Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a "part of the game," which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes' inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes' inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a “part of the game,” which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes’ inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes’ inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

Distraction,Control, and Dental Stress1

This study examined the efficacy of external distraction as a coping strategy. Thirty-eight dental patients were randomly assigned to one of three groups: incidental music during the dental procedure, music coupled with suggestions that music would help reduce stress, or a no-treatment control group. Patients in both music groups reported experiencing less stress (i.e., less pain. less discomfort, more control) than patients in the no-treatment group. Patient ratings made by dentists, blind to condition, provided converging evidence for the therapeutic effect of distraction. Thus, distracting music was found to be effective in reducing stress and increasing perceptions of control. The relative ease and simplicity of implementing external distraction compared to manipulating actual control in a medical setting may make this manipulation attractive to professionals involved with individuals experiencing stress.     

How do I cope with pain? Let me count the ways: awareness of pain coping behaviors and relationships with depression and anxiety

Patients with chronic pain are often undertreated with medications alone and need alternative ways of coping. Identifying pain coping skills patients use may be beneficial; however, no research has investigated whether patients are aware of their coping skills. The purpose of this study was to determine whether patients are aware of their pain coping skills, whether certain patient characteristics were related to using coping strategies, and whether coping strategies were related to psychiatric symptoms. Chart reviews were conducted on seventy-eight chronic pain patients who completed a semi-structured psychological interview. Patients endorsed using more coping strategies on the measure compared to the verbal self-report. Identifying with certain patient demographics was related to higher use of some coping strategies. Symptoms of anxiety and depression were also related to the use of some coping strategies. Anxiety was negatively related to ignoring the pain and using self-talk coping statements and positively related to catastrophizing. Depression was negatively related to the use of distraction, ignoring the pain, and using self-talk coping statements. Depression and pain severity were both positively related to catastrophizing and prayer. Results suggest that clinicians may need to help patients become aware of adaptive coping strategies they already use and that the use of certain coping strategies is related to lower levels of depression and anxiety.     

Fewer intrusions after an attentional bias modification training for perceptual reminders of analogue trauma

The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n=22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue-location contingency was reinforcing the direction of attention away from film reminders. Control participants (n=23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.     

Fewer intrusions after an attentional bias modification training for perceptual reminders of analogue trauma

The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n=22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue–location contingency was reinforcing the direction of attention away from film reminders. Control participants (n=23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.     

Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report.

The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.     

Preliminary exploration of worry: some characteristics and processes

The present paper reports two questionnaire studies and an experimental investigation of worrying. Worry correlated more highly than general tension reports with a variety of affect scales and was characterized by: (a) feelings of anxiety, tension and apprehension; (b) moderate awareness of somatic cues including muscle tension and upset stomach; and (c) concerns over future rather than past or present situations. Self-labeled worriers were most distinguished from non-worriers by their reported uncontrollability of cognitive intrusions once worrying was initiated. In the experimental study, worriers and non-worriers were assessed for their ability to focus their attention on a monotonous (breathing) stimulus before and after 0, 15 or 30 min of worrying. Worriers reported significantly higher anxiety. depression and hostility, a lower frequency of focused attention and a greater frequency of negative thought intrusions than did non-worriers prior to the worry period. For both worriers and non-worriers. 15 min of worry resulted in an apparent incubation of negative cognitive intrusions on the subsequent attention-focusing task.     

Attention,mindwandering, and mood

We tested the hypothesis that mindwandering and external distraction are both manifestations of a common state of reduced attention focus, and examined how both relate to reported level of happiness. We conducted real-time sampling of people’s experience of mindwandering, irrelevant distraction (e.g. by music, phone, etc.), and happiness levels, in two studies with 524 people undertaking common daily-life activities. All irrelevant external distractions were positively correlated with mindwandering. Indeed mindwandering duration could be predicted from the reported duration of external distraction, when controlling for a range of background variables. An exploratory factor analysis of mindwandering and distraction reports suggested a single underlying construct. In addition, duration of irrelevant distraction by both mobile phones and mindwandering was significantly associated with reduced reported levels of happiness. The results are consistent with the hypothesis that that a state of reduced attention focus underlies both mindwandering and distractibility and clarify the link with happiness.     

The Effect of Attention Allocation Instructions on Self-paced Task Performance under Quiet and Distracted Conditions

This study examined the effectiveness of external and internal focusing attention instructions on the performance of three throwing tasks under both quiet and distracted conditions. The main finding was that during acquisition, the external focus of attention led to improved performance when compared to internal focus of attention and control, but only under quiet conditions. It was also found that during auditory and visual distraction conditions, both types of focus attention produced similar levels of performance, and both groups were superior to the control condition. It is suggested that sport psychology consultants provide their athletes with external focusing attention instructions.     

A comparison of the effects of thought suppression, distraction and concentration

This study compared the effects of suppression, focused-distraction, and concentration on controlling unwanted distressing thoughts, and examined how anxiety levels were associated with the use of each thought-control technique. In the study, college students were told to suppress thoughts about a distressing story, to suppress the same thoughts by focusing on an alternative distraction task, to simply concentrate on that alternative task, or to think about anything without restrictions for 6 minutes. This initial period was followed by a “free-thinking” period to assess the delayed effect of thought-control techniques. The results indicated that focused-distraction and concentration led to fewer intrusions of target thoughts than suppression, and concentration in turn resulted in fewer target intrusions than focused-distraction during the initial period. Participants in the focused-distraction and concentration condition also tended to report lower anxiety during the initial period than those who were told to suppress thoughts.     

The Impact of Ruminative Processing on the Experience of Self-Referent Intrusive Memories in Dysphoria

The current study sought to experimentally assess the differential effects of analytical ruminative processing and distraction on the experience of self-referent naturally occurring intrusive memories in a sample of dysphoric (BDI-II ≥ 12) participants. Seventy-seven undergraduate participants completed a memory interview to elicit details about a self-referential intrusion and were randomly assigned to either an analytical rumination or distraction condition. Subsequent to the rumination induction, participants rated their intrusive memory as more negative, more distressing, and more evocative of a negative emotional response compared to participants who were allocated to the distraction induction. Inducing analytical rumination also resulted in participants reporting worse (i.e., more sad) mood relative to those in the distraction condition. The findings align with the suggestion that depressed individuals may get caught up in a ruminative cycle that, due to the documented effects of analytical self-focus, exacerbate the emotional response elicited by intrusions and perpetuate biased attentional focus on them. Directions for future investigations of the cognitive processes that are important in the maintenance of intrusions in depressive disorders are discussed.     

Effect of distraction and coping style on in vivo exposure for specific phobia of spiders

Recent studies have generated mixed findings regarding the effects of distraction on exposure-based treatments. Results have also been inconsistent regarding the effects of monitoring and blunting coping styles on outcome. The present study attempted to integrate these two areas of research. We hypothesized that the effect of distraction on treatment outcome might depend on coping style. Specifically, we predicted that for blunters (i.e.. individuals who tend to avoid threat-related information), distraction would interfere with the effects of exposure. However, we predicted that distraction might benefit monitors (i.e., individuals who tend to seek out threat-related information). Sixty individuals with a specific phobia of spiders underwent a single, two-hour session of exposure treatment. During the first hour, half of the participants were distracted by listening to an audiotape and the other half underwent exposure without distraction. In the second hour, all participants underwent focused exposure. Based on measures of heart rate, subjective fear, and behavioral testing, participants improved after one hour of treatment, and improved further during the second hour. However, neither distraction, coping style, nor their interaction had a significant effect on outcome. The present study provides support for the benefits of behavioral treatment for specific phobias. However, our hypotheses regarding distraction and coping style were not confirmed.     

Cognitions, metacognitions, and chronic pain

Purpose: Although the content of thoughts has received a considerable amount of attention in pain research, the importance of thought processes (metacognitions) has received less attention. Method: One hundred twenty-nine individuals with muscular dystrophy and chronic pain completed measures assessing metacognitions and frequency of both catastrophizing and pain control beliefs. Results: Greater use of reappraisal and distraction metacognitions were associated with more perceived control over pain, whereas greater use of worry and punishment metacognitions were associated with more catastrophizing. Conclusions/Implications: The current findings indicate that metacognitions are associated with both pain control beliefs and catastrophizing and therefore may play an important role in the development or maintenance of pain-related cognitive content thought to influence patient functioning. Research is needed to determine whether treatments that encourage changes in both metacognitions and cognitive content are more effective than treatments that focus on cognitive content alone. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Imposed and chosen monitoring and blunting strategies in the dental setting: Effects, self-efficacy, and coping preference

Abstract In the present study, 94 dental patients received either monitoring (i.e., paying attention) or blunting (i.e., distraction) coping instructions during treatment. Half of the patients were given the possibility of choice, whereas the other half were offered one of both strategies without choice. A majority of the patients (n=61) indicated that the intervention had resulted in a decrease of their anxiety. Some indications were found for the monitoring strategy to be more effective than the blunting strategy. More specifically, monitoring strategy subjects reported that they had experienced less distress during treatment than blunting strategy subjects. In agreement with this finding, self-efficacy ratings of monitoring strategy subjects were higher than those of blunting strategy subjects. Possibility of choice and coping preference had no substantial influence on effectiveness of the interventions.     

Processing deceptive information in sports: Individual differences for responding to head fakes depends on the attentional capability of the observer

In team sports, players sometimes try to deceive their opponents by providing misleading information in order to gain a temporal advantage. Head-fakes are often applied when a player gazes in one direction, while passing/shooting the ball in another direction. The opponent is challenged to focus attention on the relevant information (i.e., pass direction), while ignoring the conflicting information (i.e., gaze direction). The present study aimed to identify the link between attentional capabilities and the effectiveness of head fakes. Twenty-seven novices performed in a basketball-specific head-fake task and in the attention-window task. A correlation between performances in both tasks revealed that participants with higher attentional capabilities were better able to focus their attention on the relevant feature (pass direction), when judging basketball situations, than participants with lower attentional capabilities. The results emphasize the relevance of high attentional capabilities in team sports and indicate that focusing one’s attention to the pass direction poses a possibility of reducing the effects of head fakes.     

Effects of attentional direction, age, and coping style on cold-pressor pain in children

This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7-14 years (n = 120) were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children's pain tolerance and perceptions of pain intensity were assessed using a 10 degrees C cold-pressor task. Results showed pain intensity ratings after 1 min were lower for both intervention conditions than for the controls. Younger children (7-9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10-14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed.     

Effects of attentional focusing on pain perception

Two experiments were conducted to examine the hypothesized differential effectiveness of two attentional focusing strategies in pain perception. In the first experiment, subjects (72 male college students) rated their levels of pain after being exposed to either low- or high-intensity pressure stimulation for 75 s. Subjects were instructed to use either an external or internal focus of attention during the pain induction. Results revealed that external focusing was more effective for coping than internal focusing across both levels of stimulus intensity. The second experiment was a replication of the first, and featured bolstered internal focusing and stimulus intensity manipulations. Results showed that high-intensity stimulation produced higher pain ratings than did low-intensity stimulation for subjects in the internal focusing conditions, but not for those in the external focusing conditions. The findings support the power of distraction strategies for dealing with short-term pain with a rapid onset. Theoretical implications are discussed.The authors thank Darwyn E. Linder and Daniel M. Landers for their help in development of this research. The authors are also indebted to Sarah Colley, Jona Davis, Nanci Neuberger, and Rebecca Roberts for their assistance in data collection.     

Reducing infant immunization distress through distraction.

Infant procedural distress is largely understudied, and there is a dearth of empirically supported interventions in the child health psychology literature. This study examined nurse-directed distraction for reducing infant immunization distress. Ninety infants and their parents were randomly assigned to a distraction condition (i.e., nurses used stimuli to divert infants' attention) or a typical care condition. Outcome measures were an observational scale, parent and nurse ratings, and infant heart rate. Results indicated that infants engaged in distraction and that distraction reduced their behavioral distress; however, ratings and heart rate were inconclusive. Analyses of procedural phases indicated that infants exhibited elevated distress immediately prior to and during an injection, but this distress was fleeting.     

Negative mood regulation mediates the relationship between distraction and engagement in pleasurable activities among college smokers

Smoking for negative mood alleviation is a strong predictor of early smoking and early dependence among undergraduates. Little is known about whether adaptive cognitive coping processes (e.g., distraction) may help decrease the likelihood of student smoking for negative mood regulation. The present study tested the hypothesis that distraction would predict (a) greater engagement in adaptive pleasant pastimes and (b) lower rates of smoking behavior among undergraduates (n = 162, 41.9% female). We further assessed whether negative mood regulation expectations would explain both relationships. Results indicated that negative mood regulation fully mediated the relationship between distraction and engagement in pleasurable activities among college smokers. Although the relationships among distraction, negative mood regulation, and cigarette consumption were not significant, they were in the expected direction (negative). Results from the present study point to the importance of prevention efforts focused on enhancing cognitive coping skills in college smokers. Such a focus may lead to more frequent adaptive cognitive coping during negative mood states, presumably instead of smoking.