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Cognitive Behaviour Therapy
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Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women
Edmund Keogh , Cate Barlow , Charlotte Mounce & Frank W. Bond
a b a a a

Department of Psychology, University of Bath, Bath, BA2 7AY, UK
b

Department of Psychology, Goldsmiths College, London, SE14 6NW, UK Available online: 22 Dec 2006

To cite this article: Edmund Keogh, Cate Barlow, Charlotte Mounce & Frank W. Bond (2006): Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women, Cognitive Behaviour Therapy, 35:4, 198-206 To link to this article: http://dx.doi.org/10.1080/16506070600898330

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Cognitive Behaviour Therapy Vol 35. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS. Key words: anxiety sensitivity. BA2 7AY. & van Son. Hughes. panic. Ellery. Jones & . controlled) pain induction techniques (e. Taylor. Olde. & Katz. 2002. 2006). 1 study found that AS mediates the relationship between prenatal negative birth expectations # 2006 Taylor & Francis ISSN 1650-6073 DOI 10. pp. BA2 7AY. No 4.ac. 2006 Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women Edmund Keogh1. 198–206. Bath. 2006). Ayers. acceptance. UK. there is growing interest in the application of anxiety sensitivity (AS) to the area of pain. What seems important about AS is that it may serve as a risk factor in the development of pain chronicity (Norton & Asmundson. E-mail: e. Tel: +44 (0)1225 383671. & Lebeck. the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. Another study found AS to be related to pain during childbirth (Lang. & Norton. Accepted March 28. UK. University of Bath. cognitive therapy Received February 5. 2006 Correspondence address: Edmund Keogh.g. using experimental (i. Rodgers. sex differences. Participants were 50 healthy adults (23 males. Bath. Department of Psychology.keogh@bath. For example. Coons. but that there may be sex differences in this relationship. 2006. There is also evidence to suggest that prenatal AS predicts subsequent post-traumatic stress symptoms (Keogh. pain. van der Hart. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds). & Holdcroft. Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. which are known to co-occur with acute and chronic pain (Asmundson. Keogh & Asmundson. These results not only confirm that AS is associated with experimental pain. Of the ASP subscales. 1999. Cate Barlow1. Bond2 1 Department of Psychology. London. 2002). An alternative approach to investigating AS and pain is to examine this relationship in healthy adults. and 2Department of Psychology.1080/16506070600898330 and fear experiences during a caesarean section (Keogh.uk As is apparent from this special issue of Cognitive Behaviour Therapy. Daniels. (ii) examining whether different coping instructions affect pain reports. When the analysis was conducted separately for each sex. University of Bath. SE14 6NW. UK Downloaded by [King's College London] at 07:47 21 March 2012 Abstract. and (iii) investigating potential differences between men and women. but also to fear avoidance and disability (Asmundson. Kleber.m. whereas the other made use of acceptance-based instructions. Charlotte Mounce1 and Frank W. Fax: +44 (0)1225 386752. one version required the use of control instructions. a similar pattern of correlations were found between the pain indexes and AS under both conditions. 2003).e. whereas they were related to the behavioural measures of pain in men. 2004). 27 females) who were required to complete 2 versions of the cold pressor pain task. Evidence from a range of acute and chronic pain states indicates that AS is related not only to the perception and experience of pain. Goldsmiths College. Sorrell. as well as play a role in acute pain episodes. Norton. & Francis. 2006). experimental pain. the ASP scales were related to the self-report measures of pain in women.

Additionally. Such sexspecific effects are not limited to the laboratory. is the Anxiety Sensitivity Profile (ASP. 2004). anterior and posterior cingulate) implies that AS is distinct from other fear constructs. the Anxiety Sensitivity Index (ASI. Whilst it seems likely that AS is related to an increased susceptibility to pain. Reiss. i. and cognitive dyscontrol. One pattern that emerges is that more consistent effects are found for self-report pain experiences than for behavioural measures of pain threshold and tolerance (although some studies do occasionally find effects) (for review see Uman et al. Gursky. however. For example. 1999. this issue. For example. Shaw. A second question is whether the AS / pain relationship can be modified. 1998). this issue). medial prefrontal region (Ochsner et al. and is the most widely used measure of this construct. While the ASI is generally considered to be a good. 1999). Bond. 2006. as results found in the laboratory seem to translate to the clinic. & Lillis. Rush. Masuda. is an acceptance-based approach (Hayes. 2004. 2004). & Vlaeyen. but also highlights the utility of using experimental pain methods. the ASP was conceptualized as consisting of 6 dimensions: cardiovascular.VOL 35. this issue).. 1999. McCracken. Beck. such as the controlbased approaches advocated by Beck (Beck. To date. Hayes. Uman et al. Hamid. both generally within the area of cognitive behaviour therapy.. there are a number of unanswered questions. For example. While the ASI consists of 16 items thought to reflect 3 lower-order dimensions (physical. Strosahl.. 2002. this issue. The utility of varying experimental coping instructions to examine the AS / pain relationship is that it also allows for the comparison of different theoretical approaches to psychological pain management. Keogh & Mansoor. The advantage of the ASP. Since AS is believed to serve as a vulnerability factor to the development of panic disorder. & Wilson. Eccleston. when we compared focused and distraction type instructions. 1979). There have been few specific interventions that aim to change.. then it may have real practical applications for those susceptible to pain. for an exception). & Keefe. Olatunji et al. 2004). one of the more obvious therapeutic approaches that may be considered appropriate to help those high in AS would be a cognitive-behavioural one.. the research conducted to date has depended on 1 measure of AS. or at least help people deal with. Keogh & Chaloner. This is important because if it is possible to change this relationship. Hamid. & McNally. as well as more specifically within the treatment of pain. within patients referred to a hospital clinic with new episodes of chest pain. A measure that has not yet been applied to a pain-induction paradigm. McCracken. Keogh & Cochrane.e. Emery. The general pattern seems to be that AS is related to increased pain sensitivity. 2006 Anxiety Sensitivity Profile and pain 199 Zachariae. 2005. & Ellery. This not only indicates that the AS / pain relationship is moderated by sex. Keogh. such AS-related pain (but see Watt et al. we found that women high in AS reported the highest pain levels (Keogh. Roelofs. & Emery. 1986). social and mental concerns. 2006). publicly observable anxiety reactions. another approach that is emerging as potentially important. Tsao et al. Taylor & Cox. NO 4. Peterson. see also Conrod. 1985. Peters. That the fear of pain was related to activation within other regions (ventral lateral frontal region. there was a suggestion that focusing on pain was a benefit for those high in AS (Keogh & Mansoor. this issue. One laboratory technique is to provide participants with different coping instructions to see whether they affect the pain reports of those high and low in AS. reliable and valid measure. 2005.. most AS / pain research has examined the global AS construct and not examined these subcomponents. Keogh & Birkby. 2001. is that it has many more items (60 vs 16) and so allows for a more detailed investigation of the subcomponents of AS. respiratory. Like the ASI. Luoma. 1 test of the generalizability of the AS / pain relationship would be to see whether it is found when using other measures. However. Carson. 2004. van der Zijden. gastrointestinal. factor analyses of the ASP reveal a number of lower-order subscales. 2002. dissociative and neurological symptoms. At least 1 study has also shown that the AS / thermal pain relationship is associated with activation in specific brain regions believed to be related to selffocused attention. Schmidt & Cook. While control-based approaches advocate patients attempting to Downloaded by [King's College London] at 07:47 21 March 2012 . 2001). & Greenberg. but that may be useful in this context. 1999. the relationship between AS and experimental pain may be stronger in women than men (Keogh & Birkby.

81) (5.54) (8.89 17. especially analgesics (but excluding oral contraceptives).453 **pv0. ASP5Anxiety Sensitivity Profile.28 Female (16. Hanmer. We are unaware of any study that has examined such coping instructions within the context of AS.25).60 34. Keogh. Importantly.468 0.351 0. see also Tsao et al. going to work or to the shops).52) (4. and not currently in pain or taking any form of medications. acceptance type coping instructions have been applied to laboratory-based pain settings. 1999. DASS5Depression Anxiety Stress Scale.28) 62. and. .976** 21. avoided. within the current context. acceptance-based attitude in which such thoughts and feelings are not changed. Pain induction task The cold pressor task was the pain induction method employed in the current study.868 0.451 21. and examine how the various subcomponents relate to pain experiences. but has been the method used within the majority of previous AS studies (Keogh & Asmundson. Then the hand is transferred to a N the fear of arousal component of the ASP would be the most strongly related to the pain variables (especially the self-report measures of pain). AS or age.81) (13. gender and pain. and found to be better at reducing pain experiences than control-based ones (Hayes. we also wanted to examine whether different pain coping instructions (control vs acceptance) would differentially affect pain reports.706 22. & Tilston.49) (7.26 years.. a second objective was to examine potential differences between men and women in the relationships between AS and pain. and that this would be most pronounced within women.. Based on the results of previous studies we predicted that: N N women would show a stronger AS / pain relationship than men.205 0.96 15. The task requires participants to place their dominant hand in a warm water bath (37 ˚C) for 2 minutes to establish a baseline.85 7. et al.18 4. Barlow.35) (6. Mounce and Bond COGNITIVE BEHAVIOUR THERAPY Downloaded by [King's College London] at 07:47 21 March 2012 change the frequency and content of thoughts and feelings associated with pain and anxiety. Our first objective was to make use of the ASP as our measure of AS.g.18) (7.212 0. This approach has not only been used to experimentally examine pain sensitivity.408 0.84 15. Participant characteristics are presented in Table 1 by sex. Finally. Inclusion criteria were that they were healthy. Independent t-tests revealed that women reported higher DASS stress scores than men.477 Cohen’s d 0. these newer approaches suggest adopting a more mindful. Bond. There were 23 males and 27 females aged between 20 and 56 years (mean age528.59 28.23) (11.133 0.96 7.433 21. Since previous work suggests that there may be sex differences in both pain and AS. over the age of 18 years.04 25. this issue.68 107. Male ASP Arousal Cognitive Gastrointestinal Total DASS Stress Anxiety Depression Age (years) 60. 2004.01. depression.14 9. SD510. acceptance-based instructions would be more beneficial than control-based instructions.07 112.69) (22. this issue).200 Keogh. Means and standard deviations of questionnaire scores and age by sex (male vs female).704 20.640 20. Method Participants A total of 50 healthy adults were recruited into the study.13) t-test 20. Uman et al.48 9. Table 1.89) (13.86 (13. 2005). No sex differences were found for anxiety.93) (6. or used as reasons not to pursue actions that would promote one’s values and goals (e.67) (7.16) (6. The primary aim of this study was to address these issues using an experimental pain induction methodology.227 21.78 30.72) (30.

factor analyses indicate that there are 4 main factors. Coping instructions Downloaded by [King's College London] at 07:47 21 March 2012 For the current study we employed the same instructions used by Keogh et al.81. 21. 44.g. 41. Pain threshold and tolerance points are both measured in seconds. Asmundson. 1985). we developed 2 sets of instruction. 0. One set was control-based in that participants were asked to try and control their thoughts and feelings during the pain task. 40. & Swinson. Since the cardiac scale of the ASP had low reliability it was excluded from all subsequent analyses. 32. AS was assessed using the ASP (Taylor & Cox. 19. Svensson. The factor structure of the SFMPQ has been confirmed through confirmatory factor analysis (Wright. 1995) was administered to capture feelings of anxiety and depression. 7. 15. 27. The pain rating scale consists of 15 descriptor items. 17. 0. 1999). or most of the time). & Arendt-Nielsen.88. this issue). 1987). 1998). 36. although there are some small discrepancies concerning how items load. 30. Cox. with scores ranging from 0 (did not apply to me at all) to 3 (applied to me very much. 13. and depression. Mounce & Brosnan. Bieling. replicable and perceived to be a good measure of thermal pain sensitivity (Graven-Nielsen.92. Participants are instructed to indicate the point at which they first detect pain (threshold). 55. This is similar to the conclusions drawn by Olatunji et al. and the point at which they can no longer stand the pain and withdraw their hand (tolerance). This scale is relatively new and is comprised of 60 items that are scored on a 7-point scale.48. and were broadly based on a Beck-type approach (Beck et al. Sergerdahl. These items are then summed to produce 3 subscales. and a total for each scale calculated. It is considered both a valid and reliable measure of pain. anxiety. 2001). 60. respectively.65. with 1 indicating ‘‘not at all likely’’ and 7 ‘‘extremely likely’’ that various sensations will lead to something bad. 1979. 9. 49. We examined the 3 analyses reported by Taylor and Cox (1998) and Olatunji et al. Enns. 50). 24. 1998). 6. all consisting of 7 items. 14). The acceptance approach was broadly based on Acceptance and Commitment Therapy (Hayes et al. 2001). and has been extensively used in experimental and clinical settings (e... Keogh. (ii) fear of cognitive dyscontrol and dissociation (items 2. 43. 54. 2006 Anxiety Sensitivity Profile and pain 201 cold water bath. The second set of instructions was acceptance-based. 23. Procedure Following screening.VOL 35. maintained around 0–2 ˚C. 47. Specifically.g. Anxiety Sensitivity Profile (ASP). Reliability analysis revealed alphas of 0. 34. Pain was assessed using the SF-MPQ (Melzack.25. 26. 39. These items formed the following 4 scales: (i) fear of arousal-related sensations (items 3. (2005) and identified the items that consistently loaded on the same factor across these studies. & McCreary. ranging from none (scored as 0) through to severe (scored as 3). Each item is rated on a 4-point scale. Questionnaire measures Short form McGill Pain Questionnaire (SFMPQ). 52.g. NO 4. Although originally conceived as a 6 subscale measure.. and 4 to the affective component of pain (e. (2005). and 0. In order to ascertain whether mood was related to pain. They completed a practise cold pressor trial in order to familiarize themselves with the task (data from this practice trial was used in an unrelated study. 45. (iii) fear of gastrointestinal symptoms (items 4. and (iv) fear of cardiac symptoms (items 1. sickening). 59. The DASS has been shown to have good factorial stability and is considered a reliable and valid measure of mood (Antony. This suggests that the majority of scales have generally good reliability. the visual analogue scale and present pain index were not utilized here. respectively. and asked participants to try to notice their thoughts and feelings during the task without actually allowing those internal events to control what they do. throbbing). 11. . The current study focused on the pain rating scale since this has previously been found to be most consistently related to the AS / pain relationship. consenting adults were provided with cold pressor instructions. with the only exception being the cardiac symptoms scale. of which 11 relate to sensory pain experiences (e. 10. The task is safe. 56). see Carleton et al. Depression Anxiety Stress Scale (DASS). the short-form DASS (Lovibond & Lovibond. relating to stress. The DASS is comprised of 21 items that are rated on a 4point scale. (2005). 18.

and coping instruction (control vs acceptance) as the within-groups factor.34. within women. transformations (Tabachnick & Fidell.05) indicating that higher levels of stress were related to lower pain thresholds.37 (36.47) Female Acceptance 29. A main effect of coping instruction was also found (acceptance529. 43)55. tolerance. although presented means represent the untransformed scores in order to aid interpretability.32.16) (2. we repeated the analysis including order (control condition first or second) as an additional between-groups factor.12) (2.35. The order of task instruction was counterbalanced between participants.98) (1. participants were immediately administered the SF-MPQ. Participants were debriefed following completion of the second experimental task. Means and standard deviations of pain measures by sex (male vs female) and coping instruction (control vs acceptance). 44)59.202 Keogh. For pain threshold.23. we transformed these measures using square root Table 2. For the correlational component of the study. pv0.57 . After each task.01). and 1 with acceptance-based instructions. pv0. women had a lower overall pain tolerance than men (F(1. 48)56. Therefore.91) (6. indicating that the acceptance instructions resulted in a lower pain threshold when compared with the control instructions.79. sex (male vs females) served as the betweengroups factor. stress as the covariate. 46)58.28) (2.22 (20.43) (7. this factor served as a covariate to control for sex-specific differences in stress on any differences in pain between men and women. pv0. control540. participants completed the ASP and DASS. All subsequent analyses were conducted on the transformed data. Simple effects revealed that when control was used first.05). the covariate stress was significant (beta520. Male Control Threshold Tolerance Sensory Affective 44. No other significant effects were found.46) Acceptance 29. this was then conducted separately for males and females. For sensory pain. Furthermore.17) (35.26.04 1. sensory and affective pain). an additional significant interaction was found between sex and order for pain tolerance (F(1.73 56.49. Results Data screening and descriptive statistics All data were subject to screening for skewness using frequency checks. In between the cold pressor tasks. 45)54.85 85.97 10.08 8. Means and standard deviations for all pain measures under the different conditions of the experiment are displayed in Table 2.25) (4.96 (36. Barlow. the only significant result found was a main effect for coping instruction (acceptance510.05). Since there was a significant sex difference on the DASS stress scale. Sex differences in pain The first set of analyses conducted were a set of mixed-groups ANCOVA’s on the 4 pain indexes.63 1. Although this did not alter the above mentioned effects. 1 with control-based instructions.80) (40.29 87. F(1.08.81. For the experimental component.85 9. Since it is possible that coping instruction order played a role.40) (6. overall pain tolerance was lower when control was used Design and analysis Downloaded by [King's College London] at 07:47 21 March 2012 A mixed experimental and correlational design was used. pv0. mixed-groups ANCOVA was used. 2001). F(1. Since the pain data were marginally positively skewed.59 1. pv0.91 10. AS scores were correlated with the pain measures under the control and acceptance conditions.21) (35. Mounce and Bond COGNITIVE BEHAVIOUR THERAPY in press).08) (38.61) Control 36.25.59 (31. The dependent variables were the various pain measures (threshold.05).69 64. Next participants completed 2 experimental cold pressor tasks. suggesting acceptance resulted in a greater sensitivity to the sensory component of pain. control59.19) . F(1.

Male Threshold Tolerance Sensory Affective Arousal Cognitive Gastrointestinal Total 20.060 20. there seems to be a relationship between the fear of arousal-related symptoms and behavioural measures of pain (pain threshold/tolerance).014 20.073 20.067 20. there was also a significant relationship between affective pain and the cognitive concerns scale). .178 0. These average scores were then correlated with the 3 ASP subscales separately for men and women to determine whether there were any sex differences.455* 0.574** 0. There were few notable relationships involving pain threshold or tolerance.368** 0. as well as a significant negative relationship between the cognitive concerns scale and pain tolerance.05. Partial correlations (controlling for stress) between Anxiety Sensitivity Profile scales and pain indexes (averaged across coping conditions) separated by sex (male vs female). Correlations between Anxiety Sensitivity Profile scales and pain measures by coping instruction condition (control vs acceptance).282* 0. **pv0. whereas within women it seems as if the fear of gastrointestinal symptoms and cognitive concerns are related to a greater sensitivity to self-reported pain. Since there were no noticeable differences in the relationship found between the coping instructions.595** 20.206 0. there were a number of positive relationships with the cognitive and gastrointestinal ASP scales.448 Female Threshold Tolerance Sensory Affective 0.184 0. However. for the self-report measures of sensory and affective pain. mean pain ratings were calculated for each index by averaging across the 2 conditions. As can be seen in Table 4.355* 0. there was a significant negative relationship Downloaded by [King's College London] at 07:47 21 March 2012 between the arousal subscale of the ASP and pain threshold and pain tolerance. but not women.01.429* 0.476* 20. NO 4.06.398** Threshold Tolerance Sensory Affective Threshold Tolerance Sensory Arousal Cognitive Gastrointestinal Total 20. For men.031 0.149 0.467* 0.061 0.265 0.032 0. was related to the pain ratings of healthy adults following a cold pressor pain challenge.032 0.149 0.232 0. 2006 Anxiety Sensitivity Profile and pain 203 first than when it was used second (F(1. for men.222 0. 44)57. Correlational analyses A series of correlations were conducted between the questionnaire measures and the pain indexes.215 0.421** 0.474* 0.407** 0.443* *pv0. Unexpectedly. as measured using the ASP.239 20.330* 0.589** 0.096 20.092 0.133 20.360* 20.285 0.184 20.462* 20.203 20.072 20. **pv0.266 0.172 20.211 0. AS was related to Table 3.01. Discussion The primary goal of this study was to determine whether AS. however. Table 4.378 20.334* 0. Since there were sex differences in stress.166 20.112 0. Together this suggests that there may be a sex-specific difference in the way in which the various components of AS are related to pain.116 0.415** *pv0. these relationships were similar across the control and acceptance conditions. The first set was conducted separately for the 2 different coping instruction conditions (see Table 3).159 20.175 0.163 20. As predicted. this variable was partialled out of the correlations.493* 20.05.352* 0.140 20.079 0.058 0.469* 0. pv0.VOL 35. Control Acceptance Affective 0. it seemed as if it was the sensory and affective components of pain that were generally related to the ASP scales (note: for men.526** 0.345* 0.05). Within women.

relating to acceptance and control-based approaches. Although the general pattern of results reported here are interesting. It is possible that this may have influenced the efficacy of the adoption of subsequent coping instructions. For males. a condition which is associated with abdominal pain. and so we need to be cautious about drawing any definite conclusions. Mounce and Bond COGNITIVE BEHAVIOUR THERAPY pain. The final objective of this study was to examine whether different coping instructions. we need to be cautious about drawing definite conclusions. However. Further investigation is required to examine whether the inclusion of such a practice trial. including those with a gastrointestinal component. 2005). Schmulson. This extends the findings of previous experimental studies that have used the ASI by demonstrating that this relationship can also be found when using an alternative measure of this construct. or women find it harder to ‘‘give up control’’ when they are first instructed to use it as a coping mechanism for pain. Mayer. This revealed that the cognitive and gastrointestinal domains seem to be particularly related to pain experiences. such explanations are speculative. Such a view is consistent with those of Norton. irritable bowel syndrome. which may have restricted the number of significant differences Downloaded by [King's College London] at 07:47 21 March 2012 . Thompson. but not females. Asmundson. 1999. influences such effects. such as threshold and tolerance (Keogh & Birkby. is also of interest as it is consistent with evidence that there are similar sex differences in gastrointestinal conditions (e. They found that AS was higher in students who met criteria for functional dyspepsia. Chial & Camilleri. 1999. the fear of arousal symptoms and cognitive concerns scales were related to lower pain thresholds and pain tolerance levels.204 Keogh. that the gastrointestinal component of the ASP was found to be related to pain in women. but it extends it by indicating that visceral (gastrointestinal) experiences may be an area of particular interest. but not for males (although there was a significant relationship between affective pain and the cognitive concerns component of the ASP in males). in fact. For example. this issue). Chang. we found the opposite effect. and order generally. all participants received a practice cold pressor trial where no coping instructions were administered. We did find that overall pain tolerance levels were lower (in both coping conditions) in women if they received the control instructions first.g. While a different pattern of associations were found between men and women. Furthermore. even when subsequently given contradictory instructions.. in that we did not replicate the finding that acceptance-based instructions would be more beneficial than control-based ones.. 2002. the use of the ASP allowed us to examine in more detail the various subcomponents of AS. Lee. but not men. 2001). Previous work into cold pressor pain responses using the ASI suggests that the AS / pain relationship in women may be stronger for self-report components of pain than behavioural measures. and Larsen (1999) who suggested that AS may be important in a range of conditions that are characterized by abnormal somatic sensations. there were some methodological differences between the current study and previous work. & Naliboff. which was to determine whether sex differences exist in the relationships found between AS and pain. Such a discrepancy could cast doubt on the reliability of the current findings. No clear differences were found. The results involving coping instructions are also surprising given the results of previous studies (Hayes et al. An additional sex-specific finding was that the various components of the ASP were generally related to the sensory and affective components of the pain experience in females.. This might suggest that either acceptance has a sexspecific protective effect. and which is related to anxiety conditions such as panic. these were not statistical differences between correlation coefficients. see also Uman et al. The present results suggest that such sex-specific dissociation between self-report and behavioural pain measures can also be found when using an alternative measure of AS. would result in differences in the AS / pain relationship. Norton. However. An additional issue is the relatively small sample size. based on very small cell sizes. Keogh et al. Barlow. such a conclusion is premature in light of the second goal of the current study. Furthermore. Whilst it may initially seem as if the arousal component of the ASP was not related to cold pressor pain as initially hypothesized. Together this not only confirms previous experimental work that AS is related to experimental pain sensitivity.

. Enns. & Francis. future research could consider using different pain induction methods. NO 4.. (2002). suggesting that there may be differences between the ASI and ASP in terms of the underlying construct being measured. (2006). A. J.. J. M. (1999). 155–165. Sergerdahl. 176–181. (1999). P.. it was not possible to address these issues here due to the limited sample size. G. J. as well as to see the ASP used more widely in pain research. sex differences in both pain and AS (e. as this may help lead towards specific interventions that help those prone to pain deal with such experiences. 1997). and so low power may partly explain why we observed no significant sex differences on either measure. Jones. G. London: The Guilford Press. H. Keogh. S. (1998). & Wilson... Cognition and Emotion. It is notable that the majority of studies to date have used the cold pressor pain task. L. Bieling. the current study demonstrated that the relationship between AS and experimental pain extends to other measures of AS. Korn. 2006.. In sum. Also. B. it would be interesting to see more clinically-based studies that examine potential interactions between AS and sex. 83. Keogh.. E. Ayers. Cox. Previous research certainly suggests that there are consistent.. Oxford: Oxford University Press. Similarly.. 91–115). 153–160. & Baker. & Emery. J. processes and outcomes. 813–829.. Hayes. it would seem sensible to follow-up on whether it is possible to modify the relationship between AS and pain. L. and so are generally limited to 1 paradigm. Stewart. The impact of acceptance versus control rationales on pain tolerance. Graven-Nielsen.VOL 35... F. 1–25. see also Tsao et al. G. (2002).. Norton. Emery. P. J. 47. 10. Keogh. 9. In G.. and not for the anxiety or depression scales. 2005). R. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. at least 1 study with a much larger sample (nv600) failed to find sex differences on the ASP (Olatunji et al. 31. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.. (1985). R. Strosahl. P. 37–45. Investigating invariance in the factorial structure of the Anxiety Sensitivity Index across adult men and women. M. & Zachariae. S.. Journal of Gender Specific Medicine. this issue). Anxiety Disorders and Phobias: A Cognitive Perspective. J. A. G. Vlaeyen. Psychological Record.. & Norton. B. Gender differences in irritable bowel syndrome. Kruger (Ed. J. Canadian Journal of Psychiatry. British Journal of Health Psychology. 49. Demonstrating that such effects occur across different pain induction paradigms would help to determine their generalizability. A. 2006 Anxiety Sensitivity Profile and pain 205 and/or relationships found. However. 97–119. Keogh. M. G. S.g. E. & Arendt-Nielsen.. et al. H.. Negative affectivity. Investigation of the interactive effects of gender and psychological factors on pain response. & Lillis... although we considered directly investigating the potential interactions between AS (e. Rush. R. Clinical Psychology Review. R. Methods in Pain Research (pp. PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. (1979). although not large.. & Swinson. It also suggests that there may be differences in the pattern of relationships found based on the subcomponents of AS measured. Finally. Taylor. Acceptance and Commitment Therapy: Model.. (2001).. Journal of Personality Assessment.g. Svensson. The effect of anxiety sensitivity and gender on the experience of pain. In L. Hayes. 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