High-Anxious People Generalize Costly Pain-Related Avoidance Behavior More to Novel Safe Contexts Compared to Low-Anxious People
Open accessAbstract
Pain-related avoidance is adaptive when there is a bodily threat, but when it generalizes to safe movements/situations, it may become disabling. Both subclinical anxiety-a vulnerability marker for chronic pain-and chronic pain are associated with excessive fear generalization to safe stimuli/situations. Previous research focused mainly on passive fear correlates (psychophysiological arousal and self-reports) leaving avoidance behavior poorly understood. Therefore, we tested whether high-anxious individuals generalize their pain-related avoidance behavior more to novel, safe contexts than low-anxious people. In a robotic-arm-reaching task, both groups (low vs high trait anxiety) performed 1 of 3 movements to reach a target. In the threat context (black background), a painful stimulus could be partly/completely prevented by performing more effortful trajectories (longer and more force needed); in the safe context (white background), no pain occurred. Generalization of avoidance was tested in 2 novel contexts (light/dark gray backgrounds). We assessed pain expectancy, pain-related fear, startle eyeblink responses for all trajectories, and avoidance behavior (ie, maximal deviation from shortest trajectory). Results indicated that differential fear and expectancy selectively generalized to the novel context resembling the original threat context in both groups. Interestingly and in contrast with the verbal reports, high-anxious participants avoided more in the novel context resembling the original safe context, but not in the 1 resembling the threat context. No generalization emerged in the startle data. Because excessive pain-related avoidance specifically may cause withdrawal from daily life activities, these findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability. PERSPECTIVE: This paper shows that high-anxious people do not overgeneralize pain-related fear and pain expectancy learned in a threat context more to novel, safe contexts than low-anxious individuals, but that they do avoid more in those contexts. These findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability.
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Phobias are often associated with significant avoidance behaviors, such as refusal due to impairment in undertaking everyday activities, and have social, occupational, and health consequences, including lack of adherence to screening painful medical procedures.
“Phobias often associate with significant avoidance behaviors, such as refusal due to impairment in undertaking everyday activities, and therefore, have essential social, occupational, and even health consequences concerning a lack of adherence towards screening painful medical procedures [13].”
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“Phobias often associate with significant avoidance behaviors, such as refusal due to impairment in undertaking everyday activities, and therefore, have essential social, occupational, and even health consequences concerning a lack of adherence towards screening painful medical procedures [13].”
BackgroundMacIntyre, E., Pinto, E. A., Mouatt, B., Henry, M. L., Lamb, C., BRAITHWAITE, F., Meulders, A., & Stanton, T. R. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102449 · Cited by 6 · see citing works
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“These findings iterate the relationship between anxiety, fear generalization and avoidance behaviours (Meulders et al. 2024).”
Traxler, J., Vandael, K., Hulle, N. V., Gatzounis, R., Glogan, E., & Meulders, A. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105120
- Authors
- Meulders, A., Traxler, J., Vandael, K., & Scheepers, S.
- Affiliations
- Maastricht University (NL)
- KU Leuven (BE)
- Corresponding author
- Meulders, Ann
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2024-03
- Volume
- 25
- Issue
- 3
- Pages
- 702-714
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W4387518311
- Cited by
- 6
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Lirias (submittedVersion, other-oa)
- Funders
- FWO
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (ID 452-17-002)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- trait anxiety, pain avoidance, fear generalization, chronic pain, pain anticipation, fear of pain, subclinical anxiety
- MeSH terms
- Anxiety, Avoidance Learning, Fear, Humans, Phobic Disorders, Self Report, Chronic Pain
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