Completed research projects
DFG INTERO: Activation of the defensive system through interoceptive sensations in adolescents with chronic pain
Project duration: 2015 - 2018
Promotion: German Research Foundation (DFG) (HE 5942/4-1; SCHN 415/5-1)
Project status: Completed
Contact: Prof. Dr. Tanja Hechler & Prof. Dr. Silvia Schneider
Cooperation partners: Prof. Dr. Silvia Schneider (Ruhr-Universität Bochum), Dr. Dirk Adolph (Ruhr-Universität Bochum), Dr. Christiane Pané-Farré (Ernst-Moritz-Universität Greifswald), Piotr Gruszka (Ruhr-Universität Bochum) and Christoph Benke (Ernst-Moritz-Universität Greifswald)
Chronic pain disorders in children and adolescents are not only increasing, but also cause serious limitations in school, physical and social life for those affected. Chronic headache and abdominal pain in particular are widespread among children and adolescents. Research in recent years has shown that it is not the intensity of the pain itself, but the fear of pain that is largely responsible for the severity of the impairments and the extent of avoidance behavior. The aim of this research project was therefore to investigate the effects of triggering sensations within the body (interoceptive sensations) on various psychophysiological parameters (as indicators of the activation of the defensive system) and the subjective experience of fear and pain in adolescents with chronic pain.In a quasi-experimental laboratory study, adolescents between the ages of 11 and 18 with chronic abdominal pain (CAP) or chronic headache (CH) and adolescents without chronic pain (i. e., healthy controls, HC) underwent two different paradigms: The provocation paradigm consisted of three different muscle tension tasks in which the adolescents were instructed to tense either their neck muscles, abdominal muscles or their fists in order to evoke (provoke) interoceptive sensations. It was assumed that tensing the abdominal muscles (proximal condition) for the CAP adolescents and tensing the neck muscles (proximal condition) for the CH adolescents would be more aversive than for the other two groups and that tensing the fists would not be experienced as aversive in any of the three groups (control condition). In the second paradigm, imagination paradigm, the adolescents were asked to visualize (imagine) various everyday situations that were either pain-specific, anxiety-specific or neutral using short text descriptions. It was expected that the pain-specific imagination would be aversive for adolescents with chronic pain, while the anxiety-specific imagination would be aversive for all and the neutral imagination for none of the groups. In addition to the adolescents' self-reported experienced fear, avoidance tendencies and pain intensity during the paradigms, their startle reflexes, skin conductance and heart rate were recorded as physiological parameters.
It was shown that the provocation of proximal sensations led to an increased physiological defensive response and increased self-reported anxiety, particularly in adolescents with chronic abdominal pain. The imagination of pain-specific sensations was associated with an increased heart rate, startle reflexes and self-reported anxiety in adolescents with chronic pain. The results of the provocation paradigm thus indicate that tensing of the abdominal muscles represents a kind of “imminent threat”, which reinforces defensive reflexes to prepare behavioral responses (escape). In contrast, the accelerated heart rate caused by the imagination paradigm can be interpreted as a form of personal threat that is strongly linked to individual pain symptoms. Overall, the project provided new key insights for improving therapeutic interventions such as interoceptive exposure in vivo (provocation paradigm) and in sensu (imagination paradigm), which can be used with children and adolescents to reduce their fear of bodily sensations.
Preregistration:
Gruszka, P., Schaan, L., Adolph, D., Pané-Farré, C. A., Benke, C., Schneider, S., & Hechler, T. (2018). Defence response mobilization in response to provocation or imagery of interoceptive sensations in adolescents with chronic pain: A study protocol. Pain Reports, 3(Suppl 1). doi: https://doi.org/10.1097/PR9.0000000000000680
Publications:Flack, F., Pané-Farré, C. A., Zernikow, B., Schaan, L. & Hechler, T. (2017). Do interoceptive sensations provoke fearful responses in adolescents with chronic headache or chronic abdominal pain? A preliminary experimental study. Journal of Pediatric Psychology, 42(6), 667-678. doi: https://doi.org/10.1093/jpepsy/jsx087
Gruszka, P., Schaan, L., Adolph, D., Pané-Farré, C. A., Benke, C., Schneider, S., & Hechler, T. (2018). Defence response mobilization in response to provocation or imagery of interoceptive sensations in adolescents with chronic pain: A study protocol. Pain Reports, 3(Suppl 1). doi: https://doi.org/10.1097/PR9.0000000000000680
Opdensteinen, K. D., Rach, H., Gruszka, P., Schaan, L., Adolph, D., Benke, C., Pané-Farré, C. A., Dierolf, A., Schneider, S. & Hechler, T. (2024). "The mere imagination scares me” - Evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain. PAIN. doi: http://dx.doi.org/10.1097/j.pain.0000000000003041
Opdensteinen, K. D., Rach, H., Gruszka, P., Schaan, L., Adolph, D., Melzig, C. A., & Hechler, T. (2025). Interoceptive threat in adolescents with chronic pain: Evidence for fear responses during anticipation and provocation of internal bodily sensations. The Journal of Pain, 105449. doi: https://doi.org/10.1016/j.jpain.2025.105449
Interoception in preschoolers: KiKö Stress
Project duration: 2016 - 2020
Promotion: Affiliated to the EINSTEIN project
Project status: Completed;
Continuation and adaptation as part of the ongoing research project EMA-Intero
Contact: Prof. Dr. Tanja Hechler
Cooperation partners: Prof. Dr. André Schulz (Universität Luxemburg), Prof. Dr. Gregor Domes (Universität Trier)
The identification and integration of the body's own processes (interoception) is not only relevant for theories of emotion and cognition. Altered interoceptive processes, such as increased interoception in people with panic disorder, are now discussed as relevant processes for the development and maintenance of mental disorders such as anxiety disorders and chronic pain. How functional and dysfunctional interoceptive processes develop in childhood has hardly been researched to date. Exposure to early environmental stressors (experiences of abuse, but also early experiences of pain) and altered HPA activity are discussed as potential mechanisms for dysfunctional interoceptive processes.The aim of the project is to investigate the influence of an acute child-specific laboratory stressor (cognitive matching task and unfriendly experimenter) on the interoceptive accuracy of healthy preschool children (4-6 years). In this way, findings can be generated a) on the validity of the child-specific laboratory stressor and b) on the effects of induced stress on interoceptive accuracy and the influence of physiological arousal and stress hormones.
Publications:Opdensteinen, K. D., Schaan, L., Pohl, A., Schulz, A., Domes, G., & Hechler, T. (2021). Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress. Biological Psychology, 165, 108166. https://doi.org/10.1016/j.biopsycho.2021.108166
Schaan, L., Schulz, A., Nuraydin, S., Bergert, C., Hilger, A., Rach, H., & Hechler, T. (2019). Interoceptive accuracy, emotion recognition, and emotion regulation in preschool children. International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology, 138, 47–56. https://doi.org/10.1016/j.ijpsycho.2019.02.001
Painconcepts and Treatment: Development and evaluation of a multidimensional instrument for the assessment of pain concepts in adults
Project duration: 2020 - 2025
Promotion: Internal
Project status: Completed
Contact: Prof. Dr. Tanja Hechler & Prof. Dr. Michael Schneider & Catherina Lenhof
Cooperation partners: Dr. Joshua W. Pate (University of Technology Sydney), Dr. Tabea Kloos, Dipl.-Psych. Anna Fiegler
This research project dealt with the assessment of biopsychosocial pain concepts in adults using a newly developed, innovative questionnaire, the BiPS Matrix.The concept of pain refers to a person's understanding of pain, what pain actually is, what function pain has and which biological processes contribute to its development and maintenance. The experience of pain is influenced by a person's own concepts of pain and can therefore be positively influenced by modifying misconceptions, i.e. incorrect or incomplete concepts of chronic pain, e.g. as part of psychoeducation.
In this project, the questionnaire for adults was adapted on the basis of the BiPS matrix for children and adolescents. For this purpose, already known and established questionnaires, such as the NPQ-d (Richter et al., 2019), were used.
The questionnaire was then presented to pain experts as well as healthy adults and psychotherapists in training. Based on the expert survey, which reflected the high relevance of capturing biopsychosocial pain concepts, the BiPS matrix was shortened to a length of 40 items.
Further analyses showed that latent pain profiles of healthy adults can be created on the basis of the BiPS matrix and that these specific profiles are related to other pain-related variables, such as pain-related knowledge.
The questionnaire is now available in a child (24 items) and adult version (40 items) and is currently in the validation phase.
Publications:
Wickering, L., Lautwein, C., Fiegler, A., Allerdißen, L., Kloos, T., Schneider, M., & Hechler, T. (2024). [An instrument to assess biopsychosocial pain concepts in adults: Development and evaluation by experts]. Schmerz. https://doi.org/10.1007/s00482-024-00793-2Wickering, L., Lautwein, C., Nitsche, H., Schneider, M., & Hechler, T. (2023). Know Pain, No Pain? Preliminary Testing and Application of a New Tool to Assess Biopsychosocial Pain Concepts in Children. Children, 10(5), 814. https://doi.org/10.3390/children10050814
Lenhof, C., Dukek, L., Wickering, L., Hitschler, L., Schneider, M., & Hechler, T. (2025). Identifying Latent Profiles of Healthy Adults’ Biopsychosocial Pain Concepts. Pain Research and Management, 2025(1), 5706849. https://doi.org/10.1155/prm/5706849
Assessment of biopsychosocial pain concepts in childhood and adolescence (Paincontreat): the BiPS Matrix
Project duration: 2020 - 2025
Promotion:- Short-term scholarship to start a doctorate (2021). Ministry of Science and Health Rhineland-Palatinate (MWG) as part of the Rhineland-Palatinate Research Initiative
- Graduation funding for doctoral students from the Rhineland-Palatinate Research Initiative (Young Talent Fund)
Project status: completed
Contact: Prof. Dr. Tanja Hechler & Prof. Dr. Michael Schneider & Catherina Lenhof
Cooperation partners: Dr. Joshua W. Pate (University of Technology Sydney), Dr. Tabea Kloos, Dipl.-Psych. Anna Fiegler
This research project dealt with biopsychosocial pain concepts of children and adolescents with the help of a questionnaire, the BiPS matrix.The concept of pain refers to a person's understanding of pain, what pain actually is, what function pain has and which biological processes contribute to its development and maintenance. The concept of pain becomes central when people are confronted with persistent pain, as we know that misconceptions about pain, e.g. that something in the body is “broken” in the case of chronic pain, can lead to inappropriate coping strategies. So far, however, only few data exist/have been published so far. Our long-term goal is to record children's, parents' and therapists' concepts of pain and to change misconceptions with the help of appropriate psychoeducation.
For this purpose, a question matrix was created to record biopsychosocial aspects of pain. Items from existing questionnaires and current specialist literature were considered for the development of the questionnaire. 47 participants (17 - 68 years) completed an online survey and filled out the questionnaire. Based on the psychometric data of the items, the participants' comments and content-related aspects, 62 items were selected. Preliminary analyses (Master's thesis Tabea Kloos, 2019) show an acceptable internal consistency of the scales. The sum of all scale values correlated significantly with the previously measured pain knowledge.
In the follow-up projects, the BiPS matrix was presented to experts, shortened and adapted for children and adolescents. The questionnaire is now available in a children's version (24 items) and an adult version (40 items) and is currently in the validation phase.
Publications:Wickering, L., Lautwein, C., Fiegler, A., Allerdißen, L., Kloos, T., Schneider, M., & Hechler, T. (2024). [An instrument to assess biopsychosocial pain concepts in adults: Development and evaluation by experts]. Schmerz. https://doi.org/10.1007/s00482-024-00793-2
Wickering, L., Lautwein, C., Nitsche, H., Schneider, M., & Hechler, T. (2023). Know Pain, No Pain? Preliminary Testing and Application of a New Tool to Assess Biopsychosocial Pain Concepts in Children. Children, 10(5), 814. https://doi.org/10.3390/children10050814
Lenhof, C., Dukek, L., Wickering, L., Hitschler, L., Schneider, M., & Hechler, T. (2025). Identifying Latent Profiles of Healthy Adults’ Biopsychosocial Pain Concepts. Pain Research and Management, 2025(1), 5706849. https://doi.org/10.1155/prm/5706849