Claes Nathalie, Crombez Geert, Vlaeyen Johan W S
Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
Pain. 2015 Aug;156(8):1449-1457. doi: 10.1097/j.pain.0000000000000116.
According to fear-avoidance models, a catastrophic interpretation of a painful experience may give rise to pain-related fear and avoidance, leading to the development and maintenance of chronic pain problems in the long term. However, little is known about how exactly motivation and goal prioritization play a role in the development of pain-related fear. This study investigates these processes in healthy volunteers using an experimental context with multiple, competing goals. In a differential human fear-conditioning paradigm, 57 participants performed joystick movements. In the control condition, one movement (conditioned stimulus; CS) was followed by a painful electrocutaneous unconditioned stimulus (pain-US) in 50% of the trials, whereas another movement (nonreinforced conditioned stimulus; CS) was not. In the experimental condition, a reward in the form of lottery tickets (reward-US) accompanied the presentation of the pain-US. Participants were classified into 3 groups, as a function of the goal, they reported to be the most important: (1) pain-avoidance, (2) reward-seeking, and (3) both goals being equally important. Results indicated that neither the reward co-occurring with pain nor the prioritized goal modulated pain-related fear. However, during subsequent choice trials, participants selected the painful movement more often when the reward was presented compared with the context in which the reward was absent. The latter effect was dependent on goal prioritization, with more frequent selections in the reward-seeking group, and the least selections in the pain-avoidance group. Taken together, these results underscore the importance of competing goals and goal prioritization in the attenuation of avoidance behavior.
根据恐惧-回避模型，对痛苦经历的灾难性解读可能会引发与疼痛相关的恐惧和回避行为，长期导致慢性疼痛问题的发展和持续。然而，关于动机和目标优先级如何在与疼痛相关的恐惧发展中发挥作用，我们知之甚少。本研究在健康志愿者中使用具有多个相互竞争目标的实验情境来探究这些过程。在一种差异人类恐惧条件范式中，57名参与者进行操纵杆运动。在控制条件下，在50%的试验中，一种运动（条件刺激；CS）之后会出现疼痛性皮肤电刺激非条件刺激（疼痛-US），而另一种运动（非强化条件刺激；CS）则不会。在实验条件下，彩票形式的奖励（奖励-US）伴随着疼痛-US的呈现。参与者根据他们报告的最重要目标被分为3组：（1）疼痛回避，（2）奖励寻求，（3）两个目标同等重要。结果表明，与疼痛同时出现的奖励和优先级目标均未调节与疼痛相关的恐惧。然而，在随后的选择试验中，与奖励不存在的情境相比，当呈现奖励时，参与者更频繁地选择疼痛性运动。后一种效应取决于目标优先级，在奖励寻求组中选择更频繁，而在疼痛回避组中选择最少。综上所述，这些结果强调了相互竞争的目标和目标优先级在减弱回避行为中的重要性。
