Kola, Susanna

Lee, John

O'Gorman, Tom

Walsh, Jane C.

English

University of Huddersfield Repository

University of Huddersfield RepositoryKola, Susanna, Walsh, Jane C., O'Gorman, Tom and Lee, JohnThe role of attention in reducing anxiety, pain and distress associated with a stressful diagnostic procedureOriginal CitationKola, Susanna, Walsh, Jane C., O'Gorman, Tom and Lee, John (2006) The role of attention in reducing anxiety, pain and distress associated with a stressful diagnostic procedure. In: 27th International Conference of the Stress and Anxiety Research Society, July 2006, Crete. (Unpublished) This version is available at http://eprints.hud.ac.uk/9764/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/The role of attention in reducing anxiety, pain and distress associated with a stressful diagnostic procedureSusanna Kola, Jane Walsh, Tom O’Gorman & John LeeInvasive Medical Procedures Are perceived by most patients as highly stressful and anxiety provoking  Heightened anxiety levels can lead to a variety of complications, incl. heightened experience of pain  Flexible sigmoidoscopy is an invasive diagnostic procedure to detect bowel abnormalities, and is routinely performed without sedation or analgesia despite being uncomfortable and painful Pain  An unpleasant sensory or emotional experience, associated with actual or potential tissue damage or described in terms of such damage (IASP, 1979) Pain experience results from integration of sensory-discriminative, affective-emotional, and cognitive-evaluative axes (Melzack & Katz, 1994) Anxiety and Pain Anxiety is a future-oriented emotion, characterised by negative affect and apprehensive anticipation of potential threat State anxiety is associated with  Reduced pain tolerance (Carter et al., 2002) Increased pain perception (Williams, 1999; Jones et al., 2002) Prolongation of pain experience (Williams, 1999)  Lowered pain threshold (Williams, 1999; Michelotti et al., 2000) Trait anxiety less studied, but  HTA ↓ pain tolerance (James & Hardardottir, 2002)  HTA males ↓ tolerance, ↑ pain intensity  (Jones et al., 2003)  HTA ↑ pain intensity (Tang & Gibson, 2005) Attention and Pain Focus of attention a mediational role in the perception of pain - can lead to increased or decreased pain reports  Distraction Reduced pain perception (e.g., Devine & Spanos, 1990)  Increased pain tolerance (e.g. Piira et al., 2005; James & Hardardottir, 2002)  Sensory Focus Reduced pain perception (e.g., Ahles et al., 1983) Increased pain tolerance (e.g., Keogh & Herdenfeldt, 2002) Attention and Pain Limited Capacity Resource Theory of Attention (Kahneman, 1973)  Attention is of limited capacity and distraction reduces the available resources to process pain stimulus  Parallel Processing Theory of Pain Distress(Leventhal & Everhart, 1979)  Involve focusing attention on the physical sensations of pain and discomfort in a concrete, objective, non-distressing way Distraction vs. Sensory Focus: Explanation for equivocal results Pain intensity or threat level (Eccleston & Crombez, 1999)  Temporal factors (Suls & Fletcher, 1985)  Anxiety may mediate the relationship between attention and pain (James & Hardardottir, 2002)Study Aims Intervention study to reduce patient anxiety, pain and distress relating to flexible sigmoidoscopy using different cognitive attention strategies  Investigation of which strategy is the most effective, and for whom  Examine various psychological variables in relation to the experience of the procedure Methodology Randomised controlled trial  First time flexible sigmoidoscopy patients Random assignment to one of four conditions  Audio-Visual Cognitive Distraction – lexical decision task  Sensory Focus – pay close attention to sensations Audio-Visual Relaxation – nature views and relaxing music Control – standard care Audio-Visual Distraction Conditions In the Cognitive Distraction and Relaxation conditions patients to wear virtual i-glasses Cognitive Distraction –lexical decision task  Relaxation – view “DVD 'At Water's Edge..' (SereneVision Productions Inc.)Sensory Focus and Control Conditions In the Sensory Focus condition patients are asked to pay close attention to their sensations while watching the real-time FS on the monitor Control Condition –Standard Care MeasuresPre-procedureDemographic infoBP/HRSTAI (state & trait)Marlowe-Crowne DuringBP/HRBehavioural observations of distress Post-procedure BP/HR Discomfort ratings Pain intensity ratings PANASFPQ-IIIDiscomfort   Expectancy Pain Expectancy Depth of Insertion Length of time of procedureMPQ STAI (state)Coping with Pain Questionnaire PANAS MBSS Predictions Distraction – greater adjustment and lower pain intensity levels  Sensory focus – greater adjustment and better pain outcomes if patients find it hard to disengage attention  Likely that individual difference variables will interact with focus of attention, especially trait anxiety (James & Hardardottir, 2002)   

The role of attention in reducing anxiety, pain and distress associated with a stressful diagnostic procedure

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