مقایسه اثر آموزشی توجه و آرام سازی بر روی واکنش به درد

This study aimed to investigate the efficacy of an attention training technique (ATT) on pain ratings, threshold and tolerance during the cold pressor task. One hundred and three undergraduate students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive either ATT or progressive muscle relaxation (PMR). Hence, the present study had a 2 (threat expectancy: high vs. low) × 2 (training: ATT vs. PMR) design. Analyses confirmed that the threat manipulation was effective in increasing the harm associated with the task. ATT resulted in a relative reduction in hypervigilance to sensory pain words compared to PMR. ATT was also associated with a lower degree of focus on internal sensations, but not mindfulness or difficulty disengaging from pain words. Results showed that, relative to relaxation training, those receiving ATT reported pain less quickly than those receiving relaxation, although there were no differences between the training groups for tolerance or pain ratings. These results show that ATT changes the cognitive processes of internal/external focus and hypervigilance towards sensory pain words, but not difficulty disengaging or mindfulness. Although ATT changed threshold, the fact that neither pain ratings nor tolerance was affected suggests that a single, brief session of ATT may not be sufficient to affect broader change. Nonetheless, this study shows that ATT can change cognitive processes thought to be associated with heightened perception of pain and that this changes how quickly pain is registered and is therefore worthy of further investigation.

Attention to painful stimuli has been highlighted as a determinant of response to pain [6]. If pain is interpreted as threatening, attention is directed to the pain rather than competing tasks. This prompts escape or avoidance behaviours to restore equilibrium [6]. There is considerable research that confirms that pain is associated with high attentional demands that are compounded when the threat value of pain is increased [25]. If attention to pain prompts avoidance, one might expect that interventions that reduce attention to pain would reduce pain and pain-related avoidance. Distraction, for example, has been used as a part of cognitive–behavioural therapy for patients with chronic pain [22]. However, research investigating distraction alone remains inconclusive [12]. It has been suggested that the efficacy of distraction may depend upon the threat value of pain [25]. Van Damme and colleagues manipulated threat and found that distraction increased catastrophic cognitions and anxiety under conditions of high threat. They concluded that caution is required in using distraction when pain is highly threatening, as in clinical settings. Similar concerns have been discussed in the anxiety literature, with the result that distraction is now viewed as a form of safety behaviour [24]. As such, it is no longer seen as a useful adjunct to therapy with anxious patients. Instead other ways of changing attentional processes have been developed. Wells [28] has developed a method of attention training (ATT) that focuses on helping participants to effortfully re-direct their attention away from threatening internal stimuli, such as catastrophic cognitions thought to fuel anxiety. There is some preliminary evidence that this method is beneficial in patients with panic disorders, social anxiety and hypochondriasis [23] and [29]. Wells argues that by shifting the focus of attention from internal threatening processes to external factors, anxiety is reduced [23], [28] and [29]. Since pain, like anxiety, is a noxious and potentially threatening internal experience, the rationale for the efficacy of ATT can be expanded to pain. However, ATT has not been trialed in the pain literature. The aim of this study is to test the efficacy of ATT compared to a control intervention (i.e. relaxation training) using an acute experimental pain task. We also aim to determine the likely mechanism of change. Participants were randomized to high or low threat conditions and re-randomized to receive ATT or relaxation before completing the cold pressor task. We hypothesized that the ATT group would have higher threshold and tolerance times and lower pain levels than the relaxation group. Measures were taken of possible cognitive processes that may be changed by ATT, including hypervigilance, difficulty disengaging from pain words, mindfulness and internal/external focus to identify which cognitive processes were shifted as a result of ATT.