No abstract

No abstract

Differences in fear conditioning between individuals suffering from chronic pain and healthy controls may indicate a learning bias that contributes to the acquisition and persistence of chronic pain. However, evidence from lab-controlled conditioning studies is sparse and previous experiments have produced inconsistent findings. Twenty-five participants suffering from chronic back pain and twenty-five controls not reporting chronic pain took part in a differential fear conditioning experiment measuring attention (eye tracking) and autonomic arousal (pupil dilation and skin conductance) elicited by visual cues predicting the presence or absence of electric shock. In contrast to the healthy control group, participants with chronic pain did not acquire differential autonomic responding to cues of threat and safety and specifically failed to acquire any attentional preference for the safety cue over irrelevant contextual cues (while such preference was intact for the threat cue). We present simulations of a reinforcement learning model to show how the pattern of data can be explained by assuming that participants with chronic pain might have experienced less positive emotion (relief) when the electric shock was absent following safety cues. Our model shows how this assumption can explain both, reduced differential responding to cues of threat and safety as well as less selective attention to the safety cue.

Background: We examined whether the difficulties of patients with somatoform disorders (SFDs) in integrating medical reassurance can be altered by preventing patients from devaluing reassuring information through defensive cognitive strategies. Method: Patients with SFD (n = 60), patients with major depression (n = 32), and healthy volunteers (n = 37) watched a videotaped doctor's report, which provided medical reassurance for gastroenterological complaints. Subsequently, participants were asked about their perception of the report. In the SFD sample, patients' appraisal of the reassuring was experimentally modulated: In one condition, doubts about the validity of the doctor's diagnostic assessment were triggered; in another condition, the devaluation of medical reassurance was blocked through underscoring the validity of the doctor's diagnostic assessment; and a control condition received no manipulation. Results: As evident on all outcome variables, patients with SFD had more difficulty integrating medical reassurance than depressed and healthy people. Within the SFD sample, participants from the experimental condition blocking the devaluation of medical reassurance rated the likelihood of an undetected serious disease to be significantly lower than the other two conditions. They also reported less emotional concern and a lower desire to seek the opinion of another doctor. Conclusions: By comparing patients with SFD to both a healthy and a clinical control group, the current study suggests that the difficulty in processing reassuring medical information is a specific psychopathological feature of SFD. Furthermore, our results suggest that the integration of medical reassurance can be improved by preventing patients from devaluing reassuring information through dismissive cognitive strategies.

Background Increasing the access to and improving the impact of pain treatments is of utmost importance, especially among youths with chronic pain. The engagement of patients as research partners (in contrast to research participants) provides valuable expertise to collaboratively improve treatment delivery. Objective This study looked at a multidisciplinary exposure treatment for youths with chronic pain through the lens of patients and caregivers with the aim to explore and validate treatment change processes, prioritize and develop ideas for improvement, and identify particularly helpful treatment elements. Methods Qualitative exit interviews were conducted with patients and caregivers at their discharge from 2 clinical trials (ClinicalTrials.gov NCT01974791 and NCT03699007). Six independent co-design meetings were held with patients and caregivers as research partners to establish a consensus within and between groups. The results were validated in a wrap-up meeting. Results Patients and caregivers described that exposure treatment helped them better process pain-related emotions, feel empowered, and improve their relationship with each other. The research partners developed and agreed upon 12 ideas for improvement. Major recommendations include that pain exposure treatment should be disseminated more not only among patients and caregivers but also among primary care providers and the general public to facilitate an early referral for treatment. Exposure treatment should allow flexibility in terms of duration, frequency, and delivery mode. The research partners prioritized 13 helpful treatment elements. Most of the research partners agreed that future exposure treatments should continue to empower patients to choose meaningful exposure activities, break long-term goals into smaller steps, and discuss realistic expectations at discharge. Conclusions The results of this study have the potential to contribute to the refinement of pain treatments more broadly. At their core, they suggest that pain treatments should be disseminated more, flexible, and transparent.

In an experimental study, we tested the hypothesis that patients with persistent physical symptoms (PPS) fail to integrate medical reassurance because they engage in a post-hoc devaluation of it, referred to as cognitive immunization. Sixty people with PPS watched a videotaped doctor’s report, which provided medical reassurance for gastroenterological complaints. After the doctor’s report, cognitive immunization was modulated: the cognitive immunization-enhancing condition received a manipulation suggesting that serious diseases can sometimes be overlooked, whereas the cognitive immunization-inhibiting condition received a manipulation underscoring the validity of doctors’ diagnostic assessments. A control condition received no manipulation. In addition, a clinical (i.e., people with major depression; N=32) and a healthy control group (N=37) were included. As evident on all outcome variables, patients with PPS had more difficulty integrating medical reassurance than the clinical and the healthy control group. Within the PPS sample, participants from the cognitive immunization-inhibiting condition rated the likelihood of an undetected serious disease significantly lower than participants from the cognitive immunization-enhancing condition and the control condition. They also reported less emotional concern and a lower desire to seek the opinion of another doctor. Replicating previous research, the results show that people with PPS have difficulty using medical reassurance to revise beliefs about being seriously ill. The present findings are the first to demonstrate that cognitive immunization might be a specific psychological mechanism that underlies these difficulties. The promising results of the inhibition of cognitive immunization suggest a new approach to improve the effects of medical reassurance in clinical practice.

Background: Expectations of painful sensations constitute a core feature of chronic pain. An important clinical question is whether such expectations are revised when disconfirming experiences are made (e.g., less pain than expected). The present study examined how people adjust their pain expectations when the experience of decreasing pain is expected vs. unexpected. Methods: In a novel experimental paradigm, people who frequently experience pain (N=73) were provided with painful thermal stimulations. Unbeknownst to participants, the temperature applied was decreased from trial to trial. Based on the experimental instructions provided, this experience of decreasing pain was expected in one condition (expectation-confirmation), whereas it was unexpected in another (expectation-disconfirmation). Results: Expectation violations were higher in the expectation-disconfirmation condition than in the expectation-confirmation condition, F(1, 69) = 6.339, p = .014, ηp² = .084. Participants from the expectation-confirmation condition showed a greater adjustment of their pain expectations than the expectation-disconfirmation condition, F(1.666, 114.929) = 7.486, p = .002, ηp² = .098. Across groups, expectation adjustment was related to increases in pain tolerance (r = .342, p = .004) and the ability to cope with pain (r = .234, p = .045) at a one-week follow-up. Conclusions: Participants were more likely to adjust their pain expectations when the experience of decreasing pain was expected. Though participants who experienced large discrepancies between expected and experienced pain were hesitant to adjust their pain expectations immediately, experiencing expectation violations increased their ability to cope with pain one week later, suggesting some beneficial longer-term effects of expectation violations.

Menschen mit chronischen Schmerzen haben oft Angst vor bestimmten Bewegungen. Sie vermeiden entsprechende Aktivitäten, bauen körperlich ab und leiden schlimmstenfalls unter noch stärkeren Schmerzen und Depressionen. Die Expositionstherapie sowie das Graded-Activity-Konzept helfen, den Teufelskreis des Angst-Vermeidungs-Modells zu durchbrechen.