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Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales

Jensen, Mark P. PhD; Ward, L. Charles PhD; Thorn, Beverly E. PhD; Ehde, Dawn M. PhD; Day, Melissa A. PhD

doi: 10.1097/AJP.0000000000000407
Original Articles

Objectives: We recently proposed a Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model to help explain the effects of pain treatments. In this model, treatments are hypothesized to operate primarily through their effects on the domains within 2 distinct neurophysiological systems that underlie approach (BAS) and avoidance (BIS) behaviors. Measures of the model’s domains are needed to evaluate and modify the model.

Methods: An item pool of negative responses to pain (NRP; hypothesized to be BIS related) and positive responses (PR; hypothesized to be BAS related) were administered to 395 undergraduates, 325 of whom endorsed recurrent pain. The items were administered to 176 of these individuals again 1 week later. Analyses were conducted to develop and validate scales assessing NRP and PR domains.

Results: Three NRP scales (Despondent Response to Pain, Fear of Pain, and Avoidant Response to Pain) and 2 PR scales (Happy/Hopeful Responses and Approach Response) emerged. Consistent with the model, the scales formed 2 relatively independent overarching domains. The scales also demonstrated excellent internal consistency, and associations with criterion variables supported their validity. However, whereas the NRP scales evidenced adequate test-retest stability, the 2 PR scales were not adequately stable.

Discussion: The study yielded 3 brief scales assessing NRP, which may be used to further evaluate the BIS-BAS model and to advance research elucidating the mechanisms of psychosocial pain treatments. The findings also provide general support for the BIS-BAS model, while also suggesting that some minor modifications in the model are warranted.

Department of Rehabilitation, University of Washington, Seattle, WA

The authors declare no conflict of interest.

Reprints: Mark P. Jensen, PhD, Department of Rehabilitation, University of Washington, 325 Ninth Avenue, Box 359612, Seattle, WA 98104 (e-mail:

Received February 5, 2016

Received in revised form July 20, 2016

Accepted June 21, 2016

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