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Cognitive bias modification for interpretation mitigates nocebo hyperalgesia.

Tessa Rooney¹, Louise Sharpe¹, Jemma Todd¹

¹School of Psychology, The University of Sydney, Australia.

The Journal of Pain

|December 20, 2025

Summary

This summary is machine-generated.

Modifying interpretation biases towards pain increased nocebo hyperalgesia, mediated by pain expectancy. Reducing pain-related interpretations may target nocebo pain reduction in clinical settings.

Keywords:

Cognitive bias modification for interpretation Interpretation bias Negative expectancy Nocebo hyperalgesia Pain

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Last Updated: Jan 8, 2026

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Published on: July 16, 2014

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Published on: December 5, 2025

Area of Science:

Psychology
Pain Science
Cognitive Neuroscience

Background:

Interpretation bias, the tendency to interpret ambiguous stimuli as pain-related, correlates with pain severity.
Understanding mechanisms of nocebo hyperalgesia is crucial for developing effective pain management strategies.

Purpose of the Study:

To investigate if cognitive bias modification for interpretation (CBM-I) influences nocebo hyperalgesia.
To determine the mediating role of pain expectancy in the relationship between interpretation bias and nocebo hyperalgesia.

Main Methods:

Participants were randomized to CBM-I targeting pain-related or benign interpretations.
A nocebo induction procedure involved sham Transcutaneous Electrical Nerve Stimulation (TENS) paired with thermal pain.
Nocebo hyperalgesia was assessed by comparing pain ratings during TENS and no-TENS trials under identical thermal stimuli.

Main Results:

Nocebo hyperalgesia was reliably observed and mediated by pain expectancy.
CBM-I successfully manipulated interpretation bias, with the pain-bias group showing stronger bias.
Participants receiving pain-focused CBM-I exhibited significantly greater nocebo hyperalgesia compared to the benign-focused group.

Conclusions:

Cognitive bias modification targeting pain-related interpretations amplifies nocebo hyperalgesia.
Interpretation bias plays a causal role in nocebo hyperalgesia through increased pain expectancy.
Reducing pain-related interpretation biases via CBM-I presents a potential psychological intervention for clinical pain management.