title: Comparing Counterconditioning and Extinction as Methods to Reduce Fear of Movement-Related Pain.
abstract: Cognitive-behavioral treatments for chronic pain typically target pain-related fear; exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a voluntary joystick movement paradigm. Participants were randomly allocated to the counterconditioning or extinction group. During fear acquisition, moving the joystick in 2 directions (conditioned stimulus [CS+]) was followed by a painful electrocutaneous stimulus (pain-unconditioned stimulus [US]), whereas moving the joystick in 2 other directions was not (CS-). During fear reduction, 1 CS+ was extinguished, but another CS+ was still followed by pain in the extinction group; in the counterconditioning group, 1 CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). The results indicate that counterconditioning effectively reduces pain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement attenuated neither fear nor the intensity/unpleasantness of the pain. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse.
  
  
  CONCLUSIONS
  This article reports no immediate differences between counterconditioning and extinction in reducing pain-related fear in the laboratory. Unexpectedly, both methods also altered stimulus valence. However, we cautiously suggest that methods explicitly focusing on altering the affective valence of feared movements may improve the long-term effectiveness of fear reduction and prevent relapse.
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Center for Excellence on Generalization in Health and Psychopathology, University of Leuven, Leuven, Belgium. Electronic address: ann.meulders@ppw.kuleuven.be.
authors.forename: Ann
authors.initials: A
authors.lastname: Meulders
authors.affiliation: Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Karsdorp
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Department of Experimental, Clinical and Health Psychology, Ghent University, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Claes
authors.affiliation: Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Center for Excellence on Generalization in Health and Psychopathology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
authors.forename: Johan W S
authors.initials: JWS
authors.lastname: Vlaeyen
mesh_terms: D000293:Adolescent; D000328:Adult; D001362:Avoidance Learning; D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy*; D003214:Conditioning, Classical; D005108:Extinction, Psychological; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D009068:Movement; D012008:Recurrence; D012201:Reward; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Fear of movement-related pain; chronic pain; counterconditioning; extinction; fear learning; fear-avoidance