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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

Clinical Journal of Pain:
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.

Author Information

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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