Thinking abstractly about one’s physical pain: can abstraction reduce sensitivity to painful stimuli?

Abstract

Whether people think less abstractly when they experience physical pain has been examined in previous research. However, the reverse causal possibility—that abstraction reduces sensitivity to painful stimuli—does not appear to have been empirically tested. The aim of this study was to investigate whether abstraction reduces sensitivity to painful stimuli. Using the cold pressor method, university students (N = 205) were exposed to experimental pain. Participants were randomly assigned to an abstract mindset, concrete mindset, cognitive distraction (control task), or no task (control) condition. As a manipulation of abstraction, participants focused on why they felt pain (abstract condition) versus how they felt pain (concrete condition). Pain endurance and pain intensity were evaluated. The abstract mindset condition did not show significantly lower pain sensitivity compared with the other experimental conditions. We found no evidence suggesting that abstract thinking would reduce pain sensitivity. The effectiveness of other techniques that induce abstraction, such as third-person (versus first-person) self-talk should be examined in future research. Since experimentally induced pain in healthy participants differs from clinical pain, whether abstract thinking may reduce pain sensitivity in chronic pain patients should also be examined.

Keywords:

• Abstraction
• cognition
• pain
• experimental pain
• pain sensitivity

Introduction

Pain could be described as an unpleasant sensory or emotional experience that stem from actual or potential tissue damage (Raja et al., 2020). Virtually all people have experienced acute pain, and millions of people are afflicted with chronic pain (Yong et al., 2021). Given the high prevalence of pain, it is important to identify its cognitive consequences. Indeed, a large body of research has examined whether pain states of different origins and different durations influence basic cognitive functions, such as attention, memory, executive functioning (Khera & Rangasamy, 2021). Since pain influences cognitive functioning, cognitive processes could possibly influence the perception of pain. Earlier research in this field has concentrated on distraction from the attention to the painful sensation, but only weak evidence for the usefulness of distraction in chronic pain has been presented (van Ryckeghem et al., 2018). In addition, most studies on the impact of cognition on pain seems to have examined the combined effect of relatively disparate cognitive and emotional processes, rather than that basic cognitive functions per se. Cognitive distortions such as pain catastrophizing (Barrett et al., 2020; Gilliam et al., 2021) is one example that draws on disparate cognitive and emotional processes. To fill this void in the literature, we examine whether abstraction, which constitutes a fundamental dimension of higher-order cognition, alters pain perception and endurance.

Abstraction

There is a broad agreement between theoreticians that abstraction is a cognitive process that incorporates some type of information reduction, allowing for efficient storage and retrieval of knowledge with central importance (Burgoon et al., 2013). Abstraction is also typically characterized by holistic and broad thinking (e.g. Trope & Liberman, 2010). As such, it leads to a focus on the superordinate meaning of events and actions instead of their detailed mechanics (Vallacher & Wegner, 1989). In other words, a focus on why rather than how something happens (Vallacher & Wegner, 1989). To illustrate with a pain related example, an abstract mindset may direct attention to the underlying cause of the pain e.g. a herniated disc, whereas a concrete mindset may direct attention to how the pain is felt e.g. pain radiates through my leg. Abstraction has for long been recognized as a central dimension of human higher-order cognition (Piaget, 1977; Trope & Liberman, 2010; Vallacher & Wegner, 1989), and has been found to play an important role in a wide range of outcomes, such as learning, creativity, self-control, negotiation, and morality (for an overview, see Burgoon et al., 2013; Trope & Liberman, 2010).

Abstraction and pain

Loewenstein’s (1996) visceral factors theory proposes that drive states, moods, emotions, and physical pain are concretely experienced visceral factors which lead to a narrow, egocentric focus in the here and now, particularly when experienced at high intensity levels. According to Construal Level Theory of psychological distance (Trope & Liberman, 2010), such focus constitutes a concrete way of thinking. Indeed, there is non-clinical research showing that experimentally induced pain leads to a more concrete focus on the self, here and now (Agerström et al., 2019). Research on clinical populations also suggests that greater experienced pain intensity and persistence is associated with more concrete mental representations of actions (Gunnarsson & Agerström, 2018), although some research (Agerström et al., 2017) has reported no relationship between pain and abstraction.

Given that pain is a concretely experienced visceral factor that narrows attention, would it be possible for abstract thinking to mitigate pain? While extant theories and research do not specifically account for the impact of abstraction on pain, theories and research on the impact of psychological mechanisms that elicit abstraction (e.g. psychological distancing; Trope & Liberman, 2010) on affective states, arousal, and physiological reactions could provide some guidance.

When people experience negative affect, they tend to adopt a concrete (self-immersed) perspective (Trope & Liberman, 2010) which directs attention to tangible features of their experiences (Ayduk & Kross, 2010). This subsequently increases negative arousal, which makes reflective analysis of one’s emotions difficult (Kross et al., 2005). In contrast, a more abstract perspective allows people to process information in a more reflective, informational “cool” manner, instead of an emotionally arousing “hot” and often automatic manner (Kross et al., 2005; Metcalfe & Mischel, 1999). For example, Kross et al. (2017) showed that a more abstract linguistic perspective in the form of third-person (versus first-person) self-talk resulted in more fact-based reasons not to worry about a public health threat, which in turn predicted reductions in worry and risk perceptions. Supporting the view that abstraction reduces negative affect, the results of a laboratory experiment showed that anger provoked participants who were instructed to adopt a more psychologically distant (abstract) view of themselves felt less anger than participants who adopted a more concrete view of themselves (Mischkowski et al., 2012). Furthermore, a more abstract mindset induced by psychological distancing and perspective broadening appears to reduce stress to upsetting memories as well as residual symptoms of depression in individuals with recurrent depression (Travers-Hill et al., 2017). Moreover, the physiological reactions that are linked to negative emotions have been reduced; people who adopted a more self-distanced (abstract) perspective reacted with lower blood pressure when reminded of a previous conflict (Ayduk & Kross, 2008). Evidence supporting the direct link between abstraction and less emotional reactivity comes from Kross et al. (2005). They found that participants who construed an emotionally painful event more abstractly (e.g. why it happened) reported less emotional distress than participants who construed the event more concretely (e.g. what happened). As noted above, there is also some correlational evidence for a link between abstraction and pain. People with chronic pain who are more prone to think more abstractly report lower levels of pain intensity (Gunnarsson & Agerström, 2018). However, correlation does not imply causation, meaning that the relationship could be reversed, or confounded by some unobserved factor(s).

While previous research has focused on emotional pain and not physical pain, a recent experimental study (Wang et al., 2019) provides indirect support for an analgesic effect of abstraction on experimental pain induced with the cold pressor method whereby participants keep one hand immersed in cold, painful water. As with most of the studies reviewed above, the authors studied self-distancing which is an indirect manipulation of abstraction (Trope & Liberman, 2010). The results showed that participants who imagined that they were looking at themselves from the vantage point of a fly sitting on the wall (self-distance condition) reported a lower sensation of pain compared with participants who looked at their fist from their true field of vision (self-immersed condition) and compared with the control group. However, the results should be interpreted with caution due to the small sample size (N = 65) considering that the study used a between-subjects design with three conditions. Another limitation of the study is that the authors did not include a comparison distraction condition which controlled for the distracting effect of the experimental manipulation.

To sum up, the hypothesis that abstraction would reduce sensitivity to painful stimuli is based on the following main reasoning. Physical pain has been theorized as a concretely experienced visceral factor or sensory experience by some scholars (Agerström et al., 2019; Loewenstein, 1996). Abstract thinking, as opposed to concrete thinking, is assumed to elicit cool, reflective processing that reduces attention to visceral states and tangible, bodily sensations (Trope & Liberman, 2010). Besides making the concrete sensory pain signals less cognitively salient and more “disembodied” (Wang et al., 2019), abstraction could help people reconstrue their pain experience and reduce its psychological impact (Kross et al., 2005). Abstraction could reduce rumination because it allows people to reflect on emotional experiences without activating high levels of affect (Ayduk & Kross, 2010; Kross et al., 2005), and possibly mitigate other debilitating states that reinforce the pain experience. Pain catastrophizing, whereby the person magnifies or exaggerates the threat value and seriousness of pain sensations (Sullivan et al., 1995), could be one example of a debilitating state. Hence, it seems possible that abstraction could serve as an antagonist to the visceral factor of pain.

The current research

To the best of our knowledge, no earlier study has investigated whether abstraction per se influences pain. To address this research gap, we conducted a laboratory experiment where a non-clinical sample was induced to think more abstractly (why they felt pain) or more concretely (how they felt pain) while being induced with experimental pain through a cold pressor apparatus. The outcomes of interest were perceived pain intensity as was reported by the participants and time duration of the experimentally induced pain i.e pain tolerance.

Methods

Research ethics

All participants signed an informed consent form prior to participating in the study. The study was approved by the Swedish Ethical Review Authority (code: 2020-01999).

Participants/design

Healthy, pain-free students and staff (86 males; 119 females; 18–63 years old) from a Swedish university participated in the study. Inclusion criteria were no known disease affecting the nervous system and Swedish fluency. Exclusion criteria were present pain and known disease affecting the nervous system. Participants were randomly assigned to experimental condition; abstract (why) condition (n = 51), concrete (how) condition (n = 52), cognitive distraction (control task) condition (n = 51), and no task control condition (n = 51). A research assistant blind to the research question and hypothesis checked the written assignments for all task conditions after study completion. In this procedure, two participants from the abstract condition were not consistent in their why-answers, and therefore they were removed from the analyses.

Power analysis

An a priori power calculation was conducted using G*Power. With power set to 85% (alpha= 0.05, two-tailed) to detect a medium effect (f = 0.25) with a one-way ANOVA, 51 individuals in each condition were required.

Cold pressor test

A cold pressor apparatus (Nuve BM-302 Milmedtek AB, Nättraby, Sweden) containing 10 liters circulating water (1–5 °C) was used to induce experimental pain in the participants non-dominant hand. The cold pressor apparatus has been extensively used as a validated tool to induce pain in previous studies and temperatures (1–5 °C) ensure a powerful pain manipulation without causing any tissue damage (Agerström et al., 2019; Dawson & List, 2009; Dowman et al., 2008; Neziri et al., 2011; Sharpe et al., 2015; Stening et al., 2007).

Reported pain intensity

Patients indicated how much pain they felt during the cold pressor test on a Visual Analogue Scale (VAS; 0 = “no pain,” 10 = “worst imaginable pain”) immediately after they had withdrawn their hand from the water-bath. The VAS is a 100 mm horizontal line with two endpoints (no pain and worst imaginable pain). The participants placed a mark between the “no pain” and “worst imaginable pain” endpoints, and on the backside of the VAS the mark corresponded to a number (decimals were possible) between 0–10 visible to the test leader. The VAS is a subjective scale since pain experiences are subjective. External factors as the current mood, past pain experiences, and expectations about the pain could influence every pain rating (Oliveira et al., 2014), but the VAS is considered to constitute a valid scale to measure both experimental and clinical pain (Price et al., 1983). Being simple, effective and widely used in both research settings and in the clinic, the VAS is a traditional method of pain measurement (Melzack & Katz, 2013).

Pain endurance

The time duration (in seconds) that each participant managed to hold their hand in the water-bath constituted the pain endurance measure.

Experimental manipulation

Abstract mindset condition

Participants completed an abstraction priming task prior to the cold pressor test. During this initial priming task, the participants were instructed to think about the reasons for doing things (“Why mindset”; Freitas et al., 2004). They were presented with four abstract reasons for travelling (e.g. to find new places). Next, they were asked to come up with four answers to the question of why they were educating themselves. Directly after this task, they were instructed to immerse their hand into the cold water and to think about why they felt pain, and to write down their why-thoughts, while they completed the cold pressor test. An example of a why-thought could be “I have pain due to cold water.”

Concrete mindset condition

Participants performed a concrete priming task prior to the cold pressor test. During this initial priming task, the participants were instructed to think about how they do things (“How mindset”; Freitas et al., 2004). They were presented with four concrete examples of how one could travel (e.g. by airplane). Next, they were asked to come up with four answers to the question of how they were educating themselves. Directly after this task, they were instructed to immerse their hand into the cold water and to think about how their pain was felt, and to write down their how-thoughts, while they completed the cold pressor test. An example of a how-thought could be “The hand is aching”.

The first part of the abstract (why) versus concrete (how) mindset manipulation largely followed the principles outlined by Freitas et al. (2004), the main difference being the activity (travelling versus maintaining health). The why versus how manipulation has been widely used in abstraction research (Burgoon et al., 2013). It is not uncommon to change the activity as it is not of central conceptual importance to the manipulation. The last part of the manipulation where we specifically applied the why versus how to the pain context was novel. Because the distinction between why versus how in terms of level of abstraction appears in influential theories where abstraction is a central concept, such as Construal Level Theory (Trope & Liberman, 2010) and Action Identification Theory (Vallacher & Wegner, 1989), we are confident on a conceptual level that this part of the manipulation should induce different levels of abstraction.

Cognitive distraction (control task)

In this task the participants had no priming task. Participants were instructed to write down every first name they could think of that started with any letter in the alphabet while their hand was immersed in the cold water. This task controls for the cognitive engagement, and possibly distracting effect elicited by writing down answers in the abstract and concrete mindset conditions. A similar cognitive distraction task has been used in earlier research (Nouwen et al., 2006), but in that study the participants read out the names loud.

No task control condition

In this pure control condition, the participants did not complete any task except for the cold pressor test.

Manipulation check

A research assistant blind to the research question and hypothesis checked the written assignments for all task conditions after study completion. In this procedure, two participants from the abstract condition were not consistent in their why-answers (they had written one how-answer each), and therefore they were removed from the analyses. In the other task conditions, no inconsistency in the written answers were found. Hence, it is clear that virtually all participants complied with the experimental manipulation.

Procedure

If the participants passed the inclusion criteria, they read and signed the informed consent sheet. Participants were seated in a chair next to the cold pressor apparatus and were informed that they would try to keep their non-dominant hand in the water (up to processus styloideus radii/ulnae) for as long as they could, but no more than 5 minutes at which point the experimenter would terminate the test. It was stressed that they could terminate participation if the pain became unbearable, or whenever they wished for whatever reason. They received instructions about their specific task (why-thoughts; how-thoughts; name-task). Participants were instructed to perform the assigned task (abstract, concrete, cognitive distraction) throughout the entire cold pressor test. Participants in the no task control condition did not perform any task. All participants were instructed to put their non-dominant hand in the cold pressor apparatus. Immediately after removing the hand from the water bath, they provided VAS ratings. A short debriefing concluded the session. A movie ticket was given as compensation.

Statistical analysis

The pain intensity ratings (VAS) (0–10) were normally distributed but not the pain endurance (in seconds) measure. Hence, the effect of the experimental manipulation on pain intensity was analyzed with one-way ANOVA, while the effect on pain endurance was analyzed with the Kruskal-Wallis test.

Results

Pain endurance

The experimental manipulation had no effect on pain endurance, H (3) = 2.255, p < .521. Participants in the abstract mindset condition produced almost identical pain endurance scores as the participants in the concrete mindset condition and the two control conditions (Table 1 and Figure 1).

Figure 1 Boxplot displaying the minimum score, the lower quartile, median, the upper quartile, and maximum score for pain endurance (time in seconds the hand was withheld in the cold water).

Table 1 Pain intensity (VAS) and pain endurance mean scores and standard deviations for the four experimental conditions.

	M (VAS)	SD (VAS)	M (Time in seconds)	SD (Time in seconds)
Abstract	6.2	2.1	122	102
Concrete	6.0	2.1	134	109
Distraction	5.9	1.9	146	118
Control	6.1	1.6	121	114

Pain intensity

The experimental manipulation also had no effect on the pain intensity ratings, F (3, 199) = 0.168, p < .918. The ratings for participants in the abstract mindset condition were very similar to those in the concrete mindset condition and the two control conditions (Table 1 and Figure 2).*

Figure 2 Boxplot displaying the minimum score, the lower quartile, median, the upper quartile, and maximum score on the VAS (pain intensity).

*The results were virtually the same when the two excluded participants were included in the analyses.

Discussion

We investigated whether abstract thinking would reduce the sensitivity to painful stimuli in healthy participants, but we found no support for such an effect in this study in conjunction with short-term, experimental pain. Participants who thought about the pain in a more abstract manner (why focus) experienced just as much pain as those who thought about the pain in a more concrete manner (how focus), and control participants subjected to cognitive distraction, or no cognitive task.

There may be several reasons for the current null results. Firstly, abstraction may not have any meaningful effect on pain endurance or perceived pain intensity. Another explanation could be that there is an effect but that we were unable to detect it with the methods used in this study. It should be noted, however, that we used an established manipulation of abstraction (why “vs” how) and then applied it to the pain context. The results from the abstraction manipulation check showed that the manipulation worked as intended. Indeed, participants in the abstract mindset condition consistently produced why-answers whereas participants in the concrete mindset condition consistently produced how-answers, and the manipulation check performed by a resarch assistant blind to the research question showed consistency in why- vs how-thoughts for all the participants included in the statistical analysis. As for the pain induction, we used the widely used and validated cold pressor method. The pain intensity ratings revealed that the participants experienced substantial pain stimulation during the experiment (Table 1). Nevertheless, future research may want to use some other induction method that could be tolerated for longer time periods. It has been found that the higher pain intensity experienced in clinical pain during the last 24 hours and a higher estimated percent of the time in pain were associated with less abstract action identification (Gunnarsson & Agerström, 2018). Therefore, it could be speculated that abstract representations could be more easily engaged in lower levels of pain, and therefore it could be interesting to test in future studies if an abstract thinking perspective could have an effect on lower pain levels.

The current study achieved high degree of control over extraneous variables, enabling causal inferences. The disadvantage of inducing short-lasting experimental pain is that it is different from clinical pain. Clinical pain and experimental pain differ in several important respects, such as the duration of the pain, uncertainty about the duration of the pain, knowledge of the cause of the pain, and controllability. This also introduces other differences, such as fear, anxiety and depression which often co-exist with and contribute to clinical pain (Carr et al., 2007). It has been suggested that in long-lasting, ongoing pain there will be a shift away from the somatosensory brain processes to more emotional brain processes (Hashmi et al., 2013). Still, even though there seems to be a difference in the processing of acute and long-lasting pain in the perspective of weeks and months, Schulz et al. (2015) showed that tonic pain lasting for several minutes in a dynamic way shifted the processing away from the immediate sensory brain circles to more emotional processing in the prefrontal cortex. Thus, perhaps persistent pain induction for several minutes could to some extent be similar to the dynamic processes in persistent, long-lasting pain. Previous research (Kross et al., 2017; Travers-Hill et al., 2017) suggesting that abstraction reduces worry and depressive symptoms supports the idea that abstraction could help mitigate pain in conjunction with clinical pain states. Yet, this possibility needs empirical verification. Perhaps indirect ways of inducing abstraction, such as self-distancing are more viable cognitive strategies, given that Wang et al. (2019) found an analgesic effect of self-distancing on pain. However, because imagining oneself from the vantage point of a fly sitting on the wall seems to be a relatively cognitively demanding task, researchers should examine whether less demanding self-distancing strategies also have analgesic effects. Third-person (versus first-person) self-talk which simply requires people to silently reflect on themselves using their own names (Kross et al., 2017) could be relatively simple strategies that may help people “distance” themselves from their pain.

The current research examined whether a hitherto unexplored cognitive operation, abstraction, can influence sensitivity to painful stimuli. Despite being adequately powered to detect a medium effect and using validated experimental manipulations, we find no evidence to suggest that focusing on why (as opposed to how) one feels pain has a meaningful impact on experimental pain in healthy individuals. Yet, future research should examine whether other abstraction strategies can be effective pain management strategies. It should be powered to also detect small effect sizes since they could accumulate to become practically important in clinical populations.

Ethical approval statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Swedish Ethical Review Authority (code: 2020-01999) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All participants signed a consent form.

Authors’ contributions

Both authors have contributed to the study conceptualization, design, analysis, interpretation of data, and drafting the article. H.G. collected the data. Both authors have given final approval of the version to be published.

Disclosure statement

The authors declare they have no conflict of interest.