Mechanisms of Attentional Bias in Medically Unexplained Symptoms and Physical Symptom Reporting

  • Aimee Titchen

Student thesis: Doctor of Clinical Psychology


This thesis aimed to increase understanding of the role of attentional bias in medically unexplained symptoms (MUS) and physical symptom reporting, which has been proposed as a key factor in the development and maintenance of such presentations. The thesis is presented as three separate papers. Paper One presents a narrative review of the main models of MUS, the attentional mechanisms implicated in each, and the methods used to test them. This review indicates that the precise nature of these processes is often unclear making it difficult to inform effective, evidence-based clinical interventions for MUS. Several areas are proposed where theory and research need to evolve to meet this demand: Firstly, the specific attentional mechanisms involved should be delineated such as facilitated engagement, slower disengagement, or attentional avoidance. Secondly, clarification is needed as to whether any attentional bias is towards the body itself or towards concepts, interpretations, attributions or mental representations related to the body. Thirdly, more clarity is needed regarding at which stage(s) of processing attentional mechanisms are affected, and whether they are automatic and/or strategic. Paper Two is an empirical examination of attentional bias towards the body in high and low symptom reporters on the Somatoform Dissociation Questionnaire, using an adaptation of the modality shift effect paradigm. This paradigm is thought to effectively differentiate between several attentional processes. Contrary to expectation and established theory, no significant differences were found between groups on measures of engagement, disengagement, and avoidance. Possible explanations for the findings are discussed with reference to existing theory and research, and implications for future research and clinical practice are considered. Finally, Paper Three is a critical reflection of the processes involved in conducting the project. This paper provides further detail on key decision-making processes and methods used. Strengths and limitations are considered, along with suggestions for future research. Paper three concludes with personal reflections on the thesis project.
Date of Award31 Dec 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorEllen Poliakoff (Supervisor) & Richard Brown (Supervisor)


  • hypervigilance
  • somatic symptoms
  • attentional bias
  • medically unexplained symptoms
  • physical symptom reporting

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