The influence of anxiety on pain: attentional and attributional mediators

Two psychological processes mediating the influence of anxiety on pain have been proposed: an attributional process in which the pain-relevance of anxiety is the essential factor, and an attentional process in which the focus of attention is the essential factor. The present study investigated the influences of attentional focus, pain-irrelevant anxiety and pain-relevant anxiety in a within-subject design (n = 40). Subjects received painful electrical stimulation in each of 5 experimental conditions. The results indicate that pain ratings were only influenced by attentional focus and not by anxiety, regardless of whether it was pain-relevant or pain-irrelevant. Autonomic responses (skin conductance responses) were, however, only influenced by pain-relevant anxiety. Thus, it seems that with respect to subjective pain responses the attentional theory on the influence of anxiety on pain can explain the results. The attributional theory seems to hold for autonomic pain responses. However, these responses might as well be considered as fear responses. Whereas there is clear evidence for a role of attentional focus in the influence of anxiety on pain, the role of attributional processes remains to be demonstrated.