The Role of Anxiety Sensitivity, Fear of Pain and Experiential Avoidance in Experimental Pain

DOI: 10.4236/psych.2011.28125   PDF   HTML     5,072 Downloads   9,325 Views   Citations


The aim of this study was to investigate whether distraction is less effective when pain is perceived as threatening. Forty-one female undergraduate participants were assigned to distraction and not distraction conditions that consisted in performing a distraction task and the threat value of the pain stimuli was manipulated using instructions. AS, EA an FP were considered as covariates. Results indicated that distraction manipulation had a main effect on less pain intensity, more tolerance and less catastrophic thoughts. Interestingly, the covariate AS had a significant effect over tolerance and EA had an effect on distress and anxiety related to pain. These results suggest that AS and EA are distinct processes and that each could play a different role in the response to pain. Anxiety sensitivity involves behavioural avoidance, whereas EA is a rejection of the internal experience that contributes to an increase in emotional distress.

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Gutiérrez, A. , Zarazaga, M. & Damme, S. (2011). The Role of Anxiety Sensitivity, Fear of Pain and Experiential Avoidance in Experimental Pain. Psychology, 2, 817-830. doi: 10.4236/psych.2011.28125.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ahles, T., Blanchard, E., & Leventhal, H. (1983). Cognitive control of pain: Attention to the sensory aspects of the cold pressor stimulus. Cognitive Therapy and Research, 7, 159-177.
[2] Asmundson GJG,Taylor S. (1996) Is high fear of pain associated with attentional biases for pain-related or general threat? A categorical reanalysis. Journal of Pain, 8, 11-18.
[3] Asmundson GJG, Kuperos, JL and Norton GR. (1997) Do patients with chronic pain selectively attend to pain-related information: Preliminary evidence for the mediating role of fear. Pain, 72, 27-32.
[4] Sandín, B; Valiente, R.M.; Chorot, P. and Santed, M.A.; Barraca. (2004) Propiedades psicométricas del índice de sensibilidad a la ansiedad. International Journal of Psychology and Psychological Therapy, 4 (3), 505-515.
[5] Bushnell, M.C.; Duncan, G.H.; Hofbauer, R.K.; Ha, B.; Chen, J.I.; Carrier, B. (1999) Pain perception: is there a role for primary somatosensory cortex?. Proceedings of the National Academy of Sciences, 96, 7705-7709.
[6] Camacho L., Esteve MR. (2008) Anxiety sensitivity, body vigilance and fear to pain. Behaviour Research and Therapy, 46, 715-727.
[7] Cioffi, D. (1991) Sensory awareness versus sensory impression: affect and attention interact to produce somatic meaning. Cognition and Emotion, 5, 275-294.
[8] Cioffi, D., & Holloway, J. (1993) Delayed costs of suppressed pain. Journal of Personality and Social Psychology, 64, 274-282.
[9] Cohen, J. (1988) Statistical power analysis for the behavioral sciences. Hillsdale, N.J.. Lawrence Erlbaum.
[10] Crombez G, Eccleston C, Baeyens F, Eelen P. (1998). When somatic information threatens, catastrophic thinking about pain enhances attentional interference. Pain, 75, 187-198.
[11] Crombez G, Van Damme S, Eccleston C. (2005) Hypervigilance to pain: an experimental and clinical analysis. Pain, 116, 4-7.
[12] Eccleston C, Crombez G. (1999) Pain demands attention: a cognitive biases and the experience of pain. European Journal of Pain, 4, 37- 44.
[13] Esteve MR, Camacho L. (2008) Anxiety sensitivity, body vigilance and fear of pain. Behaviour Research and Therapy, 46, 715-727.
[14] Fanurik D, Zeltzer LK, Roberts MC, Blount RL. (1993) The relationship between children’s coping styles and psychological interventions for cold pressor pain. Pain, 52, 255-257.
[15] Feldner, M.T. And Hekmat, H. (2001) Predictions of pain behaviors in a cold pressor task. Journal of Behavior Therapy and Experimental Psychiatry, 32, 191-202.
[16] Feldner, M.T.; Hekmat, H.; Zvolensky, M.J.; Vowles, K.E.; Secrist, Z. and Leen-Feldner, E.W. (2006) The role of experiential avoidance in acute pain tolerance: A laboratory test. Journal of Behavior Therapy and Experimental Psychiatry, 37, 146-158.
[17] Goubert L, Crombez G, Eccleston C, Devulder J. (2004) Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain. Pain, 110, 220-227.
[18] Hayes, S., Strosahl, K.D., & Wilson, K.G. (1999) Acceptance and Commitment Therapy. New York: Guilford.
[19] Hayes, S.C.; Strosahl, K.; Wilson, K.G.; Bissett, R.T.; Pistorello, J.; Toarmino, D.; Polusny, M.A., Dykstra, T.A.; Batten, S.V.; Bergan, J.; Stewart, S.H.; Zvolensky, M.J.; Eifert, G.H.; Bond, F.W.; Forsyth, J.P.; Karekla, M. and McCurry, S.M. (2004) Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.
[20] Hassenbring, M.; Hallner, D.; Rusu, A.C. (2008) Fear-avoidance and endurance-related responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ). European Journal of Pain, in press.
[21] Heyneman NE, Fremouw WJ, Gano D, Kirkland F and Heiden L. (1990) Individual differences in the effectiveness of different coping strategies for pain. Cognitive Therapy and Research, 14, 63-77.
[22] Herrero, A.; Ramírez-Maestre, C.; González, V. (2008) Personality, Cognitive Appraisal and Adjustment in Chronic Pain Patients. The Spanish Journal of Psychology, 11 (2), 531-542.
[23] Hodes RL, Howland EW, Lightfoot N, Cleeland C. (1990) The effects of distraction on responses to cold pressor pain. Pain, 41, 109-114.
[24] Jackson T, Pope L, Nagasaka T, Fritch A, Lezzi T, Chen H. (2005) The impact of threatening information about pain on coping and tolerance. British Journal of Health Psychiatry, 10, 441-451.
[25] James JE, Hardardottir D. Influence of attention focus on pain. (2002) British Journal of Health Psychiatry, 7, 149-162.
[26] Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006) Experimential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behavior Research and Therapy, 9, 13011320.
[27] Keogh E, Birkby J. (1999) The effect of anxiety and gender on the experience of pain. Cognitive Emotion, 13, 813-329.
[28] Keogh E, Dillon C, Georgiou G, Hunt C. (2001) Selective attention biases for physical-threat anxiety sensitivity. Journal of Anxiety Disorder, 15 (4), 299-315.
[29] Keogh E, Mansoor L. (2001) Investigating the effects of anxiety sensitivity and coping on the perception of cold pressor pain in healthy women. European Journal of Pain, 5, 11-25.
[30] Keogh E, Cochrane M. (2002) Anxiety sensitivity, cognitive biases and the experience of pain. Journal of Pain, 3, 320-329.
[31] Lethem J, Slade PD, Troup JDG and Bentley G. (1983) Outline of a fear-avoidance model of exaggerated pain perceptions. Behavior Research and Therapy, 21, 401-408.
[32] Keogh E, Thompson T, Hannent I. (2003) Selective attentional bias, conscious awareness and fear of pain. Pain ,104, 85-91.
[33] Koster, E.H., Rassin, E., Crombez, G., N?ring, W.B. (2003) The paradoxical effects of suppressing anxious thoughts during imminent threat. Behavior Research and Therapy, 41, 113-1120.
[34] Leventhal, H. I (1992) know distraction works even though it doesn’t. Health Psychology, 11, 208-209.
[35] Lillienfeld SO. (1997) The relation of anxiety sensitivity to higher and lower order personality dimensions: Implications for the aetiology of panic attacks. Journal of Abnormal Psychiatry, 106, 539-544.
[36] Masedo AI, Esteve MR. (2007) Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behavior Research and Therapy, 45, 199-209.
[37] Marx, B.P. and Sloan, D.M. (2002) The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behavior Therapy, 33, 563-577.
[38] McCaul KD, Monson N, Maki RH. (1992) Does distraction reduce pain-produced distress among college students?. Health Psychology, 11, 210-217.
[39] McNeil DW, Rainwater AJ. (1998) Development of the fear of pain questionnaire-III. Journal of Behavioral Medicine, 25, 389-410.
[40] Miron D, Duncan GB, Bushnell MC. (1989) Effects of attention on the intensity and umpleasantness of thermal pain. Pain, 39, 345-352.
[41] Moseley GL, Arntz A. (2007) The context of a noxious stimulus affects the pain it evokes. Pain, 133(1), 64-71.
[42] Morley, S., Shapiro, D.A., & Biggs, J. (2003) Developing a treatment manual for attention management in chronic pain. Cognitive and Behavior Therapy, 32, 1-12.
[43] Norton PJ, Asmundson GJG. (2003) Amending the fear-avoidance model of chronic pain: What is the role of physiological arousal?. Behavior Therapy, 34, 17-30.
[44] Peterson RA, Reiss S. (1992) Anxiety sensitivity index manual (2nd edition). Worthington, OH: International Diagnostic Systems.
[45] Peterson RA, Plehn K. (1999) Measuring anxiety sensitivity. In: Taylor S, editor. Anxiety sensitivity: Theory, research and treatment of the fear of anxiety. London: Lawrence Erlbaum Associates, 61-81.
[46] Petrovic P, Peterson KM, Ghatan PH, Stone Elander S, Ingvar M. (2000) Pain related cerebral activation is altered by a distracting cognitive task. Pain, 85, 19-30.
[47] Plehn K, Peterson RA, Williams DA. (1998) Anxiety sensitivity: it relationship to funtional status in patients with chronic pain. Journal of Occupational Rehabilitation, 8, 213-222.
[48] Osman A, Breitenstein JLL, Barrios FX, Gutiérrez PM, Koper BA. (2002) The fear of pain questionnaire-III: Further reliability and validity with nonclinical samples. Journal of Behavioral Medicine, 25, 155-173.
[49] Orsillo, S.M.; Roemer, L. and Barlow, D.H. (2003). Integrating acceptance and mindfullness into existing cognitive-behavioral treatment for GAD: A case study. Cognitive and Behavioral Practice, 10, 222- 230.
[50] Reiss S, McNally RJ. (1985) Expectancy model of fear. In S Reiss and RR Bootzin (Eds). Theoretical issues in behaviour therapy (107-121). San Diego: Academic Press.
[51] Reiss S, Peterson RA, Gursky M, McNally RJ. (1986) Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8.
[52] Roelofs J, Peters ML, Van der Zijden M, Vlaeyen JWS. (2004) Does fear of pain moderate the effects of sensory focusing and distraction on cold pressor pain in pain free individuals? The Journal of Pain, 5, 250-256.
[53] Sandin B, Chorot P, McNally RJ. (1996) Validation of Spanish version of the anxiety sensitivity index in a clinical sample. Behavior Research and Therapy, 34, 283-290.
[54] Schmidt NB, Lerew DR, Jackson RJ. (1997) The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psycholy, 106, 355-364.
[55] Schmidt NB, Cook BH. (1999) Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder. Behavior Research and Therapy, 37, 313-323.
[56] Seminowicz DA, Davis KD. (2007) A re-examination of pain-cognition interactions: Implications for neuroimaging. Pain, 130 (1), 8-13.
[57] Standford, S.; Kersh, B.; Thorn, B.; Rich, M.A. and Ward, L.C. (2002) Psychosocial mediators of sex differences in pain responsivity. Journal of Pain, 3, 58-64.
[58] Stewart SH, Conrod PJ, Gignac M, Pihl RO. (1998) Selective processing biases in anxiety-sensitive men and women. Cognition and Emotion, 12, 105-133.
[59] Sullivan MJL, Bishop SR, Pivik J. (1995) The pain catastrophizing scale: development and validation. Psychological Assesment, 7, 524- 532.
[60] Sullivan MJL, Neish N. (1999) The effects of disclosure on pain during dental hygiene treatment: the moderating role of catastrophizing. Pain, 79, 155-163.
[61] Sullivan MJL, Thorn B, Haythornthwaite J, Keefe FJ, Martin M, Bradley L et al. (2001) Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17, 103-115.
[62] Taylor S, Koch WJ, McNally RJ. (1992) How does anxiety vary across the anxiety disorders?. Journal of Anxiety Disorders, 6, 249-259.
[63] Turk DC, Meichembaum D, Genest M. (1984) Pain and behavioral medicine: A cognitive behavioural perspective. New York: Guildford Press.
[64] Vallis TM. (1984) A complete component analysis of stress inoculation for pain tolerance. Cognitive Therapy and Research, 8, 313-329.
[65] Vancleef LMG, Peters ML. (2006) Pain catastrophizing, but not Injury/ Illness Sensitivity or Anxiety Sensitivity, enhances attentional interference by pain. The Journal of Pain ,7 (1), 23-30.
[66] Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B. (2002) A confirmatory factor analysis of the Pain Catastrophizing Scale: Invariant factor structure across clinical and non-clinical populations. Pain, 96, 319-324.
[67] Van Damme S, Crombez G, Van Nieuwenborgh-De Wever K, Goubert L. (2008) Is distraction less effective when pain is threatening. An experimental investigation with the cold pressor task. European Journal of Pain, 12(1), 66-67.
[68] Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a motivational account of attention to pain. Neuroscience Biobehaviorist Rev, in press.
[69] Villemure C, Bushnel MC. (2002) Cognitive modulation of pain: how do attention and emotion influence pain processing?. Pain, 95, 195- 199.
[70] Vlaeyen, J.W.S. and Linton, S.J. (2002) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85, 317-332.
[71] Zvolensky MJ, Goodie JL, McNeil DW, Sperry JA, Sorrell JT. (2001) Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneus chronic pain population. Behavior Research and Therapy, 39, 683-696.

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