Gaining insights on the influence of attention, anxiety, and anticipation on pain perception

Figures & data

Figure 1 Summary of PCP.

Notes: This figure depicts the flow of PCP in Phase 3, after participants have undergone information manipulation. The single-headed arrow (→) denotes the sequence of the procedure from one step to another. T_B indicates baseline temperature, at which participants reported feeling uncomfortable.
Abbreviation: PCP, pain calibration procedure.

Figure 2 Predicted anticipation model.

Notes: This figure depicts the structural equation modeling used to analyze the influence of pain anticipation, pain-related anxiety, and the moderating effect of pain-related anxiety on pain perception. The rectangles () represent observed variables, while the ellipses () represent the unobserved latent factors. The single-headed arrows with solid lines (→) represent the path coefficient for regression of one variable on another. The double-headed arrows (↔) represent covariances or correlations between pairs of variables. Trait anxiety indicates pain-related trait anxiety. “×” in Anticipation × Trait anxiety box indicates the interaction between anticipation and pain-related trait anxiety. e1 indicates measurement error for pain threshold reading; e2 indicates measurement error for pain tolerance reading; e3 indicates measurement error for perceived pain intensity rating.

Figure 3 Predicted attention model.

Notes: This figure depicts the structural equation modeling used to analyze the influence of attention strategies, pain-related anxiety, and the moderating effect of pain-related anxiety on the change in pain perception. The rectangles ([img]) represent observed variables, while the ellipses ([img]) represent the unobserved latent factors. The single-headed arrows with solid lines (→) represent the path coefficient for regression of one variable on another. The double-headed arrows (↔) represent covariances or correlations between pairs of variables. Trait anxiety indicates pain-related trait anxiety. “×” in Strategy × Trait anxiety box indicates the interaction between attention strategy and pain-related trait anxiety. e1 indicates measurement error for the change in pain threshold reading; e2 indicates measurement error for the change in pain tolerance reading; e3 indicates measurement error for the change in perceived pain intensity rating.

Table 1 Summary of anticipation model

Path	B	SE	95% CI
			Lower	Upper
Pain perception ← Anticipation group	−0.28	0.44	−1.01	0.62
Pain perception ← Pain-related anxiety	−0.72*	0.33	−1.23	−0.75
Pain perception ← Anticipation × anxiety	0.81	0.48	−0.13	1.65
Pain threshold ← Pain perception	1.00		1.00	1.00
Pain tolerance ← Pain perception	20.1*	34.02	1.56	63.6
Pain intensity ← Pain perception	0.04*	0.40	−0.29	0.71

Notes: n=106.

* P<0.05.

Abbreviations: B, standardized beta coefficient; SE, standard error; 95% CI, lower and upper bounds of 95% confidence interval.

Table 2 Direction of change in pain perception in attention groups

Pain perception measures	Sensory focusing		Distraction
	M	SD	M	SD
Change in pain threshold	−0.87	2.23	1.95	1.83
Change in pain tolerance	−27.67	59.99	50.2	63.10
Change in pain intensity rating	0.65	1.33	−0.91	1.08

Notes: n=106. Sensory focusing refers to Condition Attention in which participants verbally described the sensations of pain they were experiencing. Distraction refers to Condition Distraction in which participants played a game while undergoing the pain calibration procedure. All values indicate the change from baseline.

Abbreviation: M, group mean.

Figure 4 Interaction between attention task and pain-related trait anxiety.

Notes: The change in pain perception was measured as final – initial rating of the respective pain perception ratings. Participants in attention group (n=51) were told to pay attention to and verbalize the heat sensation that they felt on their palm. Participants in the distraction group (n=55) were told to engage in a game presented on a computer in front of them.

Table 3 Summary of attention model

Path	B	SE	95% CI
			Lower	Upper
Pain perception ← Attention group	2.78*	0.38	2.04	3.34
Pain perception ← Pain-related anxiety	−1.06*	0.29	−1.59	−0.41
Pain perception ← Attention × anxiety	−0.28*	0.07	−1.36	−1.88
Pain threshold ← Pain perception	1.00		1.00	1.00
Pain tolerance ← Pain perception	29.82*	3.16	25.76	35.09
Pain intensity ← Pain perception	−0.52*	0.07	−0.75	−0.37

Notes: n=106.

* P<0.05.

Abbreviations: B, standardized beta coefficient; SE, standard error; 95% CI, lower and upper bounds of 95% CIs.