Acceptance or Distraction First while Suffering Pain? Order Effects on Visual Attention to External Painful Stimuli

Introduction: Different psychological interventions have been used to treat pain-related symptoms. The present study examines attentional biases toward pain-related facial expressions in healthy individuals before and after cold pain induction, as well as the effectiveness of acceptance- or distraction-based instruction in modifying these attentional patterns. Method: Pain-free participants completed an attentional task both before and after a pain induction using the Cold Pressor Task (CPT). Participants were randomly assigned to either an experimental group (n = 30), which performed the task with cold water, or a control group (n =30) which performed the task with room-temperature water. Additionally, both groups were instructed to use two different coping strategies —acceptance and distraction— in a counterbalanced order while undergoing the CPT. Results: Attentional biases to pain facial expressions were found under pain-free conditions. A cold pain induction did not increase attention to pain-related stimuli, instead, it decreased for pain and neutral stimuli. Most importantly, that acceptance followed by distraction (but not the reverse) significantly reduced initial attention to pain-related information. Discussion: This study confirms the presence of attentional biases in pain-free individuals. However, contrarily to expectations, a pain induction reduces general attention, probably due to participants had to perform two tasks at the same time. Our study shows that the order in which strategies are employed to cope with painful sensations is crucial for modifying an individual's attentional biases, which is the great relevance for future psychological interventions to treat pain. Perspective: This study shows that individuals without pain show attentional biases to pain-related information. Most importantly, it was found a beneficial effect of combining pain acceptance and distraction from pain to reduce attention to pain-related stimuli under an acute pain state, which is the great relevance for future psychological interventions.