title: Words putting pain in motion: the generalization of pain-related fear within an artificial stimulus category.
abstract: Patients with chronic pain are often fearful of movements that never featured in painful episodes. This study examined whether a neutral movement's conceptual relationship with pain-relevant stimuli could precipitate pain-related fear; a process known as symbolic generalization. As a secondary objective, we also compared experiential and verbal fear learning in the generalization of pain-related fear. We conducted an experimental study with 80 healthy participants who were recruited through an online experimental management system (M age = 23.04 years, SD = 6.80 years). First, two artificial categories were established wherein nonsense words and joystick arm movements were equivalent. Using a between-groups design, nonsense words from one category were paired with either an electrocutaneous stimulus (pain-US) or threatening information, while nonsense words from the other category were paired with no pain-US or safety information. During a final testing phase, participants were prompted to perform specific joystick arm movements that were never followed by a pain-US, although they were informed that it could occur. The results showed that movements equivalent to the pain-relevant nonsense words evoked heightened pain-related fear as measured by pain-US expectancy, fear of pain, and unpleasantness ratings. Also, experience with the pain-US evinced stronger acquisition and generalization compared to experience with threatening information. The clinical importance and theoretical implications of these findings are discussed.
authors.affiliation: Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium ; Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of Leuven Leuven, Belgium.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Bennett
authors.affiliation: Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of Leuven Leuven, Belgium ; Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Meulders
authors.affiliation: Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium ; Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of Leuven Leuven, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Baeyens
authors.affiliation: Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of Leuven Leuven, Belgium ; Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium ; Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University Maastricht, Netherlands.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
keywords: acceptance and commitment therapy; chronic pain disorders; fear-avoidance model; pain-related fear; symbolic generalization