Volders Stéphanie, Meulders Ann, De Peuter Steven, Vlaeyen Johan W S
*Department of Psychology, Research Group on Health Psychology †Department of Psychology, Center for Excellence on Generalization Research, University of Leuven, Leuven, Belgium ‡Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
Clin J Pain. 2015 Nov;31(11):933-45. doi: 10.1097/AJP.0000000000000187.
Previous research indicates that reducing fear of movement-related pain is hampered by engaging in safety-seeking behavior. We tested the hypothesis that fear reduction is only disrupted by behavior that serves a pain-avoidance goal (safety-seeking), but not when it is serving an achievement goal.
Using the voluntary joystick movement paradigm, fear of a painful joystick arm movement was successfully acquired by repeatedly pairing this joystick movement with a painful electrocutaneous stimulus (unconditioned stimulus [pain-US]) and this fear was subsequently extinguished using a Pavlovian extinction procedure. During extinction, a Safety group and Reward group both pressed a safety button, whereas a third Control group did not.
Pain-US expectancy and fear of movement-related pain ratings show a gradual fear reduction in the Control Group, but a return of fear when the button is pressed to avoid the pain-US (Safety group). When the same button is used to attain a reward (Reward group), subsequent return of fear is attenuated. In addition, we investigated the reliability of the return of fear in the Safety group and Reward group, using a customized Reliable Change Index. This index confirms that the return of fear was only reliable in the Safety group, and that this return of fear is associated with more perceived control over the nonoccurrence of the pain-US when pressing the button.
These results highlight the importance of motivational context in understanding the role of safety-seeking behavior in exposure-based therapies.
先前的研究表明，从事寻求安全行为会阻碍与运动相关疼痛恐惧的减轻。我们检验了这样一个假设，即恐惧减轻仅会被服务于疼痛回避目标（寻求安全）的行为所干扰，而在服务于成就目标时则不会。
使用自愿式操纵杆运动范式，通过将这种操纵杆运动与疼痛的皮肤电刺激（无条件刺激[疼痛-US]）反复配对，成功引发了对操纵杆手臂疼痛运动的恐惧，随后使用巴甫洛夫消退程序消除了这种恐惧。在消退过程中，一个安全组和奖励组都按下了安全按钮，而第三个对照组则没有。
疼痛-US预期和与运动相关疼痛的恐惧评分显示，对照组的恐惧逐渐减轻，但在按下按钮以避免疼痛-US时（安全组）恐惧又会复发。当使用相同按钮来获得奖励时（奖励组），随后恐惧的复发会减弱。此外，我们使用定制的可靠变化指数研究了安全组和奖励组中恐惧复发的可靠性。该指数证实，恐惧复发仅在安全组中可靠，并且这种恐惧复发与按下按钮时对疼痛-US不发生的更多感知控制相关。
这些结果凸显了动机背景在理解寻求安全行为在基于暴露的疗法中的作用方面的重要性。
