I can avoid pain, therefore I must be scared

Christine van Vliet, Ann Meulders, Linda Vancleef & Johan Vlaeyen
Health Psychology, KU Leuven
Clinical Psychological Science, Maastricht University
According to recent fear-avoidance models1, catastrophic misinterpretations of pain may lead to pain-related fear, which in
turn can spur avoidance behaviour, meant to avert the perceived danger. Here, we show to what extent avoidance behaviour
2 3
induces changes in threat beliefs , fear of pain , pain experience. Participants were exposed to a painful heat stimulus and
were divided into two groups, an Avoidance group (AG) and a Control group (CG). Participants in the AG, but not CG, were
instructed they could avoid the full heat intensity at a certain point. In reality, the maximum heat intensity was the same in the
previous phase for both groups. In the test phase avoidance behaviour was omitted.

Hypotheses Results
1. An increase in fear of pain at test phase compared to full = Avoidance Group = probes during stimulation
intensity phase for AG, but not CG = Control Group = probes during ITI
2. An increase in threat beliefs at the end of the experiment * p < .05 **p < .01
for the AG, but not CG Fear of pain
verbal ratings mean startle amplitude (T-scores)
3. More anticipated and experienced pain (intensity and 50 **
54
**
unpleasantness) at test than during full intensity phase for 40
52
AG, but not for CG
30
50
Materials and methods
20
48
Participants Setup Stimuli
10
• n = 64 • phasic heat stimulus 46

• 26.11 ± 9.78 years • visual feedback 0

44

• pain-free Full Intensity Intervention Test

screen • probe
• thermode Threat beliefs
Measures 30
**
• anticipated fear of pain
• anticipated and experienced threat NRS (0-100)
20
• anticipated and experienced pain experience
• eye blink startle responses (during stimulation and ITI) 10

Design and procedure

0
Start of experiment End of experiment

Pain intensity
Anticipated Experienced
70 70
Experience
65 65

60 60

Full 55 * 55

intensity 50 50

Full Intensity Intervention Test Full Intensity Intervention Test

AG Pain unpleasantness
Anticipated Experienced
Intervention
70 70
EG
65 65

60 60

55 55

Test
50 50

Full Intensity Intervention Test Full Intensity Intervention Test

Conclusions / Discussion References

1) We found support for the hypothesis that avoidance behaviour increases fear of 1. Vlaeyen, J.W.S, & Linton, S.J. (2012). Fear-avoidance model
of chronic musculoskeletal pain: 12 years on. PAIN, 153, 1144-
pain at test phase for the AG. 1147.
2) We did not find an increase of threat beliefs of the heat stimuli for AG, but the 2. Lovibond P.F., Mitchell, C.J, Minard, E., Brady, A., &
Menzies, R.G. (2009). Safety behaviours preserve threat
data showed a decrease of threat beliefs for CG. beliefs: Protection from extinction of human fear conditioning
3) The present results confirm the third hypothesis partially: increased anticipated by an avoidance response. Behaviour Research and Therapy,
47, 716-720.
unpleasantness at test compared to full intensity phase for AG, but not CG. 3. Gangemi, A., Mancini, F., & van den Hout, M. (2012).
An interesting finding is that despite identical stimulus temperatures in the Behaviour as information: if I avoid, then there must be a
danger. J. of Behav Ther and Exp Psychiatry, 43(4), 1302-1308.
intervention phase, participants in the AG reported lower experienced pain intensity.
Contact: christine.vanvliet@kuleuven.be