Safety behavior can hamper the extinction of fear of movement-related pain: An experimental investigation in healthy participants
Highlights
► We examined the effect of safety behavior on the extinction of fear of pain. ► We performed two differential conditioning experiments with proprioceptive stimuli. ► Safety behavior can interfere with extinction and promote a return of fear. ► The effects of safety behavior during and after extinction are different.
Section snippets
Participants
Fifty-two healthy students from the University of Leuven (31 men, age M = 22, range 18–50 years) participated in this study and provided written informed consent. The experimental protocol was approved by the Ethical Committee of the Department of Psychology of the University of Leuven.
Apparatus and stimulus material
Software. The experiment was programmed using Affect (version 4.0; Spruyt, Clarysse, Vansteenwegen, Baeyens, & Hermans, 2010). The entire experiment was run on a Windows XP computer (Dell Optiplex 755) with 2 GB
Participants
74 healthy students from the University of Leuven (44 men, age M = 20, range 15–26 years, 37 in each group) participated in this study and provided written informed consent. The experimental protocol was approved by the Ethical Committee of the Department of Psychology at the University of Leuven.
Apparatus and stimulus material
The apparatus and stimulus material used in this experiment were identical to those used in Experiment 1, including the selection of a shock intensity at a level described as “mildly painful and
General discussion
Two experimental studies using the VJMP were conducted to investigate whether safety behavior fosters protection from extinction in FMRP. The results of both Experiment 1 and Experiment 2 are generally in line with the expectations. Participants rapidly learned to distinguish which movements were painful (B+ and C+) and which one was not (A−). Consequently, more fear was elicited by the painful movements than by the non-painful or “safe” movement. Most importantly, a return of fear was observed
Acknowledgments
Steven De Peuter is a postdoctoral fellow of the Research Foundation – Flanders, Belgium (FWO). The authors would like to thank Ellen Beets and Quirin Dalemans for their assistance in the data collection and Jeroen Clarysse for his assistance in programming matters. The data of Experiment 2 have been presented as a poster at the 7th Congress of the European Federation of IASP® Chapters (EFIC) Pain in Europe VII, Hamburg, Germany, September 2011.
References (46)
- et al.
Does habituation matter? Emotional processing theory and exposure therapy for acrophobia
Behaviour Research and Therapy
(2010) - et al.
Optimizing inhibitory learning during exposure therapy
Behaviour Research and Therapy
(2008) - et al.
The effects of safety behaviors on the fear of contamination: an experimental investigation
Behaviour Research and Therapy
(2008) - et al.
Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear?
Journal of Behavior Therapy and Experimental Psychiatry
(2010) - et al.
Pain-related fear and daily functioning in patients with osteoarthritis
Pain
(2004) - et al.
Effects of safety behaviors on fear reduction during exposure
Behaviour Research and Therapy
(2010) - et al.
Exposure plus response prevention versus exposure plus safety behaviours in reducing feelings of contamination, fear, danger and disgust. An extended replication of Rachman, Shafran, Radomsky & Zysk (2011)
Journal of Behavior Therapy and Experimental Psychiatry
(2011) - et al.
Fear potentiation and fear inhibition in a human fear-potentiated startle paradigm
Biological Psychiatry
(2005) The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics
Journal of Anxiety Disorders
(2005)- et al.
Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial
Pain
(2008)
A functional analysis of danger and safety signals in anxiety disorders
Clinical Psychology Review
Protection from extinction in human fear conditioning
Behaviour Research and Therapy
Safety behaviours preserve threat beliefs: protection from extinction of human fear conditioning by an avoidance response
Behaviour Research and Therapy
Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor
Journal of Behavior Therapy and Experimental Psychiatry
The acquisition of fear of movement-related pain and associative learning: a novel pain-relevant human fear conditioning paradigm
Pain
Reduction of fear of movement-related pain and pain-related anxiety: an associative learning approach using a voluntary joystick movement paradigm
Pain
Safety behaviour does not necessarily interfere with exposure therapy
Behaviour Research and Therapy
Safety behaviour: a reconsideration
Behaviour Research and Therapy
Reducing contamination by exposure plus safety behaviour
Journal of Behavior Therapy and Experimental Psychiatry
An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia
Behaviour Research and Therapy
The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation
Behaviour Research and Therapy
Failure to replicate the deleterious effects of safety behaviors in exposure therapy
Behaviour Research and Therapy
Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety
Behaviour Research and Therapy
Cited by (45)
Reduction of costly safety behaviors after extinction with a generalization stimulus is determined by individual differences in generalization rules
2023, Behaviour Research and TherapyCitation Excerpt :Safety behaviors are usually adaptive when they prevent realistic harm; however, they become pathological when they persist in the absence of threat in addition to inflicting impairments and results in cost to the individual (i.e., costly safety behaviors). Empirical studies (Lovibond, Mitchell, Minard, Brady, & Menzies, 2009; Pittig, 2019; Rattel, Miedl, Blechert, & Wilhelm, 2017; Volders, Meulders, de Peuter, Vervliet, & Vlaeyen, 2012) showed that if US-avoidance was constantly engaged to the CS+ during extinction trials, participants would attribute the absence of a US to their US-avoidance, thus protecting them from extinction learning (i.e., protection from extinction). Therefore it is of clinical interest to reduce safety behaviors as it likely reduces protection from extinction and the inflicted impairments, thus enhancing the effectiveness of exposure-based treatments (see also Helbig-Lang & Petermann, 2010; Wells et al., 1995).
Pain and avoidance: The potential benefits of imagining your best possible self
2022, Behaviour Research and TherapyProspective intolerance of uncertainty is associated with maladaptive temporal distribution of avoidance responses: An extension of Flores, López, Vervliet, and Cobos (2018)
2020, Journal of Behavior Therapy and Experimental Psychiatry
- 1
These authors are supported by the Odysseus grant “The Psychology of Pain and Disability Research Program”, Fund for Scientific Research – Flanders (FWO – Vlaanderen).