Beyond attentional strategies: a cognitive-perceptual model of somatic interpretation
Abstract
The meaning people assign to physical sensations can have profound implications for their physical and psychological health. A predominant research question in somatic interpretation asks if it is more adaptive to distract one's attention away from a potentially unpleasant sensation or to focus one's attention on it. This question, however, has yielded equivocal answers. Many apparent ambiguities in this research can be traced to a failure to distinguish the content of a person's attention from its mere direction or degree. A model of somatic interpretation is discussed, incorporating not only perceptual focus but also the attributions, goals, coping strategies, and prior hypotheses of the perceiver, thus delineating the psychobiological conditions under which various attentional strategies should be adaptive. In contrast to the prevailing concern with when and why somatic distraction doesn't "work," this conceptual analysis also considers when and why somatic attention does. Theoretical and methodological issues are discussed, as is the potential utility of somatic attention in cardiac rehabilitation and multiple sclerosis.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The body awareness literature suggests that heightened awareness of bodily sensations often serves as markers for a variety of mental disorders including anxiety, panic disorder, depression, eating disorders, somatization, and others.
“For instance, the BA literature, which is slanted toward a clinical population, suggests that heightened awareness of bodily sensations often serves as markers for a variety of mental disorders including anxiety, panic disorder, depression, eating disorders, somatization, and others (Cioffi, 1991; Pollatos et al., 2008, 2009; Mehling et al., 2009; Herbert and Pollatos, 2014; Mallorquí-Bagué et al.”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Cioffi, 1991
Cites
A theory of social comparison processes
Festinger, L. (1954) · Human Relations · doi:10.1177/001872675400700202 · Cited by 20,926 · see citing works
Learned helplessness in humans: Critique and reformulation.
Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.87.1.49 · Cited by 7,121 · see citing works
Cognitive, social, and physiological determinants of emotional state.
Schachter, S., & Singer, J. (1962) · Psychological Review · doi:10.1037/h0046234 · Cited by 6,223 · see citing works
The effect of emotion on cue utilization and the organization of behavior
Easterbrook, J. A. (1959) · Psychological Review · doi:10.1037/h0047707 · Cited by 3,090 · see citing works
Clark, D. M. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90011-2 · Cited by 2,422 · see citing works
Rosenstiel, A. K., & Keefe, F. J. (1983) · Pain · doi:10.1016/0304-3959(83)90125-2 · Cited by 2,314 · see citing works
Coping as a mediator of emotion
Folkman, S., & Lazarus, R. S. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.3.466 · Cited by 2,103 · see citing works
Weinberger, D. A., Schwartz, G. E., & Davidson, R. J. (1979) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.88.4.369 · Cited by 1,083 · see citing works
Self-focused attention in clinical disorders: Review and a conceptual model
Ingram, R. E. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.156 · Cited by 1,056 · see citing works
Neuroticism, Somatic Complaints, and Disease: Is the Bark Worse than the Bite?
Costa, P. T., & McCrae, R. R. (1987) · Journal of Personality · doi:10.1111/j.1467-6494.1987.tb00438.x · Cited by 1,010 · see citing works
Taylor, C. B., Bandura, A., Ewart, C. K., Miller, N. H., & DeBusk, R. F. (1985) · The American Journal of Cardiology · doi:10.1016/0002-9149(85)90127-4 · Cited by 200 · see citing works
Mullen, B., & Suls, J. (1982) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(82)90061-7 · Cited by 190 · cited 3× · see citing works
“Recent reviewers have reported an equivocal pattern of results (McCaul & Malott, 1984; Mullen & Suls, 1982a; Suls & Fletcher, 1985), and the limiting conditions of each strategy seem far from clear.”
BackgroundResult
Flagged first, then by citations
Cited by
Sorted by citations
Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007) · Psychological Inquiry · doi:10.1080/10478400701598298 · Cited by 3,654 · see citing works
“…(1985) similarly argued that the strategic use of attention is preferable to distraction when that attention focuses on the concrete aspects of physical sensations rather than on diffuse physical states or on emotional or cognitive reactions to sensory experience (see Cioffi, 1991 for review).”
BackgroundInfluentialFear of movement/(re)injury in chronic low back pain and its relation to behavioral performance
Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Boeren, R. G. B., & van Eek, H. (1995) · Pain · doi:10.1016/0304-3959(94)00279-n · Cited by 2,446 · see citing works
Development of the Tinnitus Handicap Inventory.
Newman, C., Jacobson, G., & Spitzer, J. (1996) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1996.01890140029007 · Cited by 2,140 · see citing works
Shaping perceptions to motivate healthy behavior: The role of message framing.
Rothman, A. J., & Salovey, P. (1997) · Psychological Bulletin · doi:10.1037/0033-2909.121.1.3 · Cited by 1,932 · see citing works
“Yet, women predominantly approach BSE from the latter perspective (Cioffi, 1991a).”
BackgroundBelief and feeling: Evidence for an accessibility model of emotional self-report.
Robinson, M. D., & Clore, G. L. (2002) · Psychological Bulletin · doi:10.1037/0033-2909.128.6.934 · Cited by 1,806 · see citing works
Pain demands attention: A cognitive–affective model of the interruptive function of pain.
Eccleston, C., & Crombez, G. (1999) · Psychological Bulletin · doi:10.1037/0033-2909.125.3.356 · Cited by 1,718 · see citing works
Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992) · Cognitive Therapy and Research · doi:10.1007/bf01173486 · Cited by 1,573 · see citing works
“important ways: (1) They affect attention to somatic states (Brownlee, Leventhal, & Balaban, 1992; Watson & Pennebaker, 1989); (2) they determine interpretations of somatic states (Cioffi, 1990); and (3) they affect procedures for controlling illness threats and criteria for evaluating outcomes.”
BackgroundThe multidimensional assessment of interoceptive awareness (MAIA)
Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048230 · Cited by 1,429 · see citing works
Psychological factors in chronic pain: Evolution and revolution.
Turk, D. C., & Okifuji, A. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.70.3.678 · Cited by 1,017 · see citing works
Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review
Chawla, N., & Ostafin, B. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20400 · Cited by 805 · see citing works
Psychological factors in chronic pain: Evolution and revolution
Turk, D. C., & Okifuji, A. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.3.678 · Cited by 1,017 · see citing works
Chronic pain and posttraumatic stress disorder: Mutual maintenance?
Sharp, T. J., & Harvey, A. G. (2001) · Clinical Psychology Review · doi:10.1016/s0272-7358(00)00071-4 · Cited by 779 · see citing works
The biopsychosocial model of arousal regulation
Blascovich, J., & Tomaka, J. (1996) · Advances in Experimental Social Psychology · doi:10.1016/s0065-2601(08)60235-x · Cited by 721 · see citing works
Body awareness: construct and self-report measures.
Mehling, W. E., Gopisetty, V., Daubenmier, J., Price, C. J., Hecht, F. M., & Stewart, A. (2009) · PLoS ONE · doi:10.1371/journal.pone.0005614 · Cited by 653 · see citing works
“P B C S: P ri va te B o d y C o n sc io u sn e ss Su b -s ca le o f th e B o d y C o n sc io u sn e ss Q u e st io n n ai re b y M ill e r LC , M u rp h y R , B u ss H [1 3 5 ].”
BackgroundInfluentialDiscrete Emotions or Dimensions? The Role of Valence Focus and Arousal Focus
Barrett, L. F. (1998) · Cognition & Emotion · doi:10.1080/026999398379574 · Cited by 645 · see citing works
Symptoms and the body: taking the inferential leap
Van den Bergh, O., Witthöft, M., Petersen, S., & Brown, R. J. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.01.015 · Cited by 543 · see citing works
Transformational Teaching: Theoretical Underpinnings, Basic Principles, and Core Methods
Slavich, G. M., & Zimbardo, P. (2012) · Educational Psychology Review · doi:10.1007/s10648-012-9199-6 · Cited by 502 · see citing works
“Attention must be paid to how much arousal is elicited by these motivational strategies, given that physiological arousal can reduce students’ efficacy if the arousal is interpreted as a sign of anxiety or inadequacy rather than excitement (Bandura 2012a; Cioffi 1991).”
Psychological Mechanisms of Medically Unexplained Symptoms: An Integrative Conceptual Model.
Brown, R. J. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.5.793 · Cited by 498 · see citing works
Sex differences in physical symptoms: The contribution of symptom perception theory
van Wijk, C. M. T. G., & Kolk, A. M. M. (1997) · Social Science & Medicine · doi:10.1016/s0277-9536(96)00340-1 · Cited by 468 · see citing works
Deary, V., Chalder, T., & Sharpe, M. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.07.002 · Cited by 480 · see citing works
“Attention” to pain in persons with chronic pain: A behavioral approach
McCracken, L. M. (1997) · Behavior Therapy · doi:10.1016/s0005-7894(97)80047-0 · Cited by 483 · see citing works
Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies
Mehling, W. E., Wrubel, J., Daubenmier, J. J., Price, C. J., Kerr, C. E., Silow, T., Gopisetty, V., & Stewart, A. L. (2011) · Philosophy, Ethics, and Humanities in Medicine · doi:10.1186/1747-5341-6-6 · Cited by 475 · see citing works
“The term has been used in studies of anxiety and panic disorders to describe a cognitive attitude characterized by an exaggerated patient focus on physical symptoms, magnification ("somatosensory amplification”), rumination, and beliefs of catastrophic out-comes [45].”
McCracken, L. M., & Turk, D. C. (2002) · Spine · doi:10.1097/00007632-200211150-00033 · Cited by 439 · see citing works
Self-Efficacy and Leadership Effectiveness: Applying Social Cognitive Theory to Leadership
McCormick, M. (2001) · Journal of Leadership Studies · doi:10.1177/107179190100800102 · Cited by 395 · see citing works
Mindfulness and coping with dysphoric mood: contrasts with rumination and distraction
Broderick, P. C. (2005) · Cognitive Therapy and Research · doi:10.1007/s10608-005-3888-0 · Cited by 374 · see citing works
Delayed costs of suppressed pain.
Cioffi, D., & Holloway, J. (1993) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.64.2.274 · Cited by 360 · see citing works
Self-citationPsychological aspects of pain.
Main, C. J., & Watson, P. (1999) · Manual Therapy · doi:10.1054/math.1999.0208 · Cited by 358 · see citing works
Eccleston, C. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00057-q · Cited by 352 · see citing works
“I am not concerned here to review exhaustively the body of evidence for and against the efficacy of attention-based pain coping (see Weisenberg, 1977; Thompson, 1981; McCaul & Malott, 1984; Fernandez & Turk, 1989) and I certainly do not wish to fuel the ennui noted by Cioffi (1991a).”
BackgroundCameron, L., Leventhal, E. A., & Leventhal, H. (1993) · Health Psychology · doi:10.1037/0278-6133.12.3.171 · Cited by 315 · see citing works
Harshaw, C. (2015) · Psychological Bulletin · doi:10.1037/a0038101 · Cited by 302 · see citing works
Miller, S. M., Shoda, Y., & Hurley, K. E. (1996) · Psychological Bulletin · doi:10.1037/0033-2909.119.1.70 · Cited by 299 · see citing works
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
Riegel, B., Jaarsma, T., Lee, C. S., & Strömberg, A. (2019) · ANS. Advances in nursing science · doi:10.1097/ans.0000000000000237 · Cited by 288 · see citing works
Mindfulness, Interoception, and the Body: A Contemporary Perspective
Gibson, J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02012 · Cited by 278 · see citing works
“…often serves as markers for a variety of mental disorders including anxiety, panic disorder, depression, eating disorders, somatization, and others (Cioffi, 1991; Pollatos et al., 2008, 2009; Mehling et al., 2009; Herbert and Pollatos, 2014; Mallorquí-Bagué et al., 2014; Fischer et al., 2017).”
BackgroundDifferentiating attention styles and regulatory aspects of self-reported interoceptive sensibility
Mehling, W. (2016) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2016.0013 · Cited by 261 · see citing works
Attention and somatic awareness in chronic pain
Eccleston, C., Crombez, G., Aldrich, S., & Stannard, C. (1997) · Pain · doi:10.1016/s0304-3959(97)00030-4 · Cited by 250 · see citing works
“Barsky and Klerman (1983), for example, have argued that heightened complaint can be explained by a hypervigilance of attention to somatic sensation; the pronounced somatic focus serves to magnify bodily sensations (see also Cioffi, 1991). The present data are, however, perhaps better explained as being due to the dis…”
ResultLitz, B. (1992) · Clinical Psychology Review · doi:10.1016/0272-7358(92)90125-r · Cited by 220 · see citing works
The Effect of Manipulated Self-Efficacy on Perceived and Sustained Effort
Hutchinson, J. C., Sherman, T., Martinovic, N., & Tenenbaum, G. (2008) · Journal of Applied Sport Psychology · doi:10.1080/10413200802351151 · Cited by 215 · see citing works
Interventions and Manipulations of Interoception
Weng, H. Y., Feldman, J., Leggio, L., Napadow, V., Park, J., & Price, C. (2021) · Trends in Neurosciences · doi:10.1016/j.tins.2020.09.010 · Cited by 213 · see citing works
You can't always think what you want: Problems in the suppression of unwanted thoughts
Wegner, D. (1992) · Advances in experimental social psychology · doi:10.1016/s0065-2601(08)60284-1 · Cited by 206 · see citing works
Bornemann, B., & Singer, T. (2017) · Psychophysiology · doi:10.1111/psyp.12790 · Cited by 204 · see citing works
Somatoform disorders: personality and the social matrix of somatic distress.
Kirmayer, L. J., Robbins, J. M., & Paris, J. (1994) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.103.1.125 · Cited by 202 · see citing works
A diathesis-stress model of chronic pain and disability following traumatic injury.
Turk, D. (2002) · Pain Research and Management · doi:10.1155/2002/252904 · Cited by 200 · see citing works
“What mechanisms account for the observed association between selfefficacy and behavioural outcome? Cioffi (82) suggested that at least four psychological processes could be responsible.”
BackgroundInteroceptive Ability and Body Awareness in Autism Spectrum Disorder
Schauder, K. B., Mash, L. E., Bryant, L. K., & Cascio, C. J. (2015) · Journal of Experimental Child Psychology · doi:10.1016/j.jecp.2014.11.002 · Cited by 187 · see citing works
“Howmight enhanced attention to internal cues relate to the core symptoms of ASD? In anxiety and depression, sustained attention to internal cues is thought to be maladaptive, whereby too much internal focus leads to perseverative negative thoughts about the self (Cioffi, 1991).”
Skerrett, T., & Moss-Morris, R. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.04.018 · Cited by 186 · see citing works
“Individuals’ perceptions of what causes the symptoms, rather than the actual cause of the symptoms, determine how they react [22,23].”
BackgroundTriberti, S., Repetto, C., & Riva, G. (2014) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2014.0054 · Cited by 188 · see citing works
Janssens, T., Verleden, G., De Peuter, S., Van Diest, I., & Van den Bergh, O. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.02.006 · Cited by 176 · see citing works
Foodborne Illness: Perceptions, Experience, and Preventive Behaviors in the United States.
Fein, S. B., Lin, C., & Levy, A. (1995) · Journal of Food Protection · doi:10.4315/0362-028x-58.12.1405 · Cited by 175 · see citing works
The attentional control of pain: methodological and theoretical concerns
Eccleston, C. (1995) · Pain · doi:10.1016/0304-3959(95)00093-8 · Cited by 174 · see citing works
“Cioffi (1991) has recently drawn attention to these issues and suggests that more emphasis be given to the 'content ' of the coping strategy rather than to any single component, such as imagery load or direction of attention.”
InfluentialKeogh, E., Hatton, K., & Ellery, D. (2000) · Pain · doi:10.1016/s0304-3959(99)00270-5 · Cited by 169 · see citing works
Kaptchuk, T. (2011) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2010.0385 · Cited by 164 · see citing works
Symptom reporting in cancer patients: The role of negative affect and experienced social stigma
Koller, M., Kussman, J., Lorenz, W., Jenkins, M., Voss, M., Arens, E., Richter, E., & Rothmund, M. (1996) · Cancer · doi:10.1002/(sici)1097-0142(19960301)77:5 · Cited by 160 · see citing works
The impact of personality on the reporting of unfounded symptoms and illness.
Feldman, P. J., Cohen, S., Doyle, W., Skoner, D., & Jr. Gwaltney Jack, M. (1999) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.77.2.370 · Cited by 153 · see citing works
Cognitive and behavioral responses to illness information: the role of health anxiety.
Hadjistavropoulos, H., Craig, K., & Hadjistavropoulos, T. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00014-x · Cited by 150 · see citing works
Warren, R., Kleyn, C. E., & Gulliver, W. (2011) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2011.10280.x · Cited by 144 · see citing works
A re-examination of pain-cognition interactions: implications for neuroimaging.
Seminowicz, D., & Davis, K. (2007) · Pain · doi:10.1016/j.pain.2007.03.036 · Cited by 144 · see citing works
“We consider divided attention within the context of the hypothesis of limited cognitive resources, in which attention to pain and a cognitive task competes for a finite amount of brain resources (Norman and Bobrow, 1975; Friedman and Polson, 1981; Cioffi, 1991; Eccleston and Crombez, 1999).”
Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment.
Feuerstein, M., & Beattie, P. F. (1995) · Physical Therapy · doi:10.1093/ptj/75.4.267 · Cited by 142 · see citing works
Thought Suppression, Catastrophizing, and Pain
Sullivan, M., Rouse, D. L., Bishop, S. R., & Johnston, S. (1997) · Cognitive Therapy and Research · doi:10.1023/a:1021809519002 · Cited by 136 · see citing works
Do pain expectancies cause pain in chronic low back patients? A clinical investigation.
Crombez, G., Vervaet, L., Baeyens, F., Lysens, R., & Eelen, P. (1996) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(96)00049-6 · Cited by 134 · see citing works
Ma-Kellams, C. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01379 · Cited by 132 · see citing works
“…in this context, somatic awareness is defined primarily by adaptively focusing direct attention on in-the-moment bodily changes (Flor et al., 2001; Watkins and Moulds, 2005) rather than engaging in emotionally driven vigilance (Cioffi, 1991; Cioffi and Holloway, 1993; Watkins and Moulds, 2005).”
BackgroundFors, E. A., Sexton, H. C., & Götestam, K. G. (2002) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(02)00003-1 · Cited by 120 · see citing works
Schulz, A., Lass-Hennemann, J., Sütterlin, S., Schächinger, H., & Vögele, C. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.01.007 · Cited by 127 · see citing works
“It should be noted, however, that pain perception during the CP test is mainly limited to the duration of the procedure and quickly declines afterwards (Cioffi, 1991; Masedo and Rosa Esteve, 2007).”
BackgroundA symptom perception approach to common physical symptoms.
Kolk, A., Hanewald, G., Schagen, S., & van Wijk, C. M. T. G. (2003) · Social Science & Medicine (1967) · doi:10.1016/s0277-9536(02)00451-3 · Cited by 126 · see citing works
Idiopathic Environmental Intolerance: A Comprehensive Model
Van den Bergh, O., Brown, R. J., Petersen, S., & Witthöft, M. (2017) · Clinical Psychological Science · doi:10.1177/2167702617693327 · Cited by 121 · see citing works
“…(Van den Bergh, Witthöft, Petersen, & Brown, 2017) that is informed by cognitive-psychological models of symptom perception (e.g., Brown, 2004; Cioffi, 1991) and rests on the concepts of predictive coding and Bayesian inference (see, e.g., Barrett & Simmons, 2015; Clark, 2013; Friston, 2005;…”
BackgroundModels of adjustment to chronic illness: using the example of rheumatoid arthritis.
Walker, J., Jackson, H., & Littlejohn, G. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.03.001 · Cited by 121 · see citing works
Expectations and Placebo Response: A Laboratory Investigation into the Role of Somatic Focus
Geers, A. L., Helfer, S. G., Weiland, P., & Kosbab, K. (2006) · Journal of behavioral medicine · doi:10.1007/s10865-005-9040-5 · Cited by 119 · see citing works
“Expectancies are thought to direct attention and guide the interpretation of both internal and external sensations (Brown, 2004; Cioffi, 1991; Clark, 1994; Dennett, 1991; Ditto and Hilton, 1990; Wilson et al., 1989).”
BackgroundVan Ryckeghem, D. M., Van Damme, S., Eccleston, C., & Crombez, G. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.10.008 · Cited by 114 · see citing works
“Sensory monitoring has been recommended as a coping strategy 5 within Leventhal’s dual processing theory (Leventhal & Everhart, 1979; see also Cioffi, 1991).”
BackgroundMethodResultEkkekakis, P. (2009) · International Review of Sport and Exercise Psychology · doi:10.1080/17509840902829323 · Cited by 108 · see citing works
Steptoe, A., & Vögele, C. (1992) · Behaviour Research and Therapy · doi:10.1016/0005-7967(92)90005-2 · Cited by 109 · see citing works
Cramer, H., Mehling, W., Saha, F. J., Dobos, G., & Lauche, R. (2018) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2031-9 · Cited by 107 · see citing works
Heathcote, L., & Eccleston, C. (2017) · Pain · doi:10.1097/j.pain.0000000000000872 · Cited by 107 · see citing works
Fortune, D., Main, C. J., O'Sullivan, T., & Griffiths, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00036-6 · Cited by 106 · see citing works
Symptom patterns in long-duration chronic fatigue syndrome.
Friedberg, F., Dechene, L., McKenzie, M., & Fontanetta, R. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00077-x · Cited by 105 · see citing works
Optimism, self-efficacy and information processing of threat- and well-being-related stimuli
Karademas, E., Kafetsios, K., & Sideridis, G. (2007) · Stress and Health · doi:10.1002/smi.1147 · Cited by 98 · see citing works
Deployment stressors and a chronic multisymptom illness among Gulf War veterans.
Nisenbaum, R., Barrett, D., Reyes, M., & Reeves, W. C. (2000) · Journal of Nervous and Mental Disease · doi:10.1097/00005053-200005000-00002 · Cited by 97 · see citing works
Turk, D., & Okifuji, A. (1996) · Journal of behavioral medicine · doi:10.1007/bf01857677 · Cited by 95 · see citing works
“Past research has shown that cognitive activities, such as attention and one's beliefs about health, substantially contribute to the individual differences in symptom perception ( Cioffi, 1991; Skelton and Pennebaker, 1982) and restriction of activity (Flor and Turk, 1988; Lenthem et al., 1983).”
Backgroundde Jong, A. D., Middelkoop, E., Faber, A., & van Loey, N. V. (2007) · Burns · doi:10.1016/j.burns.2007.01.005 · Cited by 93 · see citing works
Learning subjective health complaints.
den Bergh, O. V., Winters, W., Devriese, S., & Diest, I. V. (2002) · Scandinavian Journal of Psychology · doi:10.1111/1467-9450.00280 · Cited by 93 · see citing works
Roelofs, J., Peters, M., van der Zijden, M., & Vlaeyen, J. (2004) · Journal of Pain · doi:10.1016/j.jpain.2004.04.001 · Cited by 92 · see citing works
The Positive Consequences of Pain: A Biopsychosocial Approach
Bastian, B., Jetten, J., Hornsey, M. J., & Leknes, S. (2014) · Personality and Social Psychology Review · doi:10.1177/1088868314527831 · Cited by 91 · see citing works
“Second, giving meaning to pain provides an important pathway toward pain management and treatment (Cioffi, 1991; Morris, 1991).”
BackgroundKolk, A., Hanewald, G., Schagen, S., & van Wijk, C. M. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00307-5 · Cited by 90 · see citing works
“[17–21]).”
Attentional control of pain and the process of chronification.
Hasenbring, M. (2000) · Progress in Brain Research · doi:10.1016/s0079-6123(00)29038-9 · Cited by 90 · see citing works
Attention to pain and fear of pain in patients with chronic pain
Crombez, G., Viane, I., Eccleston, C., Devulder, J., & Goubert, L. (2013) · Journal of Behavioral Medicine · doi:10.1007/s10865-012-9433-1 · Cited by 89 · see citing works
Perspectives unifying symptom interpretation.
Teel, C. S., Meek, P., McNamara, A., & Watson, L. A. (1997) · Image the Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.1997.tb01553.x · Cited by 83 · see citing works
Restricted Emotional Processing and Somatic Attribution in Fibromyalgia
Brosschot, J., & Aarsse, H. R. (2001) · International Journal of Psychiatry in Medicine · doi:10.2190/k7au-9ux9-w8bw-tetl · Cited by 81 · see citing works
“This notion, however, is inconsistent with modern insights in symptom psychology [4, 5] and, as yet, not supported by empirical evidence.”
ResultThe symptom experience of women with chronic illness.
O'Neill, E. S., & Morrow, L. L. (2001) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2001.01653.x · Cited by 81 · see citing works
Personality and Health: Progress and Problems in Psychosomatics
Wiebe, D., & Smith, T. W. (1997) · Elsevier eBooks · doi:10.1016/b978-012134645-4/50035-4 · Cited by 80 · see citing works
Coping with sales call anxiety: The role of sale perseverance and task concentration strategies
Belschak, F., Verbeke, W., & Bagozzi, R. (2006) · Journal of the Academy of Marketing Science · doi:10.1177/0092070306286535 · Cited by 78 · see citing works
“As Cioffi (1991) summed it up, rumination focuses one's attention toward the inside (i.e., on one's own thoughts and feelings).”
BackgroundThe meaning of pain: cancer patients' rating and recall of pain intensity and affect
Smith, W. B., Gracely, R., & Safer, M. A. (1998) · Pain · doi:10.1016/s0304-3959(98)00122-5 · Cited by 78 · see citing works
“The patient’s causal model of pain and cancer (Nerenz and Leventhal, 1983; Cioffi, 1991) impacts on an affective dimension of pain which can not be studied in typical laboratory research.”
BackgroundPsychometric evaluation of symptom perception related measures
Cécile, M., van Wijk, G., & Kolk, A. (1996) · Personality and Individual Differences · doi:10.1016/0191-8869(95)90023-n · Cited by 78 · see citing works
Exposure and mindfulness based therapy for irritable bowel syndrome - An open pilot study
Ljótsson, B., Andréewitch, S., Hedman, E., Rück, C., Andersson, G., & Lindefors, N. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.01.001 · Cited by 76 · see citing works
“A common behavior like distraction from the associated pain is probably not very effective and might even increase the awareness of pain (Cioffi, 1991; McCracken, 1997).”
BackgroundBrief cognitive interventions for burn pain
Haythornthwaite, J. A., Lawrence, J. W., & Fauerbach, J. A. (2001) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm2301_7 · Cited by 75 · see citing works
Dabbs, A. J. D. V., Hoffman, L., Iacono, A., Zullo, T., McCurry, K., & Dauber, J. (2004) · Heart & lung : the journal of critical care · doi:10.1016/j.hrtlng.2004.05.001 · Cited by 69 · see citing works
Biases in Perception and Reporting following a Perceived Toxic Exposure
Lees-Haley, P., & Brown, R. (1992) · Perceptual and Motor Skills · doi:10.2466/pms.1992.75.2.531 · Cited by 69 · see citing works
Hardiness and Health: A Social Psychophysiological Perspective on Stress and Adaptation
Wiebe, D., & Williams, P. G. (1992) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.1992.11.3.238 · Cited by 68 · see citing works
Somatic and psychological factors contributing to handicap in people with vertigo.
Yardley, L., Verschuur, C., Masson, E., Luxon, L. M., & Haacke, N. (1992) · British Journal of Audiology · doi:10.3109/03005369209076649 · Cited by 67 · see citing works
A biopsychosocial approach to arousal regulation
Blascovich, J. (1992) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.1992.11.3.213 · Cited by 67 · see citing works
Michael, J., & Park, S. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.06.013 · Cited by 63 · see citing works
Schoth, D. E., & Liossi, C. (2016) · Health Psychology · doi:10.1037/hea0000342 · Cited by 68 · see citing works
The Experience of Cognitive Intrusion of Pain
Attridge, N., Crombez, G., Ryckeghem, D. M. L. V., Keogh, E., & Eccleston, C. (2015) · Pain · doi:10.1097/j.pain.0000000000000257 · Cited by 69 · see citing works
Wiebe, D., Alderfer, M., Palmer, S., Lindsay, R. K., & Jarrett, L. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.62.6.1204 · Cited by 63 · see citing works
- Authors
- Cioffi, D.
- Affiliations
- University of Houston (US)
- Corresponding author
- Cioffi, Delia
- Venue
- Psychological Bulletin
- Published
- 1991
- Volume
- 109
- Issue
- 1
- Pages
- 25-41
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2059450453
- Cited by
- 426
- References
- 0
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 9 · 2023: 13 · 2022: 11 · 2021: 14 · 2020: 4 · 2019: 8 · 2018: 13 · 2017: 16 · 2016: 11 · 2015: 11 · 2014: 12 · 2013: 13 · 2012: 19
- FWCI
- 8.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- attentional strategies, attentional focus, bodily sensations, coping strategies, cardiac rehabilitation, multiple sclerosis, psychobiology
- MeSH terms
- Arousal, Attention, Awareness, Humans, Perception, Sensation, Sick Role, Somatoform Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
