Date of Award

Spring 5-20-2022

Document Type


Degree Name

PHD - Doctor of Philosophy



First Advisor

Ulas Kaplan

Second Advisor

Robert Krikorian

Third Advisor

Frank Trocco



It is recognized that nonintentional, automatic processing shapes physical health and well-being in critical ways. Conditioning––or priming––has been shown to influence attitude, beliefs, agency, behavior, and medical outcomes. Although expectations and beliefs correlate strongly with physical health, research in clinical application is needed, and studies on hope, as related to agency, in chronic pain are rare. The purpose of this study was to investigate whether, in a chronic pain sample (N = 154), hope could be primed via a Pain Neuroscience Educational (PNE) tutorial. A pre- and post-test intervention study consisting of two randomized parallel groups was designed to answer these research questions: What effect does a primed PNE have on hope in a chronic pain sample? Does exposure to a primed PNE affect pain at the present moment? What is the relationship between hope, stress-hardiness, and the perception of pain in this sample? After completing a pain inventory and obtaining baseline measures of hope, pain at the present moment, typical pain throughout the last year, and the trait of stress-hardiness, two parallel groups (n = 122) of chronic pain participants were exposed to either a primed or neutral condition and reassessed for hope and pain. After analyzing results, a third group (n = 32) was recruited and exposed to the primed condition but without the hardiness scale. A significant gain in hope at p = 0.001 was found in all three groups (N = 154), with medium effect sizes (Cohen’s d), p = 0.05. There was no change in pain at the present moment. Statistically significant Pearson’s correlations were found among hope, typical pain, and hardiness, p = 0.05. Broadly, the statistically significant elevation in hope across all groups suggests that unconscious exposure can prime or condition implicit attitudes apart from conscious goal setting, although the mechanism is unclear (i.e., tutorials and/or the Hope scale). By utilizing a novel priming method in a chronic pain sample, this study contributes to the field of health priming and its findings advance the basis for the clinical application of nonconscious methods in health and medicine.

Keywords: Subliminal priming, placebo, hope, agency, stress-hardiness, chronic pain

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.



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