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Context Sensitivity as a Shared Process: Understanding co-occurring pain and distress

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Steven J. Linton

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The mystery of the relationship between emotional distress and persistent pain is at the dawn of being unraveled. Their co-occurrence is common and associated with many negative outcomes, but poorly understood. While historically viewed as separate entities, modern psychology suggests a more delicate relationship. Indeed, one need not assume that distress is a reaction to pain or that it causes it. An alternative is to explore transdiagnostic processes that underlie both. Emotion regulation is a transdiagnostic that strives to produce appropriate responses to the ever-changing demands of the environment. To be effective this process must be in tune with the situation and research shows that rigid responses, insensitive to the context, lead to psychopathology. This context sensitivity may explain why distress and pain may persist beyond their usefulness. To help solve the mystery of distress and pain, we studied context sensitivity in three experiments. First, we tested how context insensitivity impacts on persistent responses and chronicity. Using a clever manipulation, context sensitivity can be experimentally assessed and its relation to persistence and the development of chronicity determined longitudinally. Second, in the lab, we tested how context sensitivity was improved and whether this in turn affects both distress and pain. Third, we tested how training regulatory responses in a context sensitive way impact on treatment outcome.


Flink, I. K., Boersma, K., Klein‐Strandberg, E., & Linton, S. J. (2019). Responding to social cues: An experimental paradigm exploring the link between context sensitivity and pain. British Journal of Health Psychology, 24(2), 443-459.

Flink, I. K., Klein-Strandberg, E., & Linton, S. J. (2017). Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance. Scandinavian Journal of Pain17(1), 220-225.

Linton, S. J., Flink, I. K., Schrooten, M. G., & Wiksell, R. (2016). Understanding co-occurring emotion and pain: the role of context sensitivity from a transdiagnostic perspective. Journal of Contemporary Psychotherapy, 46, 129-137.

Linton, S. J., Flink, I. K., & Vlaeyen, J. W. (2018). Understanding the etiology of chronic pain from a psychological perspective. Physical therapy98(5), 315-324.


Research funding bodies

  • The Swedish Foundation for Humanities and Social Sciences