The interrelation between interpretation biases, threat expectancies and pain-related attentional processing

Background: Few studies examining the effect of pain-related threat on eye movements have incorporated a measure of interpretation bias. However, theories suggest that interpretation biases also play an important role in the anticipation of harm in situations where pain could be imminent. The current study investigates the association between interpretation biases and pain-related threat expectancies and their associations with eye movements to pain-related imagery. Methods: Healthy adults’ (N = 91) fear of pain, emotional functioning and interpretation biases were assessed prior to a threat manipulation where they were given either threatening or reassuring information about an upcoming cold pressor task. Participants were then asked to freely view scene images that were either pain-related or neutral. Results: We used a data-driven machine learning method to analyse eye movements. We identified an explorative (i.e. greater dispersal of eye fixations) and a focused eye movement pattern subgroup (i.e. mainly focusing on foreground information) for scene viewing in the sample. Participants with more negative interpretation biases expected that the cold pressor task would be more harmful, and those with higher levels of anticipated harm used a more explorative strategy when viewing injury scene images. Subsequent analysis confirmed an indirect effect of interpretation biases on eye movements through expected bodily harm. No difference in eye movements was found between participants given threatening and reassuring information. Conclusions: Interpretation biases may play a prominent role in threat-related attentional processing. By adopting a novel eye movement analysis approach, our results revealed interesting associations among interpretations, threat expectancies and eye movements. Significance: Negative interpretation biases may be associated with greater threat expectancies for an upcoming experimental pain task. Anticipation of bodily harm may induce a stimulus non-specific hypervigilant style of scanning of pain-related scenes.