Skip to main content

Advertisement

Log in

Investigating the Modality and Redundancy Effects for Learners with Persistent Pain

  • Research into Practice
  • Published:
Educational Psychology Review Aims and scope Submit manuscript

Abstract

Two experiments were conducted to investigate how individuals with persistent pain would respond to instructional materials designed to promote the modality and redundancy effects. It was predicted that persistent pain would reduce the positive impact of narrated text due to reduced working memory capacity. One hundred thirty-seven full-time teachers from six schools in Australia participated in the study. Pain and pain-free participants were identified and matched through a demographics questionnaire before being randomly assigned to selected instructional formats. In both experiments, participants viewed system-paced multimedia presentations depicting how lightning works. In Experiment 1, it was found that for pain-free participants, illustrations plus narrated text led to significantly higher learning outcomes than illustrations plus written text (a modality effect). However, for pain participants, no advantage was found for the illustrations plus narrated text format. In Experiment 2, it was found that for pain-free participants, illustrations plus narrated text led to significantly higher learning outcomes than illustrations plus narrated text plus identical written text (a redundancy effect). For pain participants, a reverse effect was found, suggesting that the replicated written text format was not redundant but beneficial for these individuals. Furthermore, despite low scores on standardized pain measures, individuals with persistent pain achieved significantly lower learning outcomes than pain-free participants in both experiments. It was concluded that clinically low levels of pain could significantly interfere with information retention and transference. For individuals with persistent pain, the use of narrated explanatory text could be a disadvantage due to its transitory nature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

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, 683–689.

    Google Scholar 

  • Apkarian, A. V., Sosa, Y., Krauss, B. R., Thomas, P. S., Fredrickson, B. E., Levy, R. E., et al. (2004). Chronic pain patients are impaired on an emotional decision-making task. Pain, 108, 129–136.

    Article  Google Scholar 

  • Ayres, P., & Paas, F. (2007). Can the cognitive load approach make instructional animations more effective? Applied Cognitive Psychology, 21, 811–820.

    Article  Google Scholar 

  • Ayres, P., & Sweller, J. (2005). The split-attention principle in multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 135–146). NY: Cambridge University Press.

    Chapter  Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.

    Google Scholar 

  • Brunken, R., Plass, J. L., & Leutner, D. (2003). Direct measurement of cognitive load in multimedia learning. Educational Psychologist, 38, 53–61.

    Article  Google Scholar 

  • Chandler, P., & Sweller, J. (1991). Cognitive load theory and the format of instruction. Cognition and Instruction, 8, 293–332.

    Article  Google Scholar 

  • Chi, M. T. H., Feltovich, P. J., & Glaser, R. (1981). Categorization and representation of physics problems by experts and novices. Cognitive Science, 5, 121–152.

    Article  Google Scholar 

  • Choi, H.-H., van Merrienboer, J. J. G., & Paas, F. (2014). Effects of the physical environment on cognitive load and learning: towards a new model of cognitive load. Educational Psychology Review, 26, 225–244.

    Article  Google Scholar 

  • Choiniere, M., & Amsel, R. (1996). A visual analogue thermometer for measuring pain intensity. Journal of Pain and Symptom Management, 11, 299–311.

    Article  Google Scholar 

  • Christopher, G., & MacDonald, J. (2005). The impact of clinical depression on working memory. Cognitive Neuropsychiatry, 10, 379–399.

    Article  Google Scholar 

  • Clark, R. C., & Mayer, R. E. (2011). E-learning and the science of instruction: proven guidelines for consumers and designers of multimedia learning (3rd ed.). San Francisco: Wiley.

    Book  Google Scholar 

  • Cowan, N. (2014). Working memory underpins cognitive development, learning, and education. Educational Psychology Review, 26, 197–223.

    Article  Google Scholar 

  • 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, 428–434.

    Article  Google Scholar 

  • Dick, B. D., & Rashiq, S. (2007). Disruption of attention and working memory traces in individuals with chronic pain. Anesthesia and Analgesia, 104, 1223–1229.

    Article  Google Scholar 

  • Dick, B., Eccleston, C., & Crombez, G. (2002). Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients. Arthritis Care and Research, 47, 639–644.

    Article  Google Scholar 

  • Dick, B. D., Verrier, M. J., Harker, K. T., & Rashiq, S. (2008). Disruption of cognitive function in fibromyalgia syndrome. Pain, 139, 610–616.

    Article  Google Scholar 

  • Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). London: Sage.

    Google Scholar 

  • Fraser, K., Huffman, J., Ma, I., Sobczak, M. E., McIlwrick, J., Wright, B., & McLaughlin, K. (2014). The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial. Chest, 145, 958–963.

    Article  Google Scholar 

  • Ginns, P. (2005). Meta-analysis of the modality effect. Learning and Instruction, 15, 313–331.

    Article  Google Scholar 

  • Ginns, P. (2006). Integrating information: a meta-analysis of the spatial contiguity and temporal contiguity effects. Learning and Instruction, 16, 511–525.

    Article  Google Scholar 

  • Glass, J. M. (2010). Cognitive dysfunction in fibromyalgia syndrome. Journal of Musculoskeletal Pain, 18, 367–372.

    Article  Google Scholar 

  • Grisart, J. M., & Plaghki, L. H. (1999). Impaired selective attention in chronic pain patients. European Journal of Pain, 3, 325–333.

    Article  Google Scholar 

  • Grisart, J., Van der Linden, M., & Masquelier, E. (2002). Controlled processes and automaticity in memory functioning in fibromyalgia patients: Relation with emotional distress and hypervigilance. Journal of Clinical and Experimental Neuropsychology, 24, 994–1009.

    Article  Google Scholar 

  • Grisart, J., Van der Linden, M., & Bastin, C. (2007). The contribution of recollection and familiarity to recognition memory performance in chronic pain patients. Behaviour Research and Therapy, 45, 1077–1084.

    Article  Google Scholar 

  • 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, 216–222.

    Article  Google Scholar 

  • 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, 92–102.

    Article  Google Scholar 

  • Hunt, S. P., Suzuki, R., Rahman, W., & Dickenson, A. H. (2006). Chronic pain and descending facilitation. In H. Flor, E. Kalso, & J. O. Dostrovsky (Eds.), Proceedings of the 11th World Congress on Pain (pp. 349–363). Seattle: IASP.

    Google Scholar 

  • Iezzi, T., Archibald, Y., Barnett, P., Klinck, A., & Duckworth, M. (1999). Neurocognitive performance and emotional status in chronic pain patients. Journal of Behavioral Medicine, 22, 205–216.

    Article  Google Scholar 

  • Jensen, M. P., Chen, C., & Brugger, A. M. (2003). Interpretation of visual analogscale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of Pain, 4, 407–414.

    Article  Google Scholar 

  • Jensen, M. P., Chodroff, M. J., & Dworkin, R. H. (2007). The impact of neuropathic pain on health-related quality of life: review and implications. Neurology, 68, 1178–1182.

    Article  Google Scholar 

  • Kalyuga, S., Chandler, P., & Sweller, J. (1998). Levels of expertise and instructional design. Human Factors, 40, 1–17.

    Article  Google Scholar 

  • Kalyuga, S., Chandler, P., & Sweller, J. (2000). Incorporating learner experience into the design of multimedia instruction. Journal of Educational Psychology, 92, 126–136.

    Article  Google Scholar 

  • Kalyuga, S., Ayres, P., Chandler, P., & Sweller, J. (2003). The expertise reversal effect. Educational Psychologist, 38, 23–31.

    Article  Google Scholar 

  • Kalyuga, S., Chandler, P., & Sweller, J. (2004). When redundant on-screen text in multimedia technical instruction can interfere with learning. Human Factors, 46, 567–581.

    Article  Google Scholar 

  • 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, 444–452.

    Article  Google Scholar 

  • 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, 289–299.

    Article  Google Scholar 

  • Kessels, R. P. (2003). Patients’ memory for medical information. Journal of theRoyal Society of Medicine, 96, 219–222.

    Article  Google Scholar 

  • Kester, L., Kirschner, P. A., & van Merrienboer, J. J. G. (2005). The management of cognitive load during complex cognitive skill acquisition by means of computer-simulated problem solving. British Journal of Educational Psychology, 75, 71–85.

    Article  Google Scholar 

  • Kotovsky, K., Hayes, J. R., & Simon, H. A. (1985). Why are some problems hard? Evidence from Tower of Hanoi. Cognitive Psychology, 17, 248–294.

    Article  Google Scholar 

  • Kurita, G. P., Sjogren, P., Juel, K., Hojsted, J., & Ekholm, O. (2012). The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use. Pain, 153, 2332–2338.

    Article  Google Scholar 

  • Landro, N. I., Fors, E. A., Vapenstad, L. L., Holthe, O., Stiles, T. C., & Borchgrevink, P. C. (2013). The extent of neurocognitive dysfunction in a multidisciplinary pain centre population. Is there a relation between reported and tested neuropsychological functioning? Pain, 154, 972–977.

    Article  Google Scholar 

  • Larkin, J., McDermott, J., Simon, D. P., & Simon, H. A. (1980). Expert and novice performance in solving physics problems. Science, 208, 1335–1342.

    Article  Google Scholar 

  • Leahy, W., & Sweller, J. (2011). Cognitive load theory, modality of presentation and the transient information effect. Applied Cognitive Psychology, 25, 943–951.

    Article  Google Scholar 

  • Leavitt, F., & Katz, R. S. (2006). Distraction as a key determinant of impaired memory in patients with fibromyalgia. The Journal of Rheumatology, 33, 127–132.

    Google Scholar 

  • Low, R., & Sweller, J. (2005). The modality principle in multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 147–158). NY: Cambridge University Press.

    Chapter  Google Scholar 

  • Mayer, R. E. (2001). Multimedia learning. New York: Cambridge University Press.

    Book  Google Scholar 

  • Mayer, R. E. (2005). Introduction to multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 1–16). New York: Cambridge University Press.

    Chapter  Google Scholar 

  • Mayer, R. E., & Johnson, C. I. (2008). Revising the redundancy principle in multimedia learning. Journal of Educational Psychology, 100, 380–386.

    Article  Google Scholar 

  • 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, 312–320.

    Article  Google Scholar 

  • 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, 187–198.

    Article  Google Scholar 

  • Melzack, R. (1975). The McGill pain questionnaire: major properties and scoring methods. Pain, 1, 277–299.

    Article  Google Scholar 

  • Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191–197.

    Article  Google Scholar 

  • Melzack, R. (2005). The McGill pain questionnaire: from description to measurement. Anesthesiology, 103, 199–202.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Moreno, R., & Mayer, R. E. (2002). Verbal redundancy in multimedia learning: when reading helps listening. Journal of Educational Psychology, 94, 156–163.

    Article  Google Scholar 

  • Moulin, D. E., Clark, A. J., Speechley, M., & Morley-Forster, P. K. (2002). Chronic pain in Canada—prevalence, treatment, impact and the role of opioid analgesia. Pain Research and Management, 7, 179–184.

    Article  Google Scholar 

  • Niv, D., & Kreitler, S. (2001). Pain and quality of life. Pain Practice, 1, 150–161.

    Article  Google Scholar 

  • 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, 70–75.

    Article  Google Scholar 

  • Oosterman, J. M., Derksen, L. C., van Wijck, A. J. M., Kessels, R. P. C., & Veldhuijzen, D. S. (2012). Executive and attentional functions in chronic pain: does performance decrease with increasing task load? Pain Research and Management, 17, 159–165.

    Article  Google Scholar 

  • 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, 429–434.

    Article  Google Scholar 

  • Penney, C. G. (1989). Modality effects and the structure of short term verbal memory. Memory and Cognition, 17, 398–422.

    Article  Google Scholar 

  • Peterson, L. R., & Peterson, M. J. (1959). Short-term retention of individual verbal items. Journal of Experimental Psychology, 58, 193–198.

    Article  Google Scholar 

  • Peyron, R., Laurent, B., & Garcia-Larrea, L. (2000). Functional imaging of brain responses to pain. A review and meta-analysis. Clinical Neurophysiology, 30, 263–288.

    Article  Google Scholar 

  • Rode, S., Salkovskis, P. M., & Jack, T. (2001). An experimental study of attention, labelling and memory in people suffering from chronic pain. Pain, 94, 193–203.

    Article  Google Scholar 

  • Rustoen, T., Wahl, A. K., Hanestad, B. R., Lerdal, A., Paul, S., & Miaskowski, C. (2004). Prevalence and characteristics of chronic pain in the general Norwegian population. European Journal of Pain, 8, 555–565.

    Article  Google Scholar 

  • 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, 92–96.

    Article  Google Scholar 

  • Schneider, W., & Shiffrin, R. (1977). Controlled and automatic human information processing: I. Detection, search and attention. Psychological Review, 84, 1–66.

    Article  Google Scholar 

  • Singh, A.-M., Marcus, N., & Ayres, P. (2012). The transient information effect: Investigating the impact of segmentation on spoken and written text. Applied Cognitive Psychology, 26, 848–853.

    Article  Google Scholar 

  • Sjogren, P., Christrup, L. L., Petersen, M. A., & Hojsted, J. (2005). Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre. European Journal of Pain, 9, 648–663.

    Article  Google Scholar 

  • Smith, A., & Ayres, P. (2014). The impact of persistent pain on working memory and learning. Educational Psychology Review, 26, 245–264.

    Article  Google Scholar 

  • Sweller, J., van Merriënboer, J. J. G., & Pass, F. (1998). Cognitive architecture and instructional design. Educational Psychology Review, 10, 251–296.

    Article  Google Scholar 

  • Sweller, J., Ayres, P., & Kalyuga, S. (2011). Cognitive load theory. NY: Springer.

    Book  Google Scholar 

  • Tabbers, H. K., Martens, R. L., & van Merriënboer, J. J. G. (2004). Multimedia instructions and cognitive load theory: effects of modality and cueing. British Journal of Educational Psychology, 74, 71–81.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Van Gerven, P. W. M., Paas, F., van Merriënboer, J. J. G., & Schmidt, H. G. (2002). Cognitive load theory and aging: effects of worked examples on training efficiency. Learning and Instruction, 12, 87–105.

    Article  Google Scholar 

  • 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, 311–320.

    Article  Google Scholar 

  • Van Merrienboer, J. J. G., & Sweller, J. (2005). Cognitive load theory and complex learning: recent developments and future directions. Educational Psychology Review, 17, 147–177.

    Article  Google Scholar 

  • Veldhuijzen, D. S., van Wijck, A. J. M., Wille, F., Verster, J. C., Kenemans, J. L., Kalkman, C. J., Olivier, B., & Volkerts, E. R. (2006). Effect of chronic nonmalignant pain on highway driving performance. Pain, 122(1–2), 28–35.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Walteros, C., Sanchez-Navarro, J. P., Munoz, M. A., Martinez-Selva, J. M., Chialvo, D., & Montoya, P. (2011). Altered associative learning and emotional decision making in fibromyalgia. Journal of Psychosomatic Research, 70(3), 294–301.

    Article  Google Scholar 

  • Wong, A., Leahy, W., Marcus, N., & Sweller, J. (2012). Cognitive load theory, the transient information effect and e-learning. Learning and Instruction, 22(6), 449–457.

    Article  Google Scholar 

  • Wouters, P., Paas, F., & van Merriënboer, J. J. G. (2009). Observational learning from animated models: effects of modality and reflection on transfer. Contemporary Educational Psychology, 34(1), 1–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul Ayres.

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, A., Ayres, P. Investigating the Modality and Redundancy Effects for Learners with Persistent Pain. Educ Psychol Rev 28, 401–424 (2016). https://doi.org/10.1007/s10648-014-9293-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10648-014-9293-z

Keywords

Navigation