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Behavioural and neural evidence for self-reinforcing expectancy effects on pain
Open accessAbstract
Beliefs and expectations often persist despite evidence to the contrary. Here we examine two potential mechanisms underlying such 'self-reinforcing' expectancy effects in the pain domain: modulation of perception and biased learning. In two experiments, cues previously associated with symbolic representations of high or low temperatures preceded painful heat. We examined trial-to-trial dynamics in participants' expected pain, reported pain and brain activity. Subjective and neural pain responses assimilated towards cue-based expectations, and pain responses in turn predicted subsequent expectations, creating a positive dynamic feedback loop. Furthermore, we found evidence for a confirmation bias in learning: higher- and lower-than-expected pain triggered greater expectation updating for high- and low-pain cues, respectively. Individual differences in this bias were reflected in the updating of pain-anticipatory brain activity. Computational modelling provided converging evidence that expectations influence both perception and learning. Together, perceptual assimilation and biased learning promote self-reinforcing expectations, helping to explain why beliefs can be resistant to change.
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“Studies of confirmation bias in direct perceptual experiences like pain are more rare, but early evidence indicates biases in pain perception caused by predictive cues can short-circuit learning, creating positive feedback loops between predictions and experiences that result in resistance to disconfirming evidence (26).”
From Social information creates self-fulfilling prophecies in judgments of pain, vicarious pain, and cognitive effort (2026) · cites this paper as [26]
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“Even cues conditioned to conceptual representations of reinforcers (e.g., images of thermometers indicating high or low pain) can elicit enduring effects in some cases (26).”
From Social information creates self-fulfilling prophecies in judgments of pain, vicarious pain, and cognitive effort (2026) · cites this paper as [26]
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Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., et al. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.2669 · Cited by 331
“A moderate amount 11 (22) 15 (29) 16 (32)”
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Metadata
- Authors
- Jepma, M., Koban, L., van Doorn, J., Jones, M., & Wager, T. D.
- Affiliations
- Leiden University (NL)
- University of Colorado Boulder (US)
- Dartmouth College (US)
- Corresponding author
- Jepma, Marieke
- Venue
- Nature Human Behaviour
- Published
- 2018-10-29
- Volume
- 2
- Issue
- 11
- Pages
- 838-855
- ISSN
- 2397-3374 (ISSN-L)
- PMC
- PMC6768437
- OpenAlex
- W2898173573
- Cited by
- 155
- References
- 130
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 29 · 2023: 25 · 2022: 19 · 2021: 20 · 2020: 11 · 2019: 10 · 2018: 1
- FWCI
- 6.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Human Behaviour (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- PubMed Central (acceptedVersion)
- HAL (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH076136)
- National Institute on Drug Abuse (R01DA027794)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- pain anticipation, confirmation bias, biased learning, pain perception, expectation updating, belief updating, thermal pain, computational modelling, individual differences
- MeSH terms
- Adult, Brain, Brain Mapping, Culture, Female, Humans, Learning, Male, Motivation, Neuropsychological Tests, Pain, Psychological Theory, Reinforcement, Psychology, Pain Perception
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