Abstract
From a treatment perspective, it is highly relevant to pinpoint individual vulnerability factors for resistance to exposure treatment in highly fearful chronic pain patients. Previous
fear conditioning research showed that healthy individuals scoring relatively high
on trait anxiety display sustained fear to safety cues during extinction. In the context
of fear of movement-related pain, this intriguing question has been largely neglected
so far. Even more importantly, positive psychological traits such as trait positive
affect may function as protective factors against the spreading of fear to safe movements and improve exposure treatment outcomes.
In this study, healthy participants completed a trait anxiety and trait positive affect
questionnaire and underwent acquisition and extinction of fear of movement-related
pain using an experimental voluntary movement paradigm. During acquisition, one movement
(CS+) was paired with a painful stimulus and another movement was not (CS−). During
extinction, the CS+ was no longer reinforced. Results show failure of fear inhibition
to the CS− during extinction in healthy individuals scoring relatively high on trait
anxiety or relatively low on positive affect. These findings seem to suggest that
safety learning is more vulnerable in healthy people with a high anxious disposition
and/or relatively lower levels of positive affect. In addition, this is the first
study to show that the negative impact of high trait anxiety on fear inhibition to
safety cues during extinction can be countered by high levels of positive affect.
These findings may have important clinical implications.
Perspective
Both low positive affect and high trait anxiety are associated with impaired fear
inhibition to nonpainful movements during fear extinction. Interestingly, high levels
of positive affect buffer against the negative impact of trait anxiety. Increasing
positive affect during exposure may counter the effects of trait vulnerabilities and
improve treatment outcomes.
Key words
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Article info
Publication history
Published online: April 24, 2014
Accepted:
February 27,
2014
Received in revised form:
February 24,
2014
Received:
July 26,
2013
Footnotes
A.M. is a postdoctoral researcher of the Research Foundation, Flanders, Belgium (FWO Vlaanderen). This study was also supported by the Odysseus Grant “The Psychology of Pain and Disability Research Program” funded by the Research Foundation, Flanders, Belgium (FWO Vlaanderen) and an EFIC-Grünenthal Research Grant to A.M. These data were presented as a poster at the 7th World Congress of Cognitive and Behavioral Therapies (WCBCT), Lima, Peru. The authors report no conflict of interest.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
