title: Turning Pain Into Cues for Goal-Directed Behavior: Implementation Intentions Reduce Escape-Avoidance Behavior on a Painful Task.
abstract: Pain automatically elicits escape-avoidance behavior to avert bodily harm. In patients with chronic pain, long-term escape-avoidance behavior may increase the risk of chronic disability. The aim of the presents study was to examine whether implementation intentions reduce escape-avoidance behavior during painful tasks in healthy individuals. Implementation intentions are "if-then" self-statements associating situational cues with goal-directed behaviors. Seventy healthy participants performed a painful finger pressing task, preceded by either implementation intention instructions with pain or a nonpain cue as a cue for goal-directed behavior, or control instructions. Escape-avoidance behavior was operationalized as task duration and response rate. Inhibitory control was measured using the Stop Signal Task. The pain implementation intentions resulted in the longest task duration (P = .02), and thus less escape-avoidance behavior. Low inhibitory control was associated with shorter task duration (P = .03), and thus more escape-avoidance behavior. The nonpain implementation intentions resulted in the highest response rate, but only when inhibitory control was low (P = .04). Implementation intentions referring to pain or nonpain reduce escape-avoidance behavior on a painful task. It is worthwhile to examine whether individuals in pain and with low inhibitory control benefit from interventions that incorporate implementation intentions.
  
  
  CONCLUSIONS
  To our knowledge, this study is the first to show that forming implementation intentions reduces escape-avoidance behavior during pain and fosters nonpain goal pursuit. The use of implementation intentions is indicated to be an intervention that could be of use in patients with pain, particularly when inhibitory control is low.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands. Electronic address: P.A.Karsdorp@uu.nl.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Karsdorp
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Floor M
authors.initials: FM
authors.lastname: Kroese
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, University of Leuven, Leuven, Belgium.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001362:Avoidance Learning / Q000502:physiology*; D003463:Cues; D005260:Female; D006040:Goals; D064368:Healthy Volunteers; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Experimental pain; escape-avoidance behavior; goal pursuit; implementation intentions; inhibitory control