Meulders Ann, Traxler Juliane, Vandael Kristof, Scheepers Silke
Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium.
Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium; Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Pain. 2024 Mar;25(3):702-714. doi: 10.1016/j.jpain.2023.09.023. Epub 2023 Oct 11.
Pain-related avoidance is adaptive when there is a bodily threat, but when it generalizes to safe movements/situations, it may become disabling. Both subclinical anxiety-a vulnerability marker for chronic pain-and chronic pain are associated with excessive fear generalization to safe stimuli/situations. Previous research focused mainly on passive fear correlates (psychophysiological arousal and self-reports) leaving avoidance behavior poorly understood. Therefore, we tested whether high-anxious individuals generalize their pain-related avoidance behavior more to novel, safe contexts than low-anxious people. In a robotic-arm-reaching task, both groups (low vs high trait anxiety) performed 1 of 3 movements to reach a target. In the threat context (black background), a painful stimulus could be partly/completely prevented by performing more effortful trajectories (longer and more force needed); in the safe context (white background), no pain occurred. Generalization of avoidance was tested in 2 novel contexts (light/dark gray backgrounds). We assessed pain expectancy, pain-related fear, startle eyeblink responses for all trajectories, and avoidance behavior (ie, maximal deviation from shortest trajectory). Results indicated that differential fear and expectancy selectively generalized to the novel context resembling the original threat context in both groups. Interestingly and in contrast with the verbal reports, high-anxious participants avoided more in the novel context resembling the original safe context, but not in the 1 resembling the threat context. No generalization emerged in the startle data. Because excessive pain-related avoidance specifically may cause withdrawal from daily life activities, these findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability. PERSPECTIVE: This paper shows that high-anxious people do not overgeneralize pain-related fear and pain expectancy learned in a threat context more to novel, safe contexts than low-anxious individuals, but that they do avoid more in those contexts. These findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability.
当存在身体威胁时,与疼痛相关的回避行为具有适应性,但当这种回避行为扩展到安全的动作/情境时,它可能会导致功能障碍。亚临床焦虑(慢性疼痛的一个易感性标志物)和慢性疼痛都与对安全刺激/情境的过度恐惧泛化有关。以往的研究主要集中在被动的恐惧相关因素(心理生理唤醒和自我报告)上,对回避行为的了解甚少。因此,我们测试了高焦虑个体是否比低焦虑个体更倾向于将与疼痛相关的回避行为泛化到新的、安全的情境中。在一项机器人手臂伸展任务中,两组(低特质焦虑组与高特质焦虑组)分别执行三种动作中的一种以触及目标。在威胁情境(黑色背景)中,通过执行更费力的轨迹(需要更长的时间和更大的力量)可以部分/完全避免疼痛刺激;在安全情境(白色背景)中,不会出现疼痛。在两种新的情境(浅灰色/深灰色背景)中测试回避行为的泛化情况。我们评估了所有轨迹的疼痛预期、与疼痛相关的恐惧、惊跳眨眼反应以及回避行为(即与最短轨迹的最大偏差)。结果表明,两组中不同的恐惧和预期选择性地泛化到了与原始威胁情境相似的新情境中。有趣的是,与口头报告相反,高焦虑参与者在与原始安全情境相似的新情境中回避行为更多,但在与威胁情境相似的新情境中并非如此。在惊跳数据中未出现泛化现象。由于过度的与疼痛相关的回避行为可能特别导致个体退出日常生活活动,这些发现表明高焦虑个体可能易患慢性疼痛功能障碍。观点:本文表明,与低焦虑个体相比,高焦虑个体不会将在威胁情境中习得的与疼痛相关的恐惧和疼痛预期更多地过度泛化到新的、安全的情境中,但他们在这些情境中的回避行为更多。这些发现表明高焦虑个体可能易患慢性疼痛功能障碍。