Interpretation biases and visual attention in the processing of ambiguous information in chronic pain

Background: Theories propose that interpretation biases and attentional biases might account for the maintenance of chronic pain symptoms, but the interactions between these two forms of biases in the context of chronic pain are understudied. Methods: To fill this gap, 63 participants (40 females) with and without chronic pain completed an interpretation bias task that measures participants’ interpretation styles in ambiguous scenarios and a novel eye-tracking task where participants freely viewed neutral faces that were given ambiguous pain/health-related labels (i.e. ‘doctor’, ‘patient’ and ‘healthy people’). Eye movements were analysed with the Hidden Markov Models (EMHMM) approach, a machine-learning data-driven method that clusters people's eye movements into different strategy subgroups. Results: Adults with chronic pain endorsed more negative interpretations for scenarios related to immediate bodily injury and long-term illness than healthy controls, but they did not differ significantly in terms of their eye movements on ambiguous faces. Across groups, people who interpreted illness-related scenarios in a more negative way also focused more on the nose region and less on the eye region when looking at patients’ and healthy people's faces and, to a lesser extent, doctors’ faces. This association between interpretive and attentional processing was particularly apparent in participants with chronic pain. Conclusions: In summary, the present study provided evidence for the interplay between multiple forms of cognitive biases. Future studies should investigate whether this interaction might influence subsequent functioning in people with chronic pain.