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Pain Research and Management
Volume 20 (2015), Issue 1, Pages 39-45
Original Article

Observer trait anxiety is associated with response bias to patient facial pain expression independent of pain catastrophizing

Joshua A Rash,1 Kenneth M Prkachin,2 and Tavis S Campbell1

1Department of Psychology, University of Calgary, Calgary, Alberta, Canada
2Department of Psychology, University of Northern British Columbia, Prince George, British Columbia, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Nonverbal communication, such as facial expression, is an important component of the communication of pain to an observer. One factor that influences pain perception by an observer is characteristics specific to the observer themselves (ie, ‘top-down’ characteristics). The authors of this article aimed to assess how anxiety in the observer affects their ability to rate a sufferer’s pain, controlling for pain catastrophizing.

BACKGROUND: Top-down characteristics of an observer influence the detection and estimation of a sufferer’s pain. A comprehensive understanding of these characteristics is important because they influence observer helping behaviours and the sufferer’s experience of pain.

OBJECTIVES: To examine the hypothesis that individuals who score high in trait anxiety would perceive more intense pain in others, as indicated by a larger negative response bias, and that this association would persist after adjusting for pain catastrophizing.

METHODS: Healthy young adult participants (n=99; 50 male) watched videos containing excerpts of facial expressions taken from patients with shoulder pain and were asked to rate how much pain the patient was experiencing using an 11-point numerical rating scale. Sensitivity and response bias were calculated using signal detection methods.

RESULTS: Trait anxiety was a predictor of response bias after statistically adjusting for pain catastrophizing and observer sex. More anxious individuals had a proclivity toward imputing greater pain to a sufferer.

CONCLUSIONS: Individuals scoring higher on trait anxiety were more likely to impute pain to a sufferer. Anxious caregivers may be better able to respond with appropriate intervention once pain behaviour is detected, or they may exacerbate symptoms by engaging in excessive palliative care and solicitous behaviour.