Abstract
The study reviewed the evidence that persistent pain has the capacity to interrupt and consume working memory resources. It was argued that individuals with persistent pain essentially operate within a compromised neurocognitive paradigm of limited working memory resources that impairs task performance. Using cognitive load theory as a theoretical framework, the study investigated if multimedia materials could be used to support individuals with persistent pain. A 2 × 2 design was used where the first factor was the pain status of the participant (absence vs. presence for more than 6 months), and the second was instructional strategy (written + illustrations vs. written). Fifty-eight full-time teachers from two schools in New South Wales (Australia) were randomly assigned to an instructional strategy to learn about lightning formation. Participants that identified as experiencing pain for 6 or more months demonstrated clinically low levels of pain, but nevertheless performed significantly worse than pain-free participants on retention and transfer tests. For both pain and pain-free participants, there was a significant benefit in learning from multimedia instruction compared to a written text only strategy.
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References
Abeare, C. A., Cohen, J. L., Axelrod, B. N., Leisen, J. C. C., Mosley-Williams, A., & Lumley, M. A. (2010). Pain, executive functioning, and affect in patients with rheumatoid arthritis. Clinical Journal of Pain, 26(8), 683–689.
Apkarian, A. V., Hashmi, J. A., & Baliki, M. N. (2011). Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain, 152(Suppl. 3), S49–S64.
Ayres, P. (2006). Using subjective measures to detect variations of intrinsic cognitive load within problems. Learning and Instruction, 16, 389–400.
Baddeley, A. D. (1986). Working memory. New York: Oxford University Press.
Baliki, M. N., Geha, P. Y., Apkarian, A. V., & Chialvo, D. R. (2008). Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. The Journal of Neuroscience, 28(6), 1398–1403.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: The Guilford Press.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.
Blankstein, U., Chen, J., Diamant, N. E., & Davis, K. D. (2010). Altered brain structure in irritable bowel syndrome: potential contributions of pre-existing and disease-driven factors. Gastroenterology, 138(5), 1783–1789.
Bosma, F. K., & Kessels, R. P. C. (2002). Cognitive impairments, psychological dysfunction, and coping styles in patients with chronic whiplash syndrome. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 15(1), 56–65.
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287–333.
Brunken, R., Steinbacher, S., Plass, J. L., & Leutner, D. (2002). Assessment of cognitive load in multimedia learning using dual-task methodology. Experimental Psychology, 49, 109–119.
Brunken, R., Plass, J. L., & Leutner, D. (2003). Direct measurement of cognitive load in multimedia learning. Educational Psychologist, 38(1), 53–61.
Buckalew, N., Haut, M. W., Morrow, L., & Weiner, D. (2008). Chronic pain is associated with brain volume loss in older adults: preliminary evidence. Pain Medicine, 9(2), 240–248.
Buhle, J., & Wager, T. D. (2010). Performance-dependent inhibition of pain by an executive working memory task. Pain, 149(1), 19–26.
Bunge, S. A., Ochsner, K. N., Desmond, J. E., Glover, G. H., & Gabrieli, J. D. E. (2001). Prefrontal regions involved in keeping information in and out of mind. Brain, 124(10), 2074–2086.
Can, S. S., & Gencay-Can, A. (2012). Assessment of cognitive function in patients with fibromyalgia using the clock drawing test. Journal of Musculoskeletal Pain, 20(3), 177–182.
Cherkassky, V. L., Kana, R. K., Keller, T. A., & Just, M. A. (2006). Functional connectivity in a baseline resting-state network in autism. NeuroReport, 17(16), 1687–1690.
Chi, M. T. H., Glaser, R., & Rees, E. (1982). Expertise in problem solving. In R. J. Sternberg (Ed.), Advances in the psychology of human intelligence (Vol. 1, pp. 7–75). Hillsdale, NJ: Erlbaum.
Choiniere, M., & Amsel, R. (1996). A visual analogue thermometer for measuring pain intensity. Journal of Pain and Symptom Management, 11(5), 299–311.
Cowan, N. (2001). The magical number 4 in short-term memory: a reconsideration of mental storage capacity. Behavioural and Brain Sciences, 24(1), 87–114.
Craig, S. D., Gholson, B., & Driscoll, D. M. (2002). Animated pedagogical agents in multimedia educational environments: effects of agent properties, picture features, and redundancy. Journal of Educational Psychology, 94(2), 428–434.
Davis, K. D., Taylor, S. J., Crawley, A. P., Wood, M. L., & Mikulis, D. J. (1997). Functional MRI of pain- and attention-related activations in the human cingulate cortex. The Journal of Neurophysiology, 77(6), 3370–3380.
de Fockert, J. W., Rees, G., Frith, C. D., & Lavie, N. (2001). The role of working memory in visual selective attention. Science, 291(5509), 1803–1806.
Dick, B. D., & Rashiq, S. (2007). Disruption of attention and working memory traces in individuals with chronic pain. Anesthesia and Analgesia, 104(5), 1223–1229.
Dick, B. D., Connolly, J. F., McGrath, P. J., Finley, G. A., Stroink, G., Houlihan, M. E., et al. (2003). The disruptive effect of chronic pain on mismatch negativity. Clinical Neurophysiology, 114(8), 1497–1506.
Dick, B. D., Verrier, M. J., Harker, K. T., & Rashiq, S. (2008). Disruption of cognitive function in fibromyalgia syndrome. Pain, 139(3), 610–616.
Eccleston, C. (1994). Chronic pain and attention: a cognitive approach. British Journal of Clinical Psychology, 33(4), 535–547.
Eccleston, C., & Crombez, G. (1999). Pain demands attention: a cognitive–affective model of the interruptive function of pain. Psychological Bulletin, 125(3), 356–366.
Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: a misdirected problem-solving model. Pain, 132(3), 233–236.
Ericsson, K. A., & Kintsch, W. (1995). Long-term working memory. Psychological Review, 102(2), 211–245.
Fair, D. A., Cohen, A. L., Dosenbach, N. U. F., Church, J. A., Miezin, F. M., Barch, D. M., et al. (2008). The maturing architecture of the brain’s default network. Proceedings of the National Academy of Sciences of the United States of America, 105(10), 4028–4032.
Fletcher, J. D., & Tobias, S. (2005). The multimedia principle. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 117–133). New York: Cambridge University Press.
Flor, H. (2000). The functional organization of the brain in chronic pain. Progress in Brain Research, 129, 313–322.
Gallagher, R. M. (2004). Biopsychosocial pain medicine and mind–brain–body science. Physical Medicine and Rehabilitation Clinics of North America, 15(4), 855–882. vii.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.
Geha, P. Y., Baliki, M. N., Harden, R. N., Bauer, W. R., Parrish, T. B., & Apkarian, A. V. (2008). The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron, 60(4), 570–581.
Gilbert, C. D., & Sigman, M. (2007). Brain states: top-down influences in sensory processing. Neuron, 54(5), 677–696.
Glass, J. M. (2009). Review of cognitive dysfunction in fibromyalgia: a convergence on working memory and attentional control impairments. Rheumatic Disease Clinics of North America, 35(2), 299–311.
Gusnard, D. A., & Raichle, M. E. (2001). Searching for a baseline: functional imaging and the resting human brain. Nature Reviews Neuroscience, 2(10), 685–694.
Harman, K., & Ruyak, P. (2005). Working through pain—a controlled study of the impact of persistent pain on performing a computer task. Clinical Journal of Pain, 21(3), 216–222.
Harp, S. F., & Mayer, R. E. (1997). The role of interest in learning from scientific text and illustrations: on the distinction between emotional interest and cognitive interest. Journal of Educational Psychology, 89(1), 92–102.
Hart, R. P., Wade, J. B., & Martelli, M. F. (2003). Cognitive impairment in patients with chronic pain: the significance of stress. Current Pain and Headache Reports, 7(2), 116–126.
Henry, D. E., Chiodo, A. E., & Yang, W. (2011). Central nervous system reorganization in a variety of chronic pain states: a review. PM & R, 3(12), 1116–1125.
Hoffman, B., & Schraw, G. (2010). Conceptions of efficiency: applications in learning and problem solving. Educational Psychologist, 45, 1–14.
Jensen, M. P., Chen, C., & Brugger, A. M. (2003). Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of Pain, 4(7), 407–414.
Kalyuga, S., Chandler, P., & Sweller, J. (1998). Levels of expertise and instructional design. Human Factors, 40, 1–17.
Kalyuga, S., Ayres, P., Chandler, P., & Sweller, J. (2003). Expertise reversal effect. Educational Psychologist, 38(1), 23–31.
Karp, J. F., Reynolds, C. F., Butters, M. A., Drew, M. A., Mazumdar, S., Begley, A. E., et al. (2006). The relationship between pain and mental flexibility in older adult pain clinic patients. Pain Medicine, 7(5), 444–452.
Kendall, P. C., Hollon, S. D., Beck, A. T., Hammen, C. L., & Ingram, R. E. (1987). Issues and recommendations regarding use of the Beck Depression Inventory. Cognitive Therapy and Research, 11(3), 289–299.
Kennedy, D. P., & Courchesne, E. (2008). Functional abnormalities of the default network during self-and other-reflection in autism. Social Cognitive and Affective Neuroscience, 3(2), 177–190.
Kuhajda, M. C., Thorn, B. E., Klinger, M. R., & Rubin, N. J. (2002). The effect of headache pain on attention (encoding) and memory (recognition). Pain, 97(3), 213–221.
Kupers, R., & Kehlet, H. (2006). Brain imaging of clinical pain states: a critical review and strategies for future studies. The Lancet Neurology, 5(12), 1033–1044.
Leavitt, F., & Katz, R. S. (2006). Distraction as a key determinant of impaired memory in patients with fibromyalgia. The Journal of Rheumatology, 33(1), 127–132.
Leeuw, M., Goossens, M., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2007). The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioural Medicine, 30(1), 77–94.
Leppink, J., Paas, F., Van der Vleuten, C. P. M., Van Gog, T., & Van Merriënboer, J. J. G. (2013). Development of an instrument for measuring different types of cognitive load. Behavior Research Methods. doi:10.3758%2Fs13428-013-0334-1.
Loftus, S., & Higgs, J. (2006). Clinical decision-making in multidisciplinary clinics. In H. Flor, E. Kalso, & J. O. Dostrovsky (Eds.), Proceedings of the 11th World Congress on Pain (pp. 755–760). Seattle: IASP Press.
Luerding, R., Weigand, T., Bogdahn, U., & Schmidt-Wilcke, T. (2008). Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulated cortex in fibromyalgia patients: structural correlates of pain–cognition interaction. Brain, 131(12), 3222–3231.
Mayer, R. E. (2005). Cognitive theory of multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 31–48). New York: Cambridge University Press.
Mayer, R. E., & Moreno, R. (1998). A split attention effect in multimedia learning: evidence for dual processing systems in working memory. Journal of Educational Psychology, 90(2), 312–320.
Mayer, R. E., Heiser, J., & Lonn, S. (2001). Cognitive constraints on multimedia learning: when presenting more material results in less understanding. Journal of Educational Psychology, 93(1), 187–198.
Mayer, J. S., Bittner, R. A., Nikolic, D., Bledowski, C., Goebel, R., & Linden, D. E. J. (2007). Common neural substrates for visual working memory and attention. NeuroImage, 36(2), 441–453.
Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring methods. Pain, 1(3), 277–299.
Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30(2), 191–197.
Melzack, R. (2005). The McGill Pain Questionnaire: from description to measurement. Anesthesiology, 103(1), 199–202.
Michael, E. S., & Burns, J. W. (2004). Catastrophising and pain sensitivity among chronic pain patients: moderating effects of sensory and affect focus. Annals of Behavioral Medicine, 27(3), 185–194.
Miller, G. A. (1956). The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychological Review, 63, 81–97.
Moayedi, M., Weissman-Fogel, I., Salomons, T. V., Crawley, A. P., Goldberg, M. B., Freeman, B. V., et al. (2012). White matter brain and trigeminal nerve abnormalities in temporomandibular disorder. Pain, 153(7), 1467–1477.
Moreno, R., & Mayer, R. E. (1999). Cognitive principles of multimedia learning: the role of modality and contiguity. Journal of Educational Psychology, 91(2), 358–368.
Moreno, R., & Mayer, R. E. (2002). Verbal redundancy in multimedia learning: when reading helps listening. Journal of Educational Psychology, 94(1), 156–163.
Moriarty, O., McGuire, B. E., & Finn, D. P. (2011). The effect of pain on cognitive function: a review of clinical and preclinical research. Progress in Neurobiology, 93(3), 385–404.
Naghavi, H. R., & Nyberg, L. (2005). Common fronto-parietal activity in attention, memory, and consciousness: shared demands on integration? Consciousness and Cognition, 14(2), 390–425.
Napadow, V., Lacount, L., Park, K., As-Sanie, S., Clauw, D. J., & Harris, R. E. (2010). Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity. Arthritis and Rheumatism, 62(8), 2545–2555.
Neugebauer, V., Galhardo, V., Maione, S., & Mackey, S. C. (2009). Forebrain pain mechanisms. Brain Research Reviews, 60(1), 226–242.
Niv, D., & Kreitler, S. (2001). Pain and quality of life. Pain Practice, 1(2), 150–161.
Oosterman, J. M., Derksen, L. C., van Wijck, A. J. M., Veldhuijzen, D. S., & Kessels, R. P. C. (2011). Memory functions in chronic pain: examining contributions of attention and age to test performance. The Clinical Journal of Pain, 27(1), 70–75.
Paas, F. G. W. C. (1992). Training strategies for attaining transfer of problem solving skills in statistics: a cognitive load approach. Journal of Educational Psychology, 84(4), 429–434.
Paas, F. G. W. C., & van Merriënboer, J. J. G. (1994). Variability of worked examples and transfer of geometrical problem-solving skills: a cognitive-load approach. Journal of Educational Psychology, 86, 122–133.
Paas, F., Camp, G., & Rikers, R. (2001). Instructional compensation for age-related cognitive declines: effects of goal specificity in maze learning. Journal of Educational Psychology, 93, 181–186.
Paas, F., Tuovinen, J. E., Tabbers, H., & van Gerven, P. W. M. (2003). Cognitive load measurement as a means to advance cognitive load theory. Educational Psychologist, 38, 63–71.
Paivio, A. (1986). Mental representations: a dual-coding approach. New York: Oxford University Press.
Penney, C. G. (1989). Modality effects and the structure of short term verbal memory. Memory and Cognition, 17(4), 398–422.
Pessoa, L., Kastner, S., & Ungerleider, L. G. (2003). Neuroimaging studies of attention: from modulation of sensory processing to top-down control. The Journal of Neuroscience, 23(10), 3990–3998.
Peterson, L. R., & Peterson, M. J. (1959). Short-term retention of individual verbal items. Journal of Experimental Psychology, 58, 193–198.
Raichle, M. E. (2006). The brain’s dark energy. Science, 314(5803), 1249–1250.
Raichle, M. E., & Snyder, A. Z. (2007). A default mode of brain function: a brief history of an evolving idea. NeuroImage, 37(4), 1083–1090.
Rodriguez-Raecke, R., Niemeier, A., Ihle, K., Ruether, W., & May, A. (2009). Brain gray matter decrease in chronic pain is the consequence and not the cause of pain. Journal of Neuroscience, 29(44), 13746–13750.
Schmidt-Wilcke, T. (2008). Variations in brain volume and regional morphology associated with chronic pain. Current Rheumatology Reports, 10(6), 467–474.
Schmitz, N., Arkink, E. B., Mulder, M., Rubia, K., Admiraal-Behloul, F., Schoonman, G. G., Kruit, M. C., Ferrari, M. D., & van Buchem, M. A. (2008). Frontal lobe structure and executive function in migraine patients. Neuroscience Letters, 440(2), 92–96.
Seminowicz, D. A., & Davis, K. D. (2007). A re-examination of pain–cognition interactions: implications for neuroimaging. Pain, 130(1), 8–13.
Seo, J., Kim, S.-H., Kim, Y.-T., Song, H.-J., Lee, J.-j., Kim, S.-H., Hans, S. W., Nam, E. J., Kim, S.-K., Lee, H. J., Lee, S.-J., & Chang, Y. (2012). Working memory impairment in fibromyalgia patients associated with altered frontoparietal memory network. PLoS ONE, 7(6), e37808.
Sephton, S. E., Studts, J. L., Hoover, K., Weissbecker, I., Lynch, G., Ho, I., et al. (2003). Biological and psychological factors associated with memory function in fibromyalgia syndrome. Health Psychology, 22(6), 592–597.
Shibasaki, H. (2004). Central mechanisms of pain perception. Supplements to Clinical Neurophysiology, 57, 39–49.
Sjogren, P., Ekholm, O., Peuckmann, V., & Gronbaek, M. (2009). Epidemiology of chronic pain in Denmark: an update. European Journal of Pain, 13(3), 287–292.
Sullivan, M. J., Lynch, M. E., & Clark, A. J. (2005). Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain, 113(3), 310–315.
Sweller, J., van Merriënboer, J. J. G., & Pass, F. G. W. C. (1998). Cognitive architecture and instructional design. Educational Psychology Review, 10(3), 251–296.
Sweller, J., Ayres, P., & Kalyuga, S. (2011). Cognitive load theory. New York: Springer.
Szabo, N., Kincses, Z. T., Pardutz, A., Tajti, J., Szok, D., Tuka, B., et al. (2012). White matter microstructural alterations in migraine: a diffusion-weighted MRI study. Pain, 153(3), 651–656.
Toblin, R. L., Mack, K. A., Perveen, G., & Paulozzi, L. J. (2011). A population-based survey of chronic pain and its treatment with prescription drugs. Pain, 152(6), 1249–1255.
Tracey, I. (2005). Nociceptive processing in the human brain. Current Opinion in Neurobiology, 15(4), 478–487.
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377–391.
Turk, D. C., & Okifuji, A. (2001). Pain terms and taxonomies of pain. In J. D. Loeser, S. H. Butler, C. R. Chapman, & D. C. Turk (Eds.), Bonica’s management of pain (3rd ed., pp. 17–25). Philadelphia: Lippincott Williams & Wilkins.
Valfre, W., Rainero, I., Bergui, M., & Pinessi, L. (2008). Voxel-based morphometry reveals gray matter abnormalities in migraine. Headache, 48(1), 109–117.
Van Damme, S., Crombez, G., & Eccleston, C. (2004). Disengagement from pain: the role of catastrophic thinking about pain. Pain, 107(1–2), 70–76.
van Gerven, P., Paas, F. G. W. C., van Merriënboer, J. J. G., & Schmidt, H. (2002). Cognitive load theory and aging: effects of worked examples on training efficiency. Learning and Instruction, 12, 87–105.
van Gerven, P., Paas, F. G. W. C., van Merriënboer, J. J. G., & Schmidt, H. (2006). Modality and variability as factors in training the elderly. Applied Cognitive Psychology, 20(3), 311–320.
Vangronsveld, K., Van Damme, S., Peters, M. L., Vlaeyen, J. W. S., Goossens, M., & Crombez, G. (2007). An experimental investigation on attentional interference by threatening neck movements in chronic whiplash patients. Pain, 127(1–2), 121–128.
Veldhuijzen, D. S., Kenemans, J. L., Van Wijck, A. J. M., Olivier, B., Kalkman, C. J., & Volkerts, E. R. (2006). Processing capacity in chronic pain patients: a visual event-related potentials study. Pain, 121(1), 60–68.
Veldhuijzen, D. S., Sondaal, S. F. V., & Oosterman, J. M. (2012). Intact cognitive inhibition in patients with fibromyalgia but evidence of declined processing speed. Journal of Pain, 13(5), 507–515.
Verdejo-Garcia, A., Lopez-Torrecillas, F., Calandre, E. P., Delgado-Rodriguez, A., & Bechara, A. (2009). Executive function and decision-making in women with fibromyalgia. Archives of Clinical Neuropsychology, 24(1), 113–122.
Vincent, K., Warnaby, C., Stagg, C. J., Moore, J., Kennedy, S., & Tracey, I. (2011). Dysmenorrhoea is associated with central changes in otherwise healthy women. Pain, 152(9), 1966–1975.
Wang, K., Liang, M., Wang, L., Tian, L., Zhang, X., Li, K., et al. (2007). Altered functional connectivity in early Alzheimer’s disease: a resting-state fMRI study. Human Brain Mapping, 28(10), 967–978.
Weissman-Fogel, I., Moayedi, M., Tenenbaum, H. C., Goldberg, M. B., Freeman, B. V., & Davis, K. D. (2011). Abnormal cortical activity in patients with temporomandibular disorder evoked by cognitive and emotional tasks. Pain, 152(2), 384–396.
Whitfield-Gabrieli, S., Thermenos, H. W., Milanovic, S., Tsuang, M. T., Faraone, S. V., McCarley, R. W., et al. (2009). Hyperactivity and hyperconnectivity of the default network in schizophrenia and in first-degree relatives of persons with schizophrenia. Proceedings of the National Academy of Sciencesof the United States of America, 106(4), 1279–1284.
Wiech, K., Ploner, M., & Tracey, I. (2008). Neurocognitive aspects of pain perception. Trends in Cognitive Sciences, 12(8), 306–313.
Acknowledgments
The first author thanks Kaytoo Kreations for technical expertise required for the experiment instructional material. Both authors thank the markers and the teachers who participated in this study. This study was funded by the Faculty of Arts and Social Sciences (University of New South Wales, Australia) and the NSW Institute for Educational Research.
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Appendix
Appendix
Sample responses to the tests provided in the response booklet to participants.
Retention Test
Responses could include the following: cool air moves, cool air becomes warmer, air rises, water vapour condenses to form a cloud, the cloud moves beyond the freezing level, crystals form, water and crystals fall, updrafts and downdrafts are produced, wind gusts are felt before the onset of rain, electrical charges build, negatively charged particles fall to the bottom of the cloud (or positive charges go to the top), a negative step leader travels down, leaders meet, negatively charged particles rush down, positively charged particles rush up, production of a bright light as a flash of lightning.
Transfer Test
For task 1, correct answers could suggest that the air temperature needs to be cooler than the ground; that there needs to be a difference in temperature between the top and the bottom of the cloud; or that the top of the cloud needs to be above the freezing level.
For task 2, solutions could highlight that the cloud or part thereof might not be above the freezing level; that there may not be enough air moisture; or there may not be enough negatively charged particles in the cloud.
For task 3, answers may have included the removal of positive ions from the ground, adding positive ions to the bottom of the cloud, heating the clouds to prevent freezing and the formation of ice crystals.
For task 4, answers acknowledging a difference in electrical charges in the cloud, a difference in temperature within the cloud, or a difference in charge between the positive charge on the ground and the negative charge in the cloud were acceptable.
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Smith, A., Ayres, P. The Impact of Persistent Pain on Working Memory and Learning. Educ Psychol Rev 26, 245–264 (2014). https://doi.org/10.1007/s10648-013-9247-x
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DOI: https://doi.org/10.1007/s10648-013-9247-x