Safety behavior can hamper the extinction of fear of movement-related pain: An experimental investigation in healthy participants
Abstract
Excessive fear of movement-related pain (FMRP), and its associated avoidance behavior, is considered a major risk factor for disability in chronic musculoskeletal pain. The current study aimed to investigate whether engaging in safety behavior, conceptualized as an avoidance response, hampers the extinction of FMRP. In a differential conditioning paradigm, we used joystick movements as conditioned stimuli (CSs) and a painful electrocutaneous stimulus as the unconditioned stimulus (US). In the Safety group, participants received the opportunity to avoid the pain-US by pressing a safety button during the extinction phase, whereas in the Control group, this option was not included. In a subsequent test phase, this safety button was no longer available. In two experiments, results demonstrate successful acquisition and extinction. Retrospective FMRP ratings in both experiments revealed a return of fear of pain in the test phase in the Safety group, but not in the Control group. In Experiment 1, mean eyeblink startle reflex amplitudes partly corroborated the self-report findings on fear of pain. The present results suggest that performing safety behavior during cognitive-behavioral interventions, i.e., exposure, might increase the risk of a return of FMRP.
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Other experiments in humans, as well as clinical studies, have found that avoidance or safety behavior during extinction or exposure therapy can hinder the reduction of threat responses or fear.
“Other experiments in humans, as well as clinical studies, have found that avoidance or safety behavior during extinction or exposure therapy can hinder the reduction of threat responses or fear (Lovibond et al., 2009; Blakey and Abramowitz, 2016; Volders et al., 2012).”
From Active avoidance: Neural mechanisms and attenuation of pavlovian conditioned responding (2017) · cites this paper as Volders et al., 2012
Cites
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BackgroundVlaeyen, J. W. S., de Jong, J., Geilen, M., Heuts, P. H. T. G., & van Breukelen, G. (2002) · The Clinical Journal of Pain · doi:10.1097/00002508-200207000-00006 · Cited by 499 · see citing works
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Learning to predict and control harmful events: chronic pain and conditioning
Vlaeyen, J. W. S. (2015) · Pain · doi:10.1097/j.pain.0000000000000107 · Cited by 159 · see citing works
Self-citationActive avoidance: Neural mechanisms and attenuation of pavlovian conditioned responding
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“Other experiments in humans, as well as clinical studies, have found that avoidance or safety behavior during extinction or exposure therapy can hinder the reduction of threat responses or fear (Lovibond et al., 2009; Blakey and Abramowitz, 2016; Volders et al., 2012).”
ResultVlaeyen, J. W. S., Morley, S., & Crombez, G. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.08.016 · Cited by 117 · see citing works
Self-citationAvoidance behavior in chronic pain research: a cold case revisited
Volders, S., Boddez, Y., De Peuter, S., Meulders, A., & Vlaeyen, J. W. S. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.003 · Cited by 97 · see citing works
Self-citationOdriozola, P., & Gee, D. G. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20020232 · Cited by 62 · see citing works
Flores, A., López, F. J., Vervliet, B., & Cobos, P. L. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101527 · Cited by 45 · see citing works
A hybrid emotion-focused exposure treatment for chronic pain: A feasibility study
Linton, S. J., & Fruzzetti, A. E. (2014) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2014.05.008 · Cited by 41 · see citing works
Extinction of instrumental avoidance
Urcelay, G. P., & Prével, A. (2019) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2019.01.018 · Cited by 28 · see citing works
- Authors
- Volders, S., Meulders, A., De Peuter, S., Vervliet, B., & Vlaeyen, J. W. S.
- Affiliations
- KU Leuven (BE)
- Maastricht University (NL)
- Corresponding author
- Volders, Stéphanie
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 50
- Issue
- 11
- Pages
- 735-746
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2162665933
- Cited by
- 56
- References
- 12
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 2 · 2017: 4 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 1
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- safety behavior, fear extinction, avoidance behavior, return of fear, chronic musculoskeletal pain, differential conditioning, exposure therapy, cognitive-behavioral intervention
- MeSH terms
- Adolescent, Adult, Avoidance Learning, Blinking, Chronic Disease, Conditioning, Classical, Electric Stimulation, Extinction, Psychological, Fear, Female, Humans, Male, Middle Aged, Psychomotor Performance, Safety, Reflex, Startle, Musculoskeletal Pain
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