The 'match/mismatch' model of fear: empirical status and clinical implications

The match-mismatch model and panic patients' accuracy in predicting naturally occurring panic attacks

The match-mismatch model of panic states that panic disorder patients tend to overestimate the probability of panic prior to engaging in a fear-provoking situation. Furthermore, patients are expected to become more accurate in predicting panic over subsequent occasions of exposure. We tested the model with naturally occurring panic attacks. Patients rated the probability of a panic attack in the morning, and these ratings were compared to the actual occurrence of panic that day. Ratings were collected daily in a baseline period before treatment, during treatment, and again for 2 weeks after treatment. The results confirmed that panic disorder patients tend to overpredict the likelihood of panic. However, patients did not become more accurate in their predictions over time. In fact, overprediction bias increased because expectancy of panic remained stable, in spite of the decline of the frequency of panic from pre- to post-test. Thus, over a short course of therapy panic patients tend to persist in overestimating the chance that panic may occur. At baseline, expectancy of panic and the tendency to overpredict were not associated with other aspects of the symptomatology. Neither expectancy nor overprediction bias was predictive of treatment outcome. Finally, improvement in treatment was not associated with a decreased expectancy of panic.

Physical health correlates of overprediction of physical discomfort during exercise

This study sought to determine if overprediction of physical discomfort prior to and following exercise was related to a number of self-report and objective measures of physical health status in a general population sample. Cross-sectional findings indicated a significant and specific relation between patterns of discomfort overprediction (vs under- or accurate prediction) and negative self-reported health status and attitudes to exercise, lower levels of physical activity, as well as poorer scores for resting heart rate, cardiorespiratory fitness and body mass index (but not waist:hip ratio). Females were more likely to overpredict discomfort, were less active and had poorer physical health than males. The potential usefulness of the prediction match-mismatch paradigm for studying exercise-related appraisal processes as proximal determinants of physical activity are discussed. Information obtained from such studies could prove useful in public health education campaigns aimed at increasing levels of physical activity in the general population, particularly among the less active.

Expectancy variables predicting tolerance and avoidance of pain in chronic pain patients

Previous research on anxiety and some recent reports on chronic pain suggest that the response to aversive stimuli may be influenced by expectations rather than actual experience. This study examined the contributions of four expectancy-related variables to the tolerance and avoidance of pain: pain expectancy, response expectancy, self-efficacy expectancy, and danger expectancy. Chronic pain sufferers volunteered to undergo cold pressor pain on two trials (the first for practice, and the second to determine tolerance) and then faced the prospect of a third trial (to determine avoidance). It was found that expected tolerance (or response expectancy) significantly predicted actual tolerance, whereas expected danger significantly predicted avoidance. These findings are in partial agreement with previous research. Among the clinical implications are that chronic pain sufferers generally associate pain with damage and they predict their pain tolerance well; they do not necessarily escape from a compulsory activity that produces pain, but given the chance they would rather avoid it in the first place.

Underprediction of pain in children undergoing ear piercing

Ear piercing is a brief, standard, painful stimulus which is submitted to voluntarily, offering a unique opportunity for research on children's anticipation of pain in a naturalistic context. Self-ratings on visual analogue scales of fear, predicted pain, and experienced pain were collected, as each ear was pierced in turn, from 32 girls aged 5-11 yr. Of these, 69% underpredicted their pain on the first ear. These underpredictors of pain on the first ear expected and reported significantly greater pain when the second ear was pierced than did overpredictors or children who accurately predicted the pain for the first ear. Fear scores taken before the first ear was pierced did not significantly predict pain for the second ear. Younger children made less accurate predictions and were more likely to use the extremes of the scale. The results, which are consistent with those of previous studies of prediction of pain and anxiety, have implications for preparation of children for brief procedural pain: they support recommendations to encourage children to expect realistic rather than minimal amounts of pain.