Cognitive bias in systemic lupus erythematosus Fiona J. Denton a , Louise Sharpe a, * , Leslie Schrieber b,c a Clinical Psychology Unit (F12), School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia b Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia c Department of Medicine, The University of Sydney, NSW, Australia Received 13 May 2003; accepted 4 February 2004 Available online 11 March 2004 Abstract Evidence of cognitive bias in depression and anxiety has sparked an increasing interest in the potential for pain-related bias in patients suffering from chronic pain and/or illness. Research to date has been somewhat inconsistent, and the vast majority has been conducted on just two patient populations: rheumatoid arthritis (RA) and chronic pain patients. The present study investigates cognitive bias in Systemic Lupus Erythematosus (SLE) patients, particularly in relation to disease activity and depression. Forty- three SLE patients are compared to RA patients and healthy controls on their endorsement and recall of pain/illness words relative to depression and control words. Patients are first divided according to their disease activity, and secondly according to depression. SLE and RA patients self-endorsed more negative illness words and fewer positive illness words than did healthy controls, regardless of disease activity or depression status. Groups did not differ in their recall patterns, although all groups demonstrated a recall bias for positive words and illness words. Post-hoc analyses revealed a significant recall bias for disability-related illness words compared to sensory pain words in ill, depressed patients compared to ill, non-depressed patients and healthy controls. Consistent with the most recent research, it appears to be both the nature of the illness stimuli and the depression status of the patient that determines cognitive bias in chronically ill populations. Ó 2004 Published by Elsevier Ltd on behalf of European Federation of Chapters of the International Association for the Study of Pain. Keywords: Cognitive bias; Lupus; Schema; Pain 1. Introduction Evidence of cognitive bias in psychological disorders has sparked interest in possible pain-related biases in chronic pain patients (CPP). Cognitive biases arise from the activation of cognitive structures, or schemas, which function to organise information (Derry and Kuiper, 1981). Individuals possess numerous schemas pertaining to various content domains, different combinations of which will be activated at different times. For example, depressed patients demonstrate memory bias for nega- tive self-referent material (Bradley and Mathews, 1988; Mathews, 1997), and anxious patients show selective attention for anxiety-related stimuli (Williams et al., 1997; Keogh et al., 2001). It makes intuitive sense that CPP may also demonstrate pain-congruent biases, thereby implicating the presence of active pain schema. Results in this area have yielded conflicting results (see Pincus and Morley, 2001). The first study to demonstrate pain bias found that CPPs show selective attention for pain-affective words and pain-sensory words (Pearce and Morley, 1989). In the only study to replicate this finding, Snider and colleagues (2000) only found a bias towards pain words after controlling for depression. Similarly, other studies have only found attention biases in sub- groups of CPPs categorised by depression, anxiety and/or fear of pain (Asmundson et al., 1992; Pincus et al., 1998; Crombez et al., 2000; Keogh et al., 2001; Dehghani et al., 2003), or more specific biases according to the type of pain stimuli (Crombez et al., 2000; Dehghani et al., 2003). Investigation of pain-related memory bias has impli- cated two main mediating variables: the nature of the European Journal of Pain 9 (2005) 5–14 www.EuropeanJournalPain.com * Corresponding author. Tel.: +61-2-9351-4558; fax: +61-2-9351- 7328. E-mail address: louises@psych.usyd.edu.au (L. Sharpe). 1090-3801/$30 Ó 2004 Published by Elsevier Ltd on behalf of European Federation of Chapters of the International Association for the Study of Pain. doi:10.1016/j.ejpain.2004.02.005