Rewarding Approach Behaviour Attenuates the Return of Pain-Related Avoidance After Successful Extinction with Response Prevention.

After successful exposure treatment for chronic pain, pain-related fear and avoidance may return, i.e., relapse may occur.

Generalization of pain-related avoidance behavior based on de novo categorical knowledge.

People with chronic pain often fear and avoid movements and activities that were never paired with pain. Safe movements may be avoided if they share some semantic relationship with an actual pain-associated movement. This study investigated whether pain-associated operant responses (movements) can become categorically associated with perceptually dissimilar responses, thus motivating avoidance of new classes of safe movements-a phenomenon known as category-based avoidance generalization.

Pain and avoidance: The potential benefits of imagining your best possible self.

Positive affect is hypothesized to improve safety learning taking place during extinction (i.e., the core mechanism of exposure treatment), therefore improving the maintenance of treatment outcomes.

Safety behaviours or safety precautions? The role of subtle avoidance in anxiety disorders in the context of chronic physical illness.

Avoidance is a hallmark symptom and a primary maintaining factor in anxiety disorders. Theories of anxiety disorders have focused not only on overt avoidance, but also on more subtle avoidance known as 'safety behaviours'. Safety behaviours involve behaviours which aim to reduce anxiety or prevent a feared outcome from occurring.

No differences in return of pain-related fear after extinction and counterconditioning.

Extinction-based protocols such as exposure-in-vivo successfully reduce pain-related fear in chronic pain conditions, but return of fear and clinical relapse often occur. Counterconditioning is assumed to attenuate return of fear, likely through changing the negative affective valence of the conditioned stimulus (CS). We hypothesized that counterconditioning would outperform extinction in mitigating return of pain-related fear and decrease CS negative affective valence.

Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory.

Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them.

When Do We Not Face Our Fears? Investigating the Boundary Conditions of Costly Pain-Related Avoidance Generalization.

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.

Will that hurt? A contingency learning task to assess pain-expectancy judgments for low back postures.

Background And Objectives: Contingency learning, i.e. learning that a cue predicts the presence (or absence) of an event, is central to the formation of beliefs regarding painfulness of body postures.

Investigating Pain-Related Avoidance Behavior using a Robotic Arm-Reaching Paradigm.

Avoidance behavior is a key contributor to the transition from acute pain to chronic pain disability. Yet, there has been a lack of ecologically valid paradigms to experimentally investigate pain-related avoidance. To fill this gap, we developed a paradigm (the robotic arm-reaching paradigm) to investigate the mechanisms underlying the development of pain-related avoidance behavior.

Once an Avoider Always an Avoider? Return of Pain-Related Avoidance After Extinction With Response Prevention.

In exposure for chronic pain, avoidance is often forbidden (extinction with response prevention; RPE) to prevent misattributions of safety. Although exposure is an effective treatment, relapse is common. Little is known about the underlying mechanisms of return of pain-related avoidance.

Generalization of instrumentally acquired pain-related avoidance to novel but similar movements using a robotic arm-reaching paradigm.

Avoidance is considered a key contributor to the development and maintenance of chronic pain disability, likely through its excessive generalization. This study investigated whether acquired avoidance behavior generalizes to novel but similar movements. Using a robotic arm, participants moved their arm from a starting to a target location via one of three possible movement trajectories.

A break from pain! Interruption management in the context of pain.

Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management.

Effects of activity interruptions by pain on pattern of activity performance - an experimental investigation.

Background And Aims: Suspending an ongoing activity with the intention to resume it again later is a natural response to pain. This response facilitates coping with the pain, but it may also have negative consequences for the resumption and performance of the activity. For example, people with pain problems are often forced to take a break from doing their household chores because of their pain.

Activity interruptions by pain impair activity resumption, but not more than activity interruptions by other stimuli: an experimental investigation.

Interrupting ongoing activities whilst intending to resume them later is a natural response to pain. Whereas this response facilitates pain management, at the same time it may also disrupt task performance. Previous research has shown that activity interruptions by pain impair subsequent resumption of the activity, but not more than pain-irrelevant interruptions.

Taking a break in response to pain. An experimental investigation of the effects of interruptions by pain on subsequent activity resumption.

Background And Aims: Interrupting ongoing activities with the intention to resume them again later is a natural response to pain. However, such interruptions might have negative consequences for the subsequent resumption and performance of the interrupted activity. Activity interruptions by pain may be more impairing than interruptions by non-painful stimuli, and also be subjectively experienced as such.

Operant learning theory in pain and chronic pain rehabilitation.

The application of operant learning theory on chronic pain by Fordyce has had a huge impact on chronic pain research and management. The operant model focuses on pain behaviors as a major component of the pain problem, and postulates that they are subject to environmental contingencies. The role of operant learning in pain behaviors generally has been supported by experimental studies, which are reviewed in the present article.