The relationship between self and pain in healthy adults: competition and individual differences

Thesis

Understanding the mechanisms that underlie psychological pain treatments is vital to improving them. Attention plays a crucial role in the development of chronic pain, and recent research has highlighted the need for better assessments of attentional bias towards pain. Attention is also important for pain treatments that rely on distraction, including novel virtual reality-based interventions. Distraction is hypothesised to reduce perceived pain intensity by diminishing cognitive resources available to process pain. Pain parameters, inter-personal differences and distraction task characteristics impact distraction effectiveness, but the role of motivational distraction components such as reward is little understood. The relationship between pain- and self-schemas has also been proposed as a factor in chronic pain. The schema enmeshment model (Pincus & Morley, 2001) postulates that frequent pain experience causes integration of pain- and self-schema, which maintains chronic pain and leads to detrimental pain outcomes in patients.

This thesis addresses 3 questions in healthy individuals: 1) Can a pain adaptation of the Perceptual Matching Paradigm (PMP; Sui, He & Humphreys, 2012) assess pain-bias, 2) Can self-related task content enhance the effectiveness of distraction from pain, and 3) does self-pain enmeshment reflect non-clinical variations in pain experience, or individual differences in self- or pain-related cognition?

In the PMP Bias task, our healthy sample prioritised pain as expected, but it is doubtful whether pain-processing was successfully elicited and pain-bias demonstrated. The relative effectiveness of neutral and self-related distraction task content and performance-based monetary reward was explored in a between-group cold pressor pain induction study. Basic distraction effects could not be replicated, although a self-related distraction reduced attention to pain more effectively than a neutral task. Finally, we showed that self-pain enmeshment is linked to increases in pain-related disability and locus of control in healthy individuals. Our findings support and add to the enmeshment model, suggesting interpersonal differences and pain disability contribute to schema enmeshment.

Authors: Boehm, E

• DOI: 10.5287/ora-2rdmq7opk
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford