Research Article: Being aware of the painful body: Validation of the German Body Awareness Questionnaire and Body Responsiveness Questionnaire in patients with chronic pain

Date Published: February 28, 2018

Publisher: Public Library of Science

Author(s): Holger Cramer, Romy Lauche, Jennifer Daubenmier, Wolf Mehling, Arndt Büssing, Felix J. Saha, Gustav Dobos, Stephanie A. Shields, Jacobus P. van Wouwe.


Body awareness is an attentional focus on and awareness of internal body sensations. This study aimed to validate German versions of the Body Awareness Questionnaire (BAQ) and the Body Responsiveness Questionnaire (BRQ) in chronic pain patients and to assess their associations with pain-related variables and to assess their responsiveness to intervention. The instruments were translated to German and administered to 512 chronic pain patients (50.3±11.4 years, 91.6% female) to assess their factor structure and reliability. Cronbach’s α for the BAQ total score was 0.86. Factor analysis of the BRQ revealed the two factors Importance of Interoceptive Awareness (Cronbach’s α = 0.75) and Perceived Connection (Cronbach’s α = 0.75) and the single-item Suppression of Bodily Sensations. The BAQ was independently associated with lower mindfulness, self-esteem, stress, and depression; Importance of Interoceptive Awareness with mindfulness, self-acceptance, self-esteem, and physical contact; Perceived Connection with self-acceptance, vitality, and lower sensory pain; Suppression of Bodily Sensations with lower self-esteem, physical contact, and higher depressive symptoms. After a 10-week multimodal mind-body program (n = 202), the BAQ and Importance of Interoceptive Awareness increased and pain intensity and Suppression of Bodily Sensation decreased. In conclusion, body awareness and body responsiveness are associated with pain-related variables in patients with chronic pain. Mind-body interventions may positively influence both pain and body awareness, hinting at a potential mechanism of action of these interventions to be tested in further research.

Partial Text

Body awareness is an attentional focus on and awareness of internal body sensations [1]. In a more elaborate conception, body awareness is a multi-dimensional construct that refers to the subjective, phenomenological aspect of proprioception and interoception that enters conscious awareness, which is modifiable by mental processes including attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes and affect [1].When taken as an intense focus on somatic symptoms, body awareness has long been associated with rumination, catastrophizing, and somatization [2], attentional strategies that increase the risk of chronic pain [3]. Distraction from pain, rather than awareness of it, has been shown to be beneficial for coping with pain [4]. On the other hand, focusing on the sensory dimension of pain rather than on the emotional dimension has been shown to yield favorable outcomes for patients with chronic pain conditions [5,6]. Similarly, ‘interoceptive exposure’ has been suggested recently as an innovative approach to chronic pain conditions and shown preliminary benefits for pain-related distress [7]. In this view, body awareness can take the form of a mindful, non-evaluative awareness of subtle body cues or sensations of discomfort and pain without overreacting to them [1]. While the concept of body awareness overlaps with that of mindfulness, body awareness has been defined as either a prerequisite for mindfulness [8], or a more specific construct that shares similarities with mindfulness but is not commonly assessed by standard mindfulness instruments [1]. In empirical research, the two constructs can be differentiated; it has e.g. been shown that associations of exercise with eating behavior are mediated by body awareness but not by mindfulness [9].

Prior research suggests that attention to bodily sensations is associated with maladaptive attentional and coping styles in chronic pain patients. Other research however suggests that the type of attentional focus, or type of response to body sensations, influences the degree of perceived pain in chronic pain patients. Specifically, mindful, non-judgmental and accepting awareness of the sensory aspects of pain has been shown to reduce the unpleasantness of experimental pain [32–35] and distress from chronic pain [7]. It has e.g. been shown that interventions that increase body awareness in patients with chronic pain may alleviate pain intensity [36], and that pain relief is associated with decreases in catastrophizing, and increases in body awareness [37].




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