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Dispositional Fear, Anxiety Sensitivity, and Hypervigilance 

Dispositional Fear, Anxiety Sensitivity, and Hypervigilance
Chapter:
Dispositional Fear, Anxiety Sensitivity, and Hypervigilance
Author(s):

R. Nicholas Carleton

and Gordon J.G. Asmundson

DOI:
10.1093/med/9780199558902.003.0073
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date: 27 July 2021

Despite the growing body of research into the dynamic, complex, and individual experience of pain, a great deal remains to be learned. Researchers are continuing to explore the relationships between dispositional fears, hypervigilance, and chronic musculoskeletal pain. Treatment outcomes for chronic musculoskeletal pain are often less encouraging than hoped, due largely to a lack of data on, and understanding of, the mechanisms that underlie chronicity. Recent efforts to design treatment protocols that reduce pain-related disability by addressing pain-related fear and anxiety have been promising (Bailey et al. 2010) as have efforts to treat pain-related anxiety through interoceptive exposure protocols developed to address elevated AS (Watt et al. 2006). Future research should consider employing Watt and colleagues’ interoceptive treatment example with people who have chronic musculoskeletal pain—the study would allow an evaluation of whether the promising results obtained in undergraduate students with elevated pain-related anxiety can be achieved in those disabled by their pain experiences. Given the relationship between AS and IU (Carleton et al. 2007b), researchers might also explore whether ambiguous pain (e.g. chronic non-specific back pain, chronic unexplained headache) is more threatening and therefore more disabling than other types of pain for which there is sometimes a reasonably clear medical explanation (e.g. arthritis). The AS and IU constructs, both of which drive catastrophizing, appear to offer promising avenues for future research into ameliorating chronic musculoskeletal pain. Alternatively, researchers might continue with efforts to clearly delineate the nature and magnitude of attentional biases associated with hypervigilance. If the biases are sufficiently specific, modifications such as those described in recent anxiety disorder research may provide additional relief for some patients (Amir et al. 2009a; Amir et al. 2009b). In any case, improving our understanding of each of the predispositional variables described in this chapter should lead to better a understanding and, thereby, potentially improved therapeutic interventions for people trying to cope with chronic musculoskeletal pain.

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