Fear reduction in patients with chronic pain: a learning theory perspective.
Acute pain informs the individual that there is an imminent threat of body damage, and is associated with the urge to escape and avoid. Fear learning takes place when neutral stimuli receive the propensity to predict the occurrence of pain, and when defensive responses are initiated in anticipation of potential threats to the integrity of the body. Fear-avoidance models have been put forward featuring the role of individual differences in catastrophic interpretations of pain in the modulation of learning and avoidance. Based on extensive literature on fear reduction in anxiety disorders; cognitive-behavioral treatments have been developed and applied to patients with chronic pain reporting substantial pain-related fear. In this article, we discuss mechanisms underlying the acquisition, the assessment and extinction of pain-related fear through the cognitive-behavioral treatment of pain-related fear. Finally, we provide a number of critical notes and directions for future research in the field of chronic pain and pain-related fear.
University Medical Centre Maastricht, and Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. marlies.denhollander@maastrichtuniversity.nl
Marlies
M
den Hollander
Jeroen R
JR
de Jong
Stéphanie
S
Volders
Mariëlle E J B
ME
Goossens
Rob J E M
RJ
Smeets
Johan W S
JW
Vlaeyen
D001007:Anxiety / Q000523:psychology; D001362:Avoidance Learning; D002908:Chronic Disease / Q000523:psychology; D003214:Conditioning, Classical; D005108:Extinction, Psychological; D005239:Fear / Q000523:psychology*; D006801:Humans; D008960:Models, Psychological; D010146:Pain / Q000523:psychology*