Indoor or outdoor? Generalization of costly pain-related avoidance behavior to conceptually related contexts

Tabea Kloos, Christine van Vliet, Jenny Riecke, Ann Meulders*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


When pain persists beyond healing time and becomes a "false alarm" of bodily threat, protective strategies, such as avoidance, are no longer adaptive. More specifically, generalization of avoidance based on conceptual knowledge may contribute to chronic pain disability. Using an operant robotic-arm avoidance paradigm, healthy participants (N=50), could perform more effortful movements in the threat context (e.g. pictures of outdoor scenes) to avoid painful stimuli, whereas no pain occured in the safe context (e.g. pictures of indoor scenes). Next, we investigated avoidance generalization to conceptually related contexts (i.e. novel outdoor/indoor scenes). As expected, participants avoided more when presented with novel contexts conceptually related to the threat context than in novel exemplars of the safe context. Yet, exemplars belonging to one category (outdoor/indoor scenes) were not interchangeable; there was a generalization decrement. Posthoc analyses revealed that contingency-aware participants (n=27), but not non-aware participants (n=23), showed the avoidance generalization effect and also generalized their differential pain-expectancy and pain-related fear more to novel background scenes conceptually related to the original threat context. In contrast, the fear-potentiated startle response was not modulated by context.

Original languageEnglish
Pages (from-to)657-668
Number of pages12
JournalThe Journal of Pain
Issue number4
Early online date16 Nov 2021
Publication statusPublished - 4 Apr 2022


  • Pain
  • avoidance
  • concept-based generalization
  • context modulation
  • operant learning


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