority of young people experience persistent, chronic pain that impairs their physical, emotional, and social functioning. Research presented in this thesis examines cognitive and affective factors in the emergence and chronicity of pain experiences in adolescence. In Chapters Two and Three, data are presented showing that, in community samples of adolescents, associations between pain-related attention biases and pain-related anxiety and catastrophizing are moderated by adolescents' ability to exert effortful attention control. Attention control is also shown to moderate associations between anxiety and tolerance of experimentally-induced pain. In Chapter Four, Attention Bias Modification (ABM) training methodology is used to investigate the plasticity and causal impact of pain-related attention biases in adolescents with chronic pain. Findings indicated that ABM, compared with placebo or no training, did not manipulate attention bias or attention control, nor did it significantly impact pain symptoms, pain catastrophizing, anxious and depressive symptoms, or physical functioning. In Chapters Five and Six, a novel measure of pain-related interpretation bias was developed; the Adolescent Interpretations of Bodily Threat (AIBT) task. Data from this task indicated that, in a community sample of adolescents, the tendency to interpret ambiguous information as indicative of pain and bodily threat mediated associations between pain catastrophizing and recent pain experiences. Additional data indicated that adolescents with chronic pain were less likely to believe benign interpretations of ambiguous bodily-threat information than healthy controls. This interpretation pattern was associated with increased disability among adolescents with chronic pain. In summary, studies in this thesis support the contribution of cognitive biases to pain experiences in adolescence, although the efficacy of ABM was not supported. Further studies investigating the interaction of attention bias and control, as well as biased interpretations of bodily threat, may be particularly useful going forward.