When do we not face our fears? Investigating the boundary conditions of costly pain-related avoidance generalization

Eveliina Glogan, Kristof Vandael, Rena Gatzounis, Ann Meulders*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Excessive generalization of fear and avoidance are hallmark symptoms of chronic pain disability, yet research focusing on the mechanisms underlying generalization of avoidance specifically, is scarce. Two experiments investigated the boundary conditions of costly pain related avoidance generalization in healthy participants who learned to avoid pain by performing increasingly effortful (in terms of deviation and force) arm-movements using a robot-arm (acquisition). During generalization, novel, but similar arm-movements, without pain, were tested. Experiment 1 (N = 64) aimed to facilitate generalization to these movements by reducing visual contextual changes between acquisition and generalization, whereas Experiment 2 (N = 70) aimed to prevent extinction by increasing pain uncertainty. Both experiments showed generalization of pain-expectancies and pain-related fear. However, Experiment 2 was the first and only to also demonstrate generalization of avoidance, ie, choosing the novel effortful arm movements in the absence of pain. These results suggest that uncertainty about the occurrence of pain may delay recovery, due to reduced disconfirmation of threat beliefs when exploring, resulting in persistent avoidance.

Perspective: This article demonstrates generalization of instrumentally acquired costly pain related avoidance in healthy people under conditions of uncertainty. The results suggest that targeting pain-related uncertainty may be a useful tool for clinicians adopting a psychological approach to treating excessive pain-related avoidance in chronic pain. (C) 2021 The Author(s). Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.

Original languageEnglish
Pages (from-to)1221-1232
Number of pages12
JournalThe Journal of Pain
Volume22
Issue number10
Early online date11 Apr 2021
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Avoidance behavior
  • fear generalization
  • avoidance generalization
  • chronic pain
  • operant conditioning
  • MOVEMENT-RELATED PAIN
  • COMMITMENT THERAPY
  • BEHAVIOR
  • ANXIETY
  • ACQUISITION
  • CONTEXT
  • CONSEQUENCES
  • UNCERTAINTY
  • EXTINCTION
  • ACCEPTANCE

Cite this