Assessing the content specificity of interpretation biases in community adolescents with persistent and interfering pain

Abstract

The tendency to select threatening over benign interpretations of ambiguous bodily sensations and cues characterises young people with chronic pain. However, previous studies disagree over whether these biases extend to nonbodily harm situations such as social evaluation. Understanding the content of these biases is crucial to the development of pain management strategies seeking to modify such biases. Two hundred forty-three young people aged 16 to 19 years completed an expanded version of the Adolescent Interpretation of Bodily Threat task. Using a factor-analytic approach, we removed items that did not consistently associate with bodily harm or social evaluation. Next, we examined whether the variance underlying negative and benign interpretations of bodily harm and social evaluation situations were best represented as a common factor (ie, one-factor model), 2 distinct factors (ie, 2-factor model), or one common and 2 distinct factors (ie, 2-factor bifactor model) in all adolescents. We then compared youth with and without persistent and impairing pain on factor scores derived from the best-fitting model. Although negative interpretations of bodily harm and social evaluation situations emerged as distinct factors, benign interpretations across situations were best captured by a common factor and 2 situation-specific factors (ie, bifactor model). Group comparisons showed that young people with moderate-to-high pain interference were more likely to endorse negative interpretations across all situations, and less likely to manifest a general benign interpretational style, than youth without interfering pain, although some of these group differences were explained by co-occurring anxiety and depressive symptoms. Replication of these findings is needed.

Evaluation of the Factor Structure and Content Specificity of the Interpretation Bias Task (IBT)

“…In comparison, scenarios in social rejection and performance failure domains appear more relevant to social anxiety, which is characterised by the fear of negative social feedback and perfectionistic self-presentation (Nepon et al 2011). Additionally, previous studies using the AIBT task revealed mixed results regarding its content specificity (Heathcote et al 2016(Heathcote et al , 2017Lau et al 2020). This inconsistency highlights the need for replication in larger and more varied samples of participants.…”

“…Using this task, Heathcote et al (2017) found that adolescent chronic pain patients endorsed fewer benign interpretations for bodily threat scenarios compared to healthy controls, but this group difference did not extend to social situations, suggesting that the AIBT task is a suitable measure of interpretation biases while also providing evidence for content specificity in their patient sample. More recently, this task has been adapted to include a wider array of scenarios and validated by factor analyses in adolescents with and without persistent and impairing pain (Lau et al 2020). The original bodily threat domain has been expanded to include eight scenarios describing immediate bodily injury (e.g., cut) and eight scenarios describing longterm illness (e.g., tumour).…”

“…The original bodily threat domain has been expanded to include eight scenarios describing immediate bodily injury (e.g., cut) and eight scenarios describing longterm illness (e.g., tumour). Similarly, the original social evaluation domain has been expanded to include eight scenarios describing social rejection and eight describing performance failure (Lau et al 2020). In this expanded AIBT, an example of an immediate bodily injury scenario is: 'Someone kicks a ball and it hits you in the face.…”

“…You are sure that you will do …' followed by 'well' and 'badly'. In their study, Lau et al (2020) collapsed the immediate bodily injury and long-term illness domains into one subscale and the social rejection and performance failure domains into another subscale following model-fitting of item coherence. However, contrary to the content specificity hypothesis, their results showed that adolescents with moderate-to-high pain interference endorsed a more negative and less benign interpretation bias across all domains compared to adolescents without interfering pain (Lau et al 2020).…”

“…Despite the novelty of the original and adapted AIBT tasks, several research gaps are evident. First, this task has only been used in Western adolescent samples with and without pain problems (Heathcote et al 2016(Heathcote et al , 2017Lau et al 2020) and therefore its suitability for adult samples and for people from non-Western cultures remains unknown. Second, although a significant body of research has examined the role of interpretation biases in anxiety disorders (Blanchette and Richards 2010;Hirsch et al 2016;Mobini et al 2013;Stuijfzand et al 2018), no study has yet tested the associations between responses to the AIBT task and different subtypes of anxiety symptoms, such as health and social anxiety.…”