The Role of Pain and Interpretation Bias in Fear of Disease Progression in People With Diabetes

Abstract

Research indicates that fear of progression (FoP) may be a transdiagnostic construct underlying anxiety in people with chronic health conditions. Theories propose that the interpretation of illness-related symptoms (such as pain) might be an important mechanism driving the development of FoP. However, FoP has rarely been studied in diabetes. In this study, we assessed FoP, pain, health threat-related interpretation bias, emotional states, and treatment adherence in 198 participants with type 1 or type 2 diabetes and an age- and gender-matched control group. We hypothesized that 1) people with diabetes will be more likely to interpret ambiguous stimuli as health threat-related than people without diabetes; 2) among those with diabetes, pain severity and interpretation bias will be associated with more severe levels of FoP; and 3) interpretation bias will moderate the relationship between pain severity and FoP in people with diabetes, such that the positive association between pain and FoP will become stronger when people have greater interpretation bias. Our results confirmed that people with diabetes were more likely to interpret ambiguous information as health threat-related compared with people without diabetes, with a large effect (d = .84). Moreover, people with diabetes who reported persistent pain were more likely to interpret ambiguous stimuli as health threat-related (d = .49). Among people with diabetes, pain severity and interpretation bias were significantly associated with FoP. However, we did not find evidence that interpretation bias moderated the relationship between pain and FoP and these relationships could not be accounted for by general psychopathology.

Perspective

People with diabetes had greater health threat-related interpretation bias than people without diabetes, especially for those with persistent pain and more severe FoP. Both pain severity and interpretation bias were associated with greater FoP, but interpretation bias did not moderate the relationship between pain and FoP.