The effect of threat on cognitive biases and pain outcomes: An eye-tracking study

Background: Theoretical accounts of attentional and interpretation biases in pain suggest that these biases are interrelated and are both influenced by perceived threat. A laboratory-based study was conducted to test whether these biases are influenced by threat and their interrelationship and whether attention or interpretation biases predict pain outcomes. Methods: Healthy participants (n = 87) received either threatening or reassuring pain information and then completed questionnaires, interpretation and attentional bias tasks (with eye-tracking) and a pain task (the cold pressor). Results: There was an interaction effect for threat group and stimuli type on mean dwell time for face stimuli, such that there was an attentional bias towards happy faces in the low-but not high-threat group. Further, high threat was also associated with shorter pain tolerance, increased pain and distress. In correlational analyses, avoidance of affective pain words was associated with increased pain. However, no relationship was found between attention and interpretation biases, and interpretation biases were not influenced by threat or associated with pain. Conclusions: These findings provide partial support for the threat interpretation model and the importance of threat and affective pain biases, yet no relationship between cognitive processing biases was found, which may only occur in clinical pain samples. What does this study add?: In healthy participants, no relationship between attention and interpretation biases was found. Eye tracking revealed an association between later attentional processes and pain. Threat influenced attentional biases and pain outcomes, partially supporting theoretical accounts.