Effect of attention bias modification (ABM) on chronic pain and associated health outcomes in Defence personnel

This study aims to determine whether multiple sessions of an ABM using pain cues will reduce attention bias to pain cues, reduce pain severity and related disability (e.g., pain interference) and improve mental health in ADF members (serving and ex-serving) with chronic pain. The study will be a parallel-groups randomized superiority trial comparing 5 sessions of ABM (using pain-related word cue attention modification training via a modified dot-probe task) versus sham training (i.e., placebo control condition, via a dot-probe task) in Defence personnel who self-report chronic pain experience lasting at least 3 months. The 2 arms include: 1. Behavioural: Attention bias modification (ABM) treatment Attention training using a computerized spatial attention task (dot-probe, DPT) modified to alter pain-related attention patterns using pain and neutral stimuli (with the probe placed in the opposite location to the pain stimuli). 2. Behavioural: Sham ABM placebo control condition Attention training using a computerized spatial attention task (dot-probe) not intended to alter pain-related attention patterns using the same pain and neutral stimuli (with the probe replacing the pain vs. neutral stimuli equally often). Stage 1: Participants will complete a series of online (or hard-copy option upon request) validated questionnaires to assess baseline (and at post-intervention) levels of key outcome and demographic variables. Participants will then be randomised to receive double-blinded administration of either ABM or sham (placebo control) training. Stage 2: Participants attend 1 training session a week for 5 weeks (of ABM or sham training). Prior to the first training session and at the completion of the final training session, pre- and post-intervention attention biases will be assessed, respectively, via a computerised visual probe task (<10 mins) where reaction times for different categories of pain words related to sensory and affective experiences will be measured. Participants are randomly allocated to receive either ABM or sham training, taking approximately 10 minutes each session (n = 50 each). *ABM, ‘away pain’ – in this condition, participants’ attention is implicitly re-directed away from pain-related cues (compared to neutral cues). This occurs via the placement of the dot probe in the opposite location of the pain cue on all trials. *Sham ABM control – participants’ attention is not trained toward or away from any stimuli type in this condition (i.e., similar to the assessment task, with the location of the dot probe replacing the pain cues 50% of the time). This condition serves as a placebo control group. During the 5-week intervention period, a brief (5-10 min) online survey will be completed the day following each training session to assess incremental changes in mood and pain ratings. Stage 3: Online questionnaires (or hard copy upon request) will be administered immediately and at 1-month following the final training session to assess acute and sustained or delayed effects on key clinical outcome variables (e.g., pain, disability, negative affect). Session 1 includes pre-intervention DPT assessment prior to ABM trials (20 min). Sessions 2-4 include only ABM trials (10 min). Session 5 includes post-intervention DPT assessment following the ABM trials (20 min). Each session includes instruction screens and practice trials using neutral stimuli. The interventions are delivered face-to-face by trained research assistants (with postgraduate psychology qualifications) via the experiment presentation software, E-prime 2.0, on laptop computers at a workstation (individual testing) in an office space or consulting room at the participant's local Defence base (e.g., local Barracks office space), local ex-service organisation, public library meeting room, or in a quiet room at one of the QUT campuses. All participant instructions for performing the dot probe task are contained within the program, such that the participant can read these at their own pace, pause to ask any questions of the research assistant before proceeding from the practice block to the intervention or assessment block.