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Dewitte M, Meulders A. Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model. JOURNAL OF SEX RESEARCH 2023; 60:768-785. [PMID: 36648251 DOI: 10.1080/00224499.2022.2164242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
| | - Ann Meulders
- Department of Clinical Psychological Science, Maastricht University
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Garbusow M, Ebrahimi C, Riemerschmid C, Daldrup L, Rothkirch M, Chen K, Chen H, Belanger MJ, Hentschel A, Smolka MN, Heinz A, Pilhatsch M, Rapp MA. Pavlovian-to-Instrumental Transfer across Mental Disorders: A Review. Neuropsychobiology 2022; 81:418-437. [PMID: 35843212 DOI: 10.1159/000525579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
A mechanism known as Pavlovian-to-instrumental transfer (PIT) describes a phenomenon by which the values of environmental cues acquired through Pavlovian conditioning can motivate instrumental behavior. PIT may be one basic mechanism of action control that can characterize mental disorders on a dimensional level beyond current classification systems. Therefore, we review human PIT studies investigating subclinical and clinical mental syndromes. The literature prevails an inhomogeneous picture concerning PIT. While enhanced PIT effects seem to be present in non-substance-related disorders, overweight people, and most studies with AUD patients, no altered PIT effects were reported in tobacco use disorder and obesity. Regarding AUD and relapsing alcohol-dependent patients, there is mixed evidence of enhanced or no PIT effects. Additionally, there is evidence for aberrant corticostriatal activation and genetic risk, e.g., in association with high-risk alcohol consumption and relapse after alcohol detoxification. In patients with anorexia nervosa, stronger PIT effects elicited by low caloric stimuli were associated with increased disease severity. In patients with depression, enhanced aversive PIT effects and a loss of action-specificity associated with poorer treatment outcomes were reported. Schizophrenic patients showed disrupted specific but intact general PIT effects. Patients with chronic back pain showed reduced PIT effects. We provide possible reasons to understand heterogeneity in PIT effects within and across mental disorders. Further, we strengthen the importance of reliable experimental tasks and provide test-retest data of a PIT task showing moderate to good reliability. Finally, we point toward stress as a possible underlying factor that may explain stronger PIT effects in mental disorders, as there is some evidence that stress per se interacts with the impact of environmental cues on behavior by selectively increasing cue-triggered wanting. To conclude, we discuss the results of the literature review in the light of Research Domain Criteria, suggesting future studies that comprehensively assess PIT across psychopathological dimensions.
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Affiliation(s)
- Maria Garbusow
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Carlotta Riemerschmid
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Luisa Daldrup
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Marcus Rothkirch
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ke Chen
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Hao Chen
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Matthew J Belanger
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Angela Hentschel
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Maximilan Pilhatsch
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Elblandklinikum, Radebeul, Germany
| | - Michael A Rapp
- Area of Excellence Cognitive Sciences, University of Potsdam, Potsdam, Germany
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Degni LAE, Dalbagno D, Starita F, Benassi M, di Pellegrino G, Garofalo S. General Pavlovian-to-instrumental transfer in humans: Evidence from Bayesian inference. Front Behav Neurosci 2022; 16:945503. [PMID: 36051636 PMCID: PMC9426756 DOI: 10.3389/fnbeh.2022.945503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
When repeatedly paired with rewarding outcomes (i.e., Pavlovian conditioning), environmental cues may acquire predictive and motivational significance and later enhance instrumental responding for the same (i.e., outcome-specific transfer) or motivationally similar (i.e., general transfer) outcomes. Although outcome-specific and general Pavlovian-to-Instrumental Transfer (PIT) are characterized by different neural substrates and behavioral mechanisms, general transfer has never been studied in isolation from outcome-specific transfer in humans. The first aim of the present study was to test whether the general transfer effect could emerge in isolation and independently of outcome-specific transfer. Our results showed that general transfer can be elicited without the concurrent presence of outcome-specific transfer, supporting the idea that outcome-specific and general transfer can be studied independently of each other. The second aim of the present study was to clarify whether the affordance-like properties of the outcomes can affect the general transfer. In fact, a critical difference in current studies on general transfer concerns the use of cues associated with outcomes for which an action was previously learned (or not) during the instrumental training. This apparently minor difference affects the affordance-like properties of the outcome and may also be transferred to the cue, in turn impacting general transfer. Results revealed a general transfer of the same magnitude regardless of whether cues were associated with reward earned or not during instrumental conditioning. These findings increase the current knowledge on the incentive motivational mechanism behind general transfer, indicating that it is independent of the motor features of the outcome.
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Affiliation(s)
- Luigi A. E. Degni
- Center for studies and research in Cognitive Neuroscience (CsrNC), Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Daniela Dalbagno
- Center for studies and research in Cognitive Neuroscience (CsrNC), Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Francesca Starita
- Center for studies and research in Cognitive Neuroscience (CsrNC), Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Mariagrazia Benassi
- Psychometrics and Neuropsychology Lab, Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Giuseppe di Pellegrino
- Center for studies and research in Cognitive Neuroscience (CsrNC), Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Sara Garofalo
- Center for studies and research in Cognitive Neuroscience (CsrNC), Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
- Psychometrics and Neuropsychology Lab, Department of Psychology, University of Bologna, Bologna, Emilia-Romagna, Italy
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Avoidance behaviour performed in the context of a novel, ambiguous movement increases threat and pain-related fear. Pain 2021; 162:875-885. [PMID: 32947543 DOI: 10.1097/j.pain.0000000000002079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT The fear-avoidance model of chronic pain predicts that catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability. Here, we investigated whether performing a movement to avoid a painful stimulus in the context of a novel movement increases threat and pain-related fear towards this novel movement and whether avoidance behaviour persisted when given the choice between performing the acquired movement to avoid a painful stimulus or an alternative, novel movement. Applying a robotic arm-reaching task, participants could choose between 2 movements to reach a target location: a short, but painful movement trajectory, or a longer nonpainful movement trajectory. After avoidance acquisition, the option to choose the painful trajectory was removed. The experimental group (N = 50) could choose between the longest trajectory or a novel intermediate trajectory, whereas the control group (N = 50) was allowed to only perform the novel trajectory. In a final test, participants of both groups were allowed to choose any of the 3 trajectories. After acquisition, experimental group participants showed elevated pain expectancy and pain-related fear towards the novel trajectory, compared with the control group. During test, the experimental group participants persisted in performing the longest pain-free (avoidance) trajectory and were less likely to choose the novel trajectory. In addition, these participants maintained higher levels of pain-related fear for the novel trajectory compared with the control group. These findings suggest that avoidance in the context of other neutral activities/movements may lead to the development and maintenance of threat appraisals and irrational fears.
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Changes in Pain-Related Fear and Pain When Avoidance Behavior is no Longer Effective. THE JOURNAL OF PAIN 2020; 21:494-505. [DOI: 10.1016/j.jpain.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 12/28/2022]
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Abstract
Exposure therapy is an economical and promising psychological method for the treatment of chronic back pain, although little research has been done and its evidence needs further clarification. Exposure therapy has so far been little used in practice, which is partly due to the few published studies on this topic and partly to the uncertainty of the practitioners as to whether exposure therapy can be carried out without risk. Exposure therapy can be classified as a "tailored treatment" approach, in which patients with certain profiles (here: increased fear of movement) receive specific treatments. In this review article, the theoretical principles of exposure therapy are presented. Subsequently, possibilities for the identification of those patients suitable for exposure treatment are explained. The practical procedure is presented using a case study. The four randomized controlled trials available to date are described in detail and discussed.
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Affiliation(s)
- J A Glombiewski
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Universität Koblenz-Landau, Ostbahnstr. 10, 76829, Landau, Deutschland.
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Adamczyk WM, Buglewicz E, Szikszay TM, Luedtke K, Bąbel P. Reward for Pain: Hyperalgesia and Allodynia Induced by Operant Conditioning: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:861-875. [DOI: 10.1016/j.jpain.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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Watson P, Wiers RW, Hommel B, de Wit S. Motivational sensitivity of outcome-response priming: Experimental research and theoretical models. Psychon Bull Rev 2018; 25:2069-2082. [PMID: 29468416 PMCID: PMC6267533 DOI: 10.3758/s13423-018-1449-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Outcome-response (O-R) priming is at the core of various associative theories of human intentional action. This is a simple and parsimonious mechanism by which activation of outcome representations (e.g. thinking about the light coming on) leads to activation of the associated motor patterns required to achieve it (e.g. pushing the light switch). In the current manuscript, we review the evidence for such O-R associative links demonstrated by converging (yet until now, separate) strands of research. While there is a wealth of evidence that both the perceptual and motivational properties of an outcome can be encoded in the O-R association and mediate O-R priming, we critically examine the integration of these mechanisms and the conditions under which motivational factors constrain the sensory O-R priming effect. We discuss the clinical relevance of this O-R priming mechanism, whether it can satisfactorily account for human goal-directed behaviour, and the implications for theories of human action control.
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Affiliation(s)
- Poppy Watson
- ADAPT lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
- Habit Lab, Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands
| | - Reinout W Wiers
- ADAPT lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Bernhard Hommel
- Cognitive Psychology Unit, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | - Sanne de Wit
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands.
- Habit Lab, Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands.
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