Brain study suggests that distractions ease dread
Anticipating pain may be nearly as painful as the pain itself.
That's one implication of research published today in which scientists scanned the brains of people who had been told to expect a mild electric shock.
In the first high-tech exploration of the biology of ''dread," researchers at Emory University found that even before the shock was administered to a person's foot, activity appeared in one of the brain's pain centers. In particular, dread activated a part of the brain having to do with attention to pain, implying that distraction -- like watching TV -- helps reduce the dread.
''If you're the kind of person who tends to dread things," said Gregory S. Berns, lead author of the study in today's issue of the journal Science, ''then diverting attention should decrease dread, and you can know that in advance and do something about it."
Nearly one-third of people tested were ''extreme dreaders," people who experienced dread so intensely that they actually preferred a bigger electric shock immediately to a smaller shock later. For these people, it seems, the stronger pain was a lesser evil than the dread. Scans showed that their attention-to-pain brain areas tended to get more active faster than in other people.
The volunteers were not experiencing the full-fledged pain of a shock. ''They were experiencing the misery of their overestimation of how bad it was going to be -- a pain of a different sort. A pain of the mind."
Berns said he had expected to find that parts of the brain associated with anxiety and fear, such as the almond-shaped amygdala, would be central to dread. But instead, the brain scans he conducted indicated that the ''attention parts of the pain network," mainly in the cortex, or outer rind of the brain, made the difference between normal dreaders and ''extreme dreaders."
''We found that it mainly has to do with the 'Oh, no!' response," Berns said. If you're the type of person who reacts with extreme dread, he said, ''it seems like you're imagining very early the expected response in your foot."
John Gabrieli, a brain imaging scientist at the Massachusetts Institute of Technology who was not involved in the study, said that the findings implied that ''dread is as painful as pain is, or maybe even more so."
It was surprising, Gabrieli said, that dread seemed so centered in the ''back half" of the brain, the area broadly associated with receiving input like sights, sounds, and sensations from the sensory organs, rather than the ''front half" of the brain, the area associated with decision-making and thinking.
It turns out, he said, that ''the same part of the brain that would be the most sensitive to the perception of pain" is also most involved in ''building up the anticipation of pain," he said. ''You couldn't have known that" without the new brain-imaging experiment.
The findings may be useful in certain medical situations, Gabrieli said. For example, he said, if doctors know that some patients are ''extreme dreaders," they may want to tailor carefully how they describe certain treatment options that might be unpleasant but might also be in the patient's best interest in the long term.
The experiment was the first to use a brain imaging machine called a functional MRI to explore dread, Berns said. It was already known that activity in the pain system of the brain tends to begin before a shock or other painful stimulus, but no one had tried to pinpoint the parts of the brain responsible for dread, he said.
The experiment enrolled 32 subjects, Berns said, who were paid $40 each to undergo a set of 96 electric shocks to their feet while they lay in an MRI scanner recording their brain activity. Before each shock, they would be told how strong it would be and how long they had to wait for it.
In a second part of the experiment, they would then be offered choices such as: You can have a strong shock now or a weaker shock in 30 seconds.
Paul Zak, director of the Center for Neuroeconomic Studies at Claremont Graduate University in California, complimented the study and said it reveals dread to be ''the negative placebo effect."
But, he said, he'd find it even more convincing if the researchers had gone one step further and checked to see whether distracting people actually reduced their pain. That would be ''nice to know" he said.
The findings on dread could cast light on some economic decisions people make, said George Loewenstein, a Carnegie Mellon University neuro-economist who wrote a commentary on the dread paper in today's Science.
For example, he said, when someone chooses to save money, it may be not because of a carefully considered, farsighted view of life but because of ''immediate dread induced by thoughts of an impoverished future."
The paper fits well into the burgeoning field of neuro-economics, the study of how feelings and thought processes detectable in the brain affect people's economic decisions. Loewenstein noted that one promising area of research involves the opposite of dread: the question of why sometimes it is pleasurable to revel in the anticipation of something you want, while other times it is frustrating.
''The emotional response to anticipation may be the single most important determinant of people's willingness to delay gratification," he wrote, yet no one has yet advanced a theory explaining which factors determine that response.
On a more pragmatic plane, Berns said, people face things they don't want to do every day, from public speaking to committee meetings. ''And the subjective experience of waiting for these things can be quite bad, and they take a toll. So the message is: A lot of it has to do with the attention that is focused on it, and that's easily remedied."
Carey Goldberg can be reached at goldberg@globe.com. 