Category: Comorbidity - Anxiety and Other
Introduction: Individuals with co-morbid chronic pain and anxiety experience greater distress, functional impairment, and disability relative to those with just one of the conditions (Asmundson et al., 2008). The treatment of co-morbid conditions is particularly complex; individuals with comorbid pain and anxiety disorders have worse treatment outcomes than those with no co-occurring mental disorder (Dersh et al., 2002). Accordingly, it is a priority to develop and evaluate effective treatments for co-morbid chronic pain conditions and anxiety disorders. Various theoretical accounts of co-morbidity have emerged, and these theories emphasize the importance of biased attentional processing in understanding the etiology and maintenance of co-morbidity. For example, the Mutual Maintenance model (Sharpe & Harvey, 2001) and Shared Vulnerability model (Asmundson et al., 2002) posit that attentional biases to pain-related and threatening cues are important to understanding co-morbidity; however, specific tests of these models remain unfinished. Cognitive Bias Modification, and more specifically, Attention Bias Modification training procedures have been developed to target biased attentional processing in both clinical anxiety (Hakamata et al., 2010) and chronic pain populations (Sharpe et al., 2012); however, few studies have examined attentional biases in a co-morbid sample.
Method: We examined attentional capture to and difficulty disengaging from pain-related and threatening stimuli in individuals with chronic musculoskeletal pain conditions with and without anxiety disorders. Participants (N=95) completed T2 version of the emotional attentional blink paradigm (EAB-T2) and an emotional exogenous cueing task (EECT).
Results: In the EAB-T2 task all participants across groups displayed attentional capture to emotional stimuli relative to neutral stimuli. Individuals with chronic pain displayed greater attentional capture to pain-related stimuli compared to individuals without chronic pain. In the EECT, we found that all clinical groups displayed difficulty disengaging from emotional stimuli relative to neutral stimuli.
Discussion: Our study is one of the first to empirically examined specific attentional abnormalities associated with chronic pain with and without co-occurring anxiety disorders using more precise experimental paradigms to probe to specific aspects of orienting of attention. We found consistent evidence of population-wide biased attentional processing of emotionally salient relative to neutral stimuli. We also found evidence of disorder-specific attentional capture to pain-related stimuli in individuals with chronic pain. However, we failed to replicate previous studies that have consistently demonstrated anxiety-specific biased processing of threatening information. This study supports theories of co-morbidity that emphasize the relevance of preferential attentional processing of disorder-salient stimuli and provides empirical support for the basic mechanisms underlying the therapeutic usefulness of cognitive bias modification approaches designed to ameliorate clinical anxiety, chronic pain, and potentially other psychological disorders (Bar-Haim, 2010).