Background & Aims
Adults with chronic pain often learn to manage daily life by avoiding movements that may be painful and relying on pain-relief medication1.
Such conditioned biases may interfere with treatments that encourage active strategies such as regular stretching and increasing activity whilst reducing medication2. Approach-bias modification interventions could enhance treatment, as shown in the field of addiction3.
- Develop a valid set of images depicting approach (medication), avoidance (active physical effort) and neutral.
- Detect approach and avoidance biases for these images in patients with chronic pain and healthy controls.
- Determine if Pavlovian approach and avoidance biases interfere with instrumental learning – is it more difficult for patients with chronic pain than healthy controls to learn to
- a) approach a stimulus to escape punishment and
- b) avoid a stimulus to earn reward?
Methods
Adults with chronic pain often learn to manage daily life by avoiding movements that may be painful and relying on pain-relief medication1.
Such conditioned biases may interfere with treatments that encourage active strategies such as regular stretching and increasing activity whilst reducing medication2. Approach-bias modification interventions could enhance treatment, as shown in the field of addiction3.
- Develop a valid set of images depicting approach (medication), avoidance (active physical effort) and neutral.
- Detect approach and avoidance biases for these images in patients with chronic pain and healthy controls.
- Determine if Pavlovian approach and avoidance biases interfere with instrumental learning – is it more difficult for patients with chronic pain than healthy controls to learn to
- a) approach a stimulus to escape punishment and
- b) avoid a stimulus to earn reward?
Results
Hypotheses and analyses were pre-registered at https://osf.io/xyqtd.
Explicit rating of images: Images of active physical effort were rated as more unpleasant than pleasant and more painful than relaxing by patients than by controls (ps<.001). Patients and controls rated images similarly in the medication and neutral categories (ps>.274).
Approach Avoidance Task: Approach biases were calculated as difference in median push minus pull RTs. Patients had stronger approach bias relative to controls for medication images. No difference was found for neutral and active images, with both groups recording slight approach biases.
Pavlovian Bias Task: In the non-congruent approach trial, patients were less able than controls to learn to correctly approach an image associated with punishment (p = .014). There were no further group differences on the non-congruent avoid or congruent trial types (ps>.322).
Conclusions
AAT: Patients showed a stronger approach bias than controls to images of medication, though these were rated similarly by both groups as a little unpleasant, and neither relaxing nor painful.
Despite patients rating the active physical effort images as more painful and less pleasant, we did not observe a reduced approach bias towards the active images relative to controls.
A slight approach bias to neutral images was shown by both groups, which both rated as a little pleasant and moderately relaxing.
The overall approach bias suggests it may be easier and faster to pull a joystick than push it away. Study of other interfaces is warranted.
PBT: Patients and controls showed similar ability to learn to click on an image to win, and to click away from an image to avoid a loss or to win.
As expected, patients found it harder to learn to click on an image to avoid a loss. When that image was associated with punishment, it was harder for patients to overcome the avoidance tendency than it was for controls.
References
1Blyth, F. M., March, L. M., Nicholas, M. K., & Cousins, M. J. (2005). Self-management of chronic pain: a population-based study. Pain, 113(3), 285-292.
2Mann, E. G., LeFort, S., & VanDenKerkhof, E. G. (2013). Self-management interventions for chronic pain. Pain management, 3(3), 211-222.
3Rinck, M., Wiers, R. W., Becker, E. S., & Lindenmeyer, J. (2018). Relapse prevention in abstinent alcoholics by cognitive bias modification: Clinical effects of combining approach bias modification and attention bias modification. Journal of Consulting and Clinical Psychology, 86(12), 1005.
4Eberl, C., Wiers, R. W., Pawelczack, S., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2013). Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?. Developmental cognitive neuroscience, 4, 38-51.
5Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychological science, 22(4), 490-497.
6Goudman, L., Jansen, J., Billot, M., Vets, N., De Smedt, A., Roulaud, M., Rigoard, P. and Moens, M., 2022. Virtual reality applications in chronic pain management: systematic review and meta-analysis. JMIR Serious Games, 10(2), p.e34402.
Presenting Author
Tony Hollins
Poster Authors
Tony Hollins
BScPsych(Hons) MClinPsych
Pain Management Department Prince of Wales Hospital, Sydney
Lead Author
Skye Sadokierski
BPhyt MScMed (Pain Mgmt)
Pain Management Department Prince of Wales Hospital, Sydney
Lead Author
Poppy Watson
PhD
University of New South Wales, Sydney, 3University of Technology, Sydney
Lead Author
Topics
- Novel Experimental/Analytic Approaches/Tools