The impact of social support cues on pain-related fear and avoidance learning

Recently, social support cues have been suggested to be "unique" safety signals possessing fear inhibitory properties. Yet, previous research only included autonomic fear measures (i.e., skin conductance) in passive fear conditioning procedures, therefore the impact of social support cues on operant pain-related avoidance learning and self-reported fear and pain-expectancy is unknown. In contrast, previous research showed that social threat cues facilitate pain-related fear learning, but their impact on operant pain-avoidance learning has never been investigated. Pain-free participants (N = 81) learned to avoid pain by performing increasingly effortful (in terms of deviation and force) arm-movements using a robotic arm. Participants were randomly assigned to one of three groups: Social Support (n= 27), Social Safety (n= 28), or Social Threat (n= 26). Social cues were manipulated by showing a picture of their supportive figure, a sex-matched smiling or angry stranger, respectively. We measured self-reported pain-expectancy and pain-related fear for the different arm-movements, contextual fear (fear-potentiated startle during the social cues), and avoidance behavior. Results showed successful acquisition of pain-related avoidance behavior and differential acquisition of self-reported fear and pain-expectancy. In contrast with our hypotheses, groups did not differ on any of the outcomes. Our findings suggest that in contrast to arousal-related fear measures, social support cues do not modulate avoidance behavior, nor self-reported pain-related fear and pain-expectancy in an operant pain-related avoidance paradigm. Potential explanations for this dissociation will be discussed. Perspective: Social support cues did not attenuate acquiring pain-related fear and avoidance, nor did social threat cues facilitate such learning in an operant pain-avoidance learning task. Our results can inform future studies about the boundary conditions of social support and threat cues effects on fear and avoidance learning.