Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter July 1, 2017

Taking a break in response to pain. An experimental investigation of the effects of interruptions by pain on subsequent activity resumption

Rena Gatzounis, Martien G.S. Schrooten, Geert Crombez, Linda M.G. Vancleef and Johan W.S. Vlaeyen

Abstract

Background and aims

Interrupting ongoing activities with the intention to resume them again later is a natural response to pain. However, such interruptions might have negative consequences for the subsequent resumption and performance of the interrupted activity. Activity interruptions by pain may be more impairing than interruptions by non-painful stimuli, and also be subjectively experienced as such. These effects might be more pronounced in people high in pain catastrophizing. These hypotheses were investigated in two experiments.

Methods

In Experiment 1, healthy volunteers (n = 24) performed an ongoing task requiring a sequence of joystick movements. Occasionally, they received either a painful electrocutaneous or a non-painful vibrotactile stimulus, followed by suspension of the ongoing task and temporary engagement in a different task (interruption task). After performing the interruption task for 30 s, participants resumed the ongoing task. As the ongoing task of Experiment 1 was rather simple, Experiment 2 (n = 30) included a modified, somewhat more complex version of the task, in order to examine the effects of activity interruptions by pain.

Results

Participants made more errors and were slower to initiate movements (Experiment 1 & 2) and to complete movements (Experiment 2) when they resumed the ongoing task after an interruption, indicating that interruptions impaired subsequent performance. However, these impairments were not larger when the interruption was prompted by painful than by non-painful stimulation. Pain catastrophizing did not influence the results.

Conclusions

Results indicate that activity interruptions by pain have negative consequences for the performance of an activity upon its resumption, but not more so than interruptions by non-painful stimuli. Potential explanations and avenues for future research are discussed.

Implications

Interrupting ongoing activities is a common response to pain. In two experiments using a novel paradigm we showed that activity interruptions by pain impair subsequent activity resumption and performance. However, this effect seems to not be specific to pain.


Research Group Health Psychology, University of Leuven, Tiensestraat 102, box 3726, B-3000 Leuven, Belgium. Fax: +3216326144.

  1. Ethical issues: The studies described in the present manuscript were approved by the appropriate Ethical Boards (Experiment 1: Ethical Review Committee Psychology and Neuroscience (ERCPN) of Maastricht University, study number: ECP-127 11_04_2013; Experiment 2: Social and Societal Ethics Committee and Medical Ethics Committee of the University of Leuven, study number: ML 10825). Participants of both studies provided informed consent prior to participation.

  2. Conflict of interest: The authors have no conflict of interest to report. All authors have discussed the results and commented on the manuscript.

  3. Funding sources: The conductance of these studies and preparation of the manuscript were supported by a PhD “Aspirant” grant (PSG-C5007-Asp/12) funded by the Research Foundation – Flanders, Belgium (FWO Vlaanderen).

Acknowledgments

The authors wish to thank Jeroen Clarysse and Johan Gielissen for technical support.

References

[1] Van Damme S, Crombez G, Eccleston C. Coping with pain: a motivational perspective. Pain 2008;139:1–4.10.1093/oso/9780190627898.003.0012Search in Google Scholar

[2] Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356–66.10.1037/0033-2909.125.3.356Search in Google Scholar

[3] Gatzounis R, Schrooten MGS, Crombez G, Vlaeyen JWS. Interrupted by pain: an anatomy of pain-contingent activity interruptions. Pain 2014;155:1192–5.10.1016/j.pain.2014.03.017Search in Google Scholar

[4] Boselie JJLM, Vancleef LMG, Smeets T, Peters ML. Increasing optimism abolishes pain-induced impairments in executive task performance. Pain 2014;155:334–40.10.1016/j.pain.2013.10.014Search in Google Scholar

[5] Buhle J, Wager TD. Performance-dependent inhibition of pain by an executive working memory task. Pain 2010;149:19–26.10.1016/j.pain.2009.10.027Search in Google Scholar

[6] Crombez G, Eccleston C, Baeyens F, Eelen P. Attentional disruption is enhanced by the threat of pain. Behav Res Ther 1998;36:195–204.10.1016/S0005-7967(97)10008-0Search in Google Scholar

[7] Moore DJ, Keogh E, Eccleston C. The effect of threat on attentional interruption by pain. Pain 2013;154:82–8.10.1016/j.pain.2012.09.009Search in Google Scholar PubMed

[8] Vancleef LMG, Peters ML. Pain catastrophizing, but not injury/illness sensitivity or anxiety sensitivity, enhances attentional interference by pain. J Pain 2006;7:23–30.10.1016/j.jpain.2005.04.003Search in Google Scholar PubMed

[9] Okun M, Karoly P, Mun CJ, Kim H. Pain-contingent interruption and resumption of work goals: a within-day diary analysis. J Pain 2016;17:65–75.10.1016/j.jpain.2015.09.012Search in Google Scholar PubMed PubMed Central

[10] Schrooten MGS, Karsdorp PA, Vlaeyen JWS. Pain catastrophizing moderates the effects of pain-contingent task interruptions. Eur J Pain 2013;17:1082–92.10.1002/j.1532-2149.2012.00276.xSearch in Google Scholar PubMed

[11] Boehm-Davis DA, Remington R. Reducing the disruptive effects of interruption: a cognitive framework for analysing the costs and benefits of intervention strategies. Accid Anal Prev 2009;41:1124–9.10.1016/j.aap.2009.06.029Search in Google Scholar

[12] Trafton GJ, Monk CA. Task interruptions. Rev Hum Factors Ergon 2007;3:111–26.10.1518/155723408X299852Search in Google Scholar

[13] Bailey BP, Konstan JA. On the need for attention-aware systems: measuring effects of interruption on task performance, error rate, and affective state. Comput Human Behav 2006;22:685–708.10.1016/j.chb.2005.12.009Search in Google Scholar

[14] Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010;170:683–90.10.1001/archinternmed.2010.65Search in Google Scholar

[15] Altmann EM, Trafton JG. Memory for goals: an activation-based model. Cogn Sci 2002;26:39–83.10.1207/s15516709cog2601_2Search in Google Scholar

[16] Dodhia RM, Dismukes RK. Interruptions create prospective memory tasks. Appl Cogn Psychol 2009;23:73–89.10.1002/acp.1441Search in Google Scholar

[17] Meulders A, Vansteenwegen D, Vlaeyen JWS. The acquisition of fear of movement-related pain and associative learning: a novel pain-relevant human fear conditioning paradigm. Pain 2011;152:2460–9.10.1016/j.pain.2011.05.015Search in Google Scholar

[18] Grant Da, Berg Ea. A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. J Exp Psychol 1948;38:404–11.10.1037/h0059831Search in Google Scholar

[19] Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B. A confirmatory factor analysis of the Pain Catastrophizing Scale. Invariant factor structure across clinical and non-clinical populations. Pain 2002;96:319–24.10.1016/S0304-3959(01)00463-8Search in Google Scholar

[20] Sullivan MJL, Bishop SRS, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:524–32.10.1037/1040-3590.7.4.524Search in Google Scholar

[21] Spruyt A, Clarysse J, Vansteenwegen D, Baeyens F, Hermans D. Affect 4.0: A free software package for implementing psychological and psychophysiological experiments. Exp Psychol 2009;57:36–45.10.1027/1618-3169/a000005Search in Google Scholar PubMed

[22] LimeSurvey Project Team, Schmitz C. LimeSurvey: An Open Source survey tool; 2012.Search in Google Scholar

[23] Walton DM, Wideman TH, Sullivan MJL. A Rasch analysis of the pain catastrophizing scale supports its use as an interval-level measure. Clin J Pain 2013;29:499–506.10.1097/AJP.0b013e318269569cSearch in Google Scholar PubMed

[24] Howell DC. Statistical methods for psychology. Thomson Wadsworth; 2007.Search in Google Scholar

[25] McCall RB, Appelbaum MI. Bias in the analysis of repeated-measures designs: some alternative approaches. Child Dev 1973;44:401–15.10.2307/1127993Search in Google Scholar

[26] Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 2013;4:1–12.10.3389/fpsyg.2013.00863Search in Google Scholar PubMed PubMed Central

[27] Olejnik S, Algina J. Generalized eta and omega squared statistics: measures of effect size for some common research designs. Psychol Methods 2003;8:434–47.10.1037/1082-989X.8.4.434Search in Google Scholar PubMed

[28] IBM. IBM SPSS Statistics for Windows; 2013.Search in Google Scholar

[29] Altmann EM, Trafton JG, Hambrick DZ. Momentary interruptions can derail the train of thought. J Exp Psychol Gen 2014;143:215–26.10.1037/a0030986Search in Google Scholar PubMed

[30] Altmann EM, Trafton JG. Brief lags in interrupted sequential performance: evaluating a model and model evaluation method. Int J Hum Comput Stud 2015;79:51–65.10.1016/j.ijhcs.2014.12.007Search in Google Scholar

[31] Trafton JG, Altmann EM, Ratwani RM. A memory for goals model of sequence errors. Cogn Syst Res 2011;12:134–43.10.1016/j.cogsys.2010.07.010Search in Google Scholar

[32] Hodgetts HM, Jones DM. Contextual cues aid recovery from interruption: the role of associative activation. J Exp Psychol Learn Mem Cogn 2006;32: 1120–32.10.1037/0278-7393.32.5.1120Search in Google Scholar PubMed

[33] Hodgetts HM, Jones DM. Interruptions in the Tower of London task. Can preparation minimise disruption? Proc Hum Factors Ergon Soc Annu Meet. 2013. p. 1000–4.10.1177/154193120304700810Search in Google Scholar

[34] Foroughi CK, Werner NE, Nelson ET, Boehm-Davis Da. Do interruptions affect the quality of work? Proc Hum Factors Ergon Soc Annu Meet 2013;57:154–7.10.1177/1541931213571035Search in Google Scholar

[35] Zijlstra FRH, Roe RA, Leonora AB, Krediet I. Temporal factors in mental work. Effects of interrupted activities. J Occup Organ Psychol 1999;72:163–85.10.1348/096317999166581Search in Google Scholar

[36] Speier C, Valacich JS, Vessey I. The influence of task interruption on individual decision making. An information overload perspective. Decis Sci 1999;30:337–60.10.1111/j.1540-5915.1999.tb01613.xSearch in Google Scholar

[37] Mark G, Gudith D, Klocke U. The cost of interrupted work: More speed and stress. In: CHI 2008 Proc SIGCHI Conf Hum Factors Comput Syst. 2008. p. 107–10.10.1145/1357054.1357072Search in Google Scholar

[38] Cades DM, Davis DAB, Trafton JG, Monk CA. Does the difficulty of an interruption affect our ability to resume? Proc Hum Factors Ergon Soc Annu Meet 2007;51:234–8.10.1037/e577842012-020Search in Google Scholar

[39] Trafton JG, Altmann EM, Brock DP, Mintz FE. Preparing to resume an interrupted task. Effects of prospective goal encoding and retrospective rehearsal. Int J Hum Comput Stud 2003;58:583–603.10.1016/S1071-5819(03)00023-5Search in Google Scholar

[40] Vlaeyen JWS, Morley S, Crombez G. The experimental analysis of the interruptive, interfering, and identity-distorting effects of chronic pain. Behav Res Ther 2016.10.1016/j.brat.2016.08.016Search in Google Scholar

[41] Kuhajda MC, Thorn BE, Klinger MR, Rubin NJ. The effect of headache pain on attention (encoding) and memory (recognition). Pain 2002;97:213–21.10.1016/S0304-3959(01)00488-2Search in Google Scholar

[42] Van Ryckeghem DML, Crombez G, Eccleston C, Liefooghe B, Van Damme S. The interruptive effect of pain in a multitask environment: an experimental investigation. J Pain 2012;13:131–8.10.1016/j.jpain.2011.09.003Search in Google Scholar PubMed

[43] Salvucci DD, Taatgen Na, Borst J. Toward a unified theory of the multitasking continuum. From concurrent performance to task switching, interruption, and resumption. Chi 2009:1819–28.10.1145/1518701.1518981Search in Google Scholar

[44] Birkholtz M, Aylwin L, Harman RM. Activity pacing in chronic pain management: one aim, but which method? Part two: National Activity Pacing Survey. Br J Occup Ther 2004;67:481–7.10.1177/030802260406701103Search in Google Scholar

[45] Nielson WR, Jensen MP, Karsdorp PA, Vlaeyen JWS. Activity pacing in chronic pain: concepts, evidence, and future directions. Clin J Pain 2013;29:461–8.10.1097/AJP.0b013e3182608561Search in Google Scholar PubMed

[46] Gatzounis R, Schrooten MGS, Crombez G, Vlaeyen JWS. Operant learning theory in pain and chronic pain rehabilitation. Curr Pain Headache Rep 2012;16:117–26.10.1007/s11916-012-0247-1Search in Google Scholar PubMed

[47] Murphy SL, Kratz AL. Activity pacing in daily life: a within-day analysis. Pain 2014;155:2630–7.10.1016/j.pain.2014.09.028Search in Google Scholar PubMed PubMed Central

[48] Gill JR, Brown CA. A structured review of the evidence for pacing as a chronic pain intervention. Eur J Pain 2009;13:214–6.10.1016/j.ejpain.2008.03.011Search in Google Scholar PubMed

Received: 2016-11-25
Revised: 2017-02-11
Accepted: 2017-02-21
Published Online: 2017-07-01
Published in Print: 2017-07-01

© 2017 Scandinavian Association for the Study of Pain