Acquisition, generalization and renewal of instrumental pain-related avoidance behavior in high-versus low-anxious individuals

Excessive avoidance is a key contributor to chronic pain-related disability. In the acute stage, pain-related avoidance prevents further harm, but when it persists beyond healing time it becomes maladaptive. Exposure therapy is the preferred treatment, yet avoidance often returns. Changing contexts (e.g., from therapy to home) may contribute to avoidance returning, referred to as renewal. This study aimed to experimentally investigate the moderating effects of trait anxiety on renewal of fear and avoidance, as well as on fear and avoidance during acquisition, generalization and response prevention with extinction. Eighty-eight pain-free adults, pre-selected based on high vs. low trait anxiety performed a conditioning paradigm: certain visual stimuli (conditioned stimuli, CS+) were paired with pain (unconditioned stimulus, US), while others were not (CS-). Participants then learned to avoid the US via button presses. Generalization to stimuli perceptually similar to the CSs was subsequently tested. During response prevention with extinction, CSs were presented in a new context, the CS+ was no longer followed by the US, and participants were not allowed to avoid. Renewal was tested in both the acquisition and extinction contexts, with avoidance available. Our study replicated the renewal of avoidance. Moreover, compared to low-anxious individuals, high-anxious individuals showed increased fear generalization, but not reduced differential learning, increased avoidance generalization, reduced extinction, or more renewal. High-anxious individuals did avoid more on the CS+ during the renewal test, but this effect was not modulated by context. These results support that individuals with high trait anxiety are more prone to developing anxietyrelated disorders.