Original Report| Volume 14, ISSUE 4, P412-423, April 2013

Mere Intention to Perform Painful Movements Elicits Fear of Movement-Related Pain: An Experimental Study on Fear Acquisition Beyond Actual Movements

  • Ann Meulders
    Address reprint requests to Ann Meulders, PhD, Department of Psychology, University of Leuven, Tiensestraat 102, box 3726, 3000 Leuven, Belgium.
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium
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  • Johan W.S. Vlaeyen
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium

    Center of Excellence Generalization Research in Ill Health and Psychopathology, University of Leuven, Leuven, Belgium

    Department of Clinical Psychological Science, Maastricht University, The Netherlands
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      Fresh empirical evidence supports the notion that fear of movement-related pain can be acquired through associative learning. In the context of these findings, 2 ideas are appealing, yet uninvestigated. The first is that merely the intention to perform a painful movement acts as a covert conditioned stimulus (CS) inducing defensive fear responses (ie, gaining excitatory properties following Pavlovian acquisition). The second idea is that after extinction, fear of movement-related pain can easily be reinstated after unexpected painful stimuli (ie, reinstatement). In a voluntary differential conditioning movement paradigm with movements as CSs and a painful electrocutaneous stimulus as the unconditioned stimulus (pain-US), 2 groups were included (Experimental/Control). One movement (CS+) was followed by the pain-US and another movement (CS−) was not during acquisition, while the CS+ was no longer reinforced during extinction. Next, the Experimental group received 2 reinstating pain-USs, whereas the Control group did not. The CS+ but not the CS− evoked fear of movement-related pain in self-reports and eye-blink startles. Intriguingly, the mere intention to perform the painful movement produced higher eye-blink startle responses than the intention to perform the nonpainful movement. We also demonstrated nondifferential reinstatement in the verbal fear ratings in the Experimental group only.


      This study demonstrates that the mere intention to perform a painful movement prior to the actual painful movement itself can come to elicit conditioned fear responses. These results suggest that actual movement may not be necessary to elicit pain-related fear responses, maintaining chronic pain-related fear, avoidance, and disability.

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