15,342 research outputs found
sj-xlsx-1-pss-10.1177_09567976231170878 – Supplemental material for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge
No full textSupplemental material, sj-xlsx-1-pss-10.1177_09567976231170878 for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge by Eveliina Glogan, Peixin Liu and Ann Meulders in Psychological Science</p
sj-pdf-4-pss-10.1177_09567976231170878 – Supplemental material for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge
No full textSupplemental material, sj-pdf-4-pss-10.1177_09567976231170878 for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge by Eveliina Glogan, Peixin Liu and Ann Meulders in Psychological Science</p
Once an avoider always an avoider? Return of pain-related avoidance after extinction with response prevention
No full textIn exposure for chronic pain, avoidance is often forbidden (extinction with response prevention; RPE) to prevent misattributions of safety. Although exposure is an effective treatment, relapse is common. Little is known about the underlying mechanisms of return of pain-related avoidance. We hypothesized that pain-related avoidance would recover when becoming available again after RPE and after unexpected pain episodes ("reinstatement"), especially when restricting avoidance during RPE (compared to instructing not to use it). In an operant pain-related avoidance conditioning paradigm, healthy volunteers used a robotic arm to perform various arm reaching movements differing in pain-effort trade-off. During acquisition, participants learned to avoid pain by performing more effortful movements. During RPE they only performed the formerly pain-associated movement under extinction, and were either forbidden (Restricted group) or merely instructed (Instructed group) not to perform other movements. One day later, we tested spontaneous recovery and reinstatement of pain-related fear and avoidance with availability of all movements. Results showed that pain-related fear and avoidance re-emerge after RPE, though not to pretreatment levels. The reinstatement manipulation had no additional effect. No group differences were observed. We discuss findings in the context of learning processes in (chronic) pain disability and relapse prevention in chronic pain treatment. Perspective: Using experimental models of relapse, we investigated the return of pain-related avoidance behavior after extinction with response prevention. Findings are potentially informative for clinicians performing exposure treatment with chronic pain patients.sponsorship: This research was supported by a Vidi grant from the Netherlands Organization for Scientific Research (NWO), The Netherlands (Grant ID 452-17-002) granted to Ann Meulders. Ann Meulders is also a postdoctoral researcher of the Research Foundation Flanders (FWO-Vlaanderen), Belgium (Grant ID: 12E3717N). The authors have no conflict of interests to report. (Netherlands Organization for Scientific Research (NWO), The Netherlands|452-17-002, Research Foundation Flanders (FWO-Vlaanderen), Belgium|12E3717N)status: Publishe
sj-docx-2-pss-10.1177_09567976231170878 – Supplemental material for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge
No full textSupplemental material, sj-docx-2-pss-10.1177_09567976231170878 for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge by Eveliina Glogan, Peixin Liu and Ann Meulders in Psychological Science</p
sj-pdf-3-pss-10.1177_09567976231170878 – Supplemental material for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge
No full textSupplemental material, sj-pdf-3-pss-10.1177_09567976231170878 for Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge by Eveliina Glogan, Peixin Liu and Ann Meulders in Psychological Science</p
Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain
No full textBACKGROUND: Generic self-report measures do not reflect the complexity of a person's pain-related behavior. Since variations in a person's fear of movement and avoidance behavior may arise from contextual and motivational factors, a person-centered evaluation is required-addressing the cognitions, emotions, motivation, and actual behavior of the person. CLINICAL QUESTION: Most musculoskeletal rehabilitation clinicians will recognize that different people with chronic pain have very different patterns of fear and avoidance behavior. However, an important remaining question for clinicians is "How can I identify and reconcile discrepancies in fear of movement and avoidance behavior observed in the same person, and adapt my management accordingly?" KEY RESULTS: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centered evaluation (ie, patient interview, self-report measures, and behavioral assessment) when working with patients to manage fear of movement and avoidance behavior. CLINICAL APPLICATION: Understanding the discrepancies in a person's fear of movement and avoidance behavior is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviors. J Orthop Sports Phys Ther 2023;53(5):1-10. Epub: 9 March 2023. doi:10.2519/jospt.2023.11420.status: Publishe
Generalization of instrumentally acquired pain-related avoidance to novel but similar movements using a robotic arm-reaching paradigm
Full text linkAvoidance is considered a key contributor to the development and maintenance of chronic pain disability, likely through its excessive generalization. This study investigated whether acquired avoidance behavior generalizes to novel but similar movements. Using a robotic arm, participants moved their arm from a starting to a target location via one of three possible movement trajectories. For the Experimental Group, the shortest, easiest trajectory was always paired with pain (T1 = 100% reinforcement/no resistance and deviation). Pain could be partly or completely avoided by choosing increasingly effortful movements (T2 = 50% reinforcement, moderate resistance/deviation; T3 = 0% reinforcement, strongest resistance/largest deviation). A Yoked Group received the same number of painful stimuli irrespective of their own behavior. Outcomes were self-reported fear of movement-related pain, pain-expectancy, avoidance behavior, (maximal deviation from the shortest trajectory), and trajectory choice behavior. We tested generalization to three novel trajectories (G1-3) positioned between the acquisition trajectories. Whereas acquired fear of movement-related pain and pain-expectancy generalized in the Experimental Group, avoidance behavior did not, suggesting that threat beliefs and high-cost avoidance may not be directly related. The lack of avoidance generalization may be due to a perceived context-switch in the configurations of the acquisition and the generalization phases.sponsorship: This research is supported by a Vidi grant from the Netherlands Organization for Scientific Research (NWO), The Netherlands (grant ID 452-17-002) granted to Ann Meulders. Ann Meulders is also a post-doctoral researcher of the Research Foundation Flanders (FWO-Vlaanderen), Belgium (grant ID: 12E3717N). The authors report no conflict of interest. (Vidi grant from the Netherlands Organization for Scientific Research (NWO), The Netherlands|452-17-002, Research Foundation Flanders (FWO-Vlaanderen), Belgium|12E3717N)status: Published onlin
Alike, But Not Quite: Comparing the Generalization of Pain-Related Fear and Pain-Related Avoidance
No full textPain-related fear and −avoidance crucially contribute to pain chronification. People with chronic pain may adopt costly avoidance strategies above and beyond what is necessary, aligning with experimental findings of excessive fear generalization to safe movements in these populations. Furthermore, recent evidence suggests that, when avoidance is costly, it can dissociate from fear. Here, we investigated whether concurrently measured pain-related fear and costly avoidance generalization correspond in one task. We also explored whether healthy participants avoid excessively despite associated costs, and if avoidance would decrease as a function of dissimilarity from a painassociated movement. In a robotic arm-reaching task, participants could avoid a low-cost, pain-associated movement trajectory (T+), by choosing a high-cost non-painful movement trajectory (T-), at opposite ends of a movement plane. Subsequently, in the absence of pain, we introduced three movement trajectories (G1-3) between T+ and T-, and one movement trajectory on the side of Topposite to T+ (G4), linearly increasing in costs from T+ to G4. Avoidance was operationalized as maximal deviation from T+, and as trajectory choice. Fear learning was measured using self-reported painexpectancy, pain-related fear, and startle eye-blink electromyography. Self-reports generalized, both decreasing with increasing distance from T+. In contrast, all generalization trajectories were chosen equally, suggesting that avoidance-costs and previous pain balanced each other out. No effects emerged in the electromyography. These results add to a growing body of literature showing that (pain-related) avoidance, especially when costly, can dissociate from fear, calling for a better understanding of the factors motivating, and mitigating, disabling avoidance.
Perspective: This article presents a comparison of pain-related fear- and avoidance generalization, and an exploration of excessive avoidance in healthy participants. Our findings show that painrelated avoidance can dissociate from fear, especially when avoidance is costly, calling for a better understanding of the factors motivating and mitigating disabling avoidance
Short fiction set in Maine by author Ann Hood.
No full textShort fiction set in Maine by author Ann Hood
PLAY - Differences in fear learning across different age groups amongst individuals with chronic pain and pain free peers
No full textWhen pain persists in the absence of injury or beyond the normal healing time (typically >3 months) it no longer serves a protective role and can lead to disability and reduced quality of life. Previous research has demonstrated that altered learning processes play a crucial role in the development, maintenance, and reduction of chronic pain (Meulders et a., 2020; Gatzounis et al., 2021). Specifically, impaired safety learning (Schlitt et al., 2021: Zaman et al., 2015) excessive fear generalization (Meulders et al., 2014; Meulders et al., 2015) and resistance to extinction learning (Meulders et al., 2015) are typically observed in comparisons of adults with chronic pain compared to pain-free peers. Furthermore, these processes can result in individual engaging in maladaptive behaviors that maintain disability (Meulders et al., 2019; Breivik et al., 2006). While this research has informed contemporary models of pain-related disability and its treatment, investigation in adolescents (12-24 years) is limited, despite an equally high prevalence of chronic pain in this group. Research into learning processes in this population has largely been in the field of anxiety, and has demonstrated less differential learning, greater generalization, and reduced extinction when compared to adults. Therefore, we propose a comprehensive study of pain-related fear acquisition, generalization and extinction across adolescents and adults in both chronic pain and pain-free participants, with the aim of ascertaining the degree of generalizability of findings from adults to adolescents
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