Highlights
- •Counterconditioning is as effective as extinction to reduce pain-related fear.
- •Adding a reward to a painful movement did not attenuate pain-related fear.
- •Adding a reward to a painful movement did not reduce the painfulness.
- •Adding a reward to a painful movement did not reduce the pain unpleasantness.
- •Both extinction and counterconditioning changed the acquired stimulus valence.
Abstract
Cognitive-behavioral treatments for chronic pain typically target pain-related fear;
exposure in vivo is a common treatment focusing on disconfirming harm expectancy of
feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative
fear reduction technique that also alters stimulus valence is counterconditioning.
We compared both procedures to reduce pain-related fear using a voluntary joystick
movement paradigm. Participants were randomly allocated to the counterconditioning
or extinction group. During fear acquisition, moving the joystick in 2 directions
(conditioned stimulus [CS+]) was followed by a painful electrocutaneous stimulus (pain-unconditioned
stimulus [US]), whereas moving the joystick in 2 other directions was not (CS−). During
fear reduction, 1 CS+ was extinguished, but another CS+ was still followed by pain
in the extinction group; in the counterconditioning group, 1 CS+ was extinguished
and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US
and reward-US). The results indicate that counterconditioning effectively reduces
pain-related fear but that it does not produce deeper fear reduction than extinction.
Adding a reward-US to a painful movement attenuated neither fear nor the intensity/unpleasantness
of the pain. Both procedures changed stimulus valence. We contend that changing the
affective valence of feared movements might improve fear reduction and may prevent
relapse.
Perspective
This article reports no immediate differences between counterconditioning and extinction
in reducing pain-related fear in the laboratory. Unexpectedly, both methods also altered
stimulus valence. However, we cautiously suggest that methods explicitly focusing
on altering the affective valence of feared movements may improve the long-term effectiveness
of fear reduction and prevent relapse.
Key words
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Article info
Publication history
Published online: October 02, 2015
Accepted:
September 5,
2015
Received in revised form:
August 13,
2015
Received:
March 10,
2015
Footnotes
A.M. is a postdoctoral researcher of the Research Foundation–Flanders (FWO-Vlaanderen), Belgium (grant ID: 12E33714N). This study was also supported by an EFIC-Grünenthal Research Grant to A.M. (E-G-G ID: 169518451). The contribution of P.A.K. was supported by a Veni Grant (grant ID: 453-04-003) provided by the Netherlands Organization for Scientific Research. The contribution of N.C. was supported by a research grant of the Research Foundation–Flanders (FWO-Vlaanderen), Belgium (grant ID: G091812N). The contribution of J.W.S.V. was supported by the Odysseus Grant “The Psychology of Pain and Disability Research Program” funded by the Research Foundation–Flanders (FWO-Vlaanderen), Belgium (grant ID: G090208N). The authors report no conflict of interest.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
