Research Article: Does attention bias modification training impact on task performance in the context of pain: An experimental study in healthy participants

Date Published: July 18, 2018

Publisher: Public Library of Science

Author(s): Dimitri M. L. Van Ryckeghem, Stefaan Van Damme, Tine Vervoort, Mariella Pazzaglia.


Attention has been theorized to play a key role in the experience of pain and associated task interference. Training attention away from pain via attention bias modification (ABM) training techniques has been proposed to improve pain-related outcomes, but evidence is inconsistent. In an experimental study, we investigated the impact of a single session ABM training -using a visual probe paradigm with idiosyncratic pain words- on cold pressor test (CPT) pain experience and task interference by pain. Fifty-eight healthy volunteers were randomly assigned to an ABM training group (N = 28; attending away from pain) and a sham training group (N = 30; no training direction). At pre-training, participants performed a baseline Random-Interval-Repetition (RIR) task and the CPT. Participants reported on sensations they experienced during the baseline CPT. Relevant descriptors were integrated in the visual probe paradigm during the training phase. At post-training, participants completed the RIR task again while experiencing CPT pain. Participants also reported on the extent they attended to the pain and the intensity/unpleasantness of the pain. Results indicated that, in contrast with our hypotheses, ABM training did also not reduce task interference due to CPT pain. Furthermore, ABM training did not change self-reported attending to CPT pain. Finally, ABM training did not reduce CPT pain intensity or pain unpleasantness. Overall, the current study provides no support for the effectiveness of a single session ABM training in improving pain-related outcomes. Future research addressing the conditions under which ABM training improves or fails to improve pain-related outcomes is warranted.

Partial Text

Attention plays a pivotal role in the experience of pain and its impact upon task performance [1,2,3,4]. In particular, research amongst healthy volunteers and chronic pain patients has shown that attention bias toward pain-related information—i.e., the tendency to select pain information over non-pain information—increases the experience of pain [5,6] and the level of interference by pain with ongoing activities [7,8,9]. Given the key role of attention bias, attempts have been undertaken to investigate whether pain-related attention biases can be reduced using Attention Bias Modification (ABM) training, and whether ABM training affects pain and/or pain-related outcomes. ABM training typically consists of a computerized training protocol in which participants are trained to attend away from pain-related stimuli and towards neutral stimuli [10,11,12,6]. As yet, research investigating the effectiveness of ABM is still in its infancy. Early evidence has indicated that ABM can be effective in improving certain pain-related outcomes. In particular, experimental research in healthy adults indicated that a single ABM training session away from pain increased CPT pain outcomes (e.g., pain threshold [10, 13], pain intensity [14]). However, the effects of single session ABM training on pain-related outcomes are inconsistent and recent findings of a single session ABM training in healthy adults failed to replicate the positive effects of ABM training away from pain [15]. Similar inconsistent effects of ABM training on pain-related outcomes have been reported in chronic pain patients (See [16,17], but see [11]).

The primary aim of the current study was to investigate the impact of a single ABM training session on pain-related task interference. In addition, we investigated the impact of a single ABM training session on participants’ pain experience when performing a competing task in a controlled laboratory context. Importantly, these aims were addressed, while optimizing the stimulus content used for the ABM training procedure. In particular, we used idiosyncratic pain words instead of a standard set of pain words. The use of stimulus content that activates participants’ personal pain schemata is considered essential in effectively measuring and manipulating attention bias for pain [18]. Furthermore, we used parameters that have shown to have the largest impact on pain experience in previous ABM research (i.e., pain words instead of pain pictures [13]); stimulus presentation time of 500 ms [10,13]). Results of the current study can be readily summarised. First, the ABM training did not significantly change participants’ level of attention bias for pain. Furthermore, while pain was found to interfere with task performance, ABM training did not result in better task performance when experiencing pain. Finally, and in contrast to earlier findings showing that ABM training affects self-reported pain experience, no evidence was found for the impact of ABM training upon pain experience.