Objectives: Previous research indicates that reducing fear of movement-related pain is
hampered by engaging in safety-seeking behavior. We tested the hypothesis that fear
reduction is only disrupted by behavior that serves a pain avoidance goal (safety seeking),
but not when it is serving an achievement goal.
Methods: Using the voluntary joystick movement paradigm, fear of a painful joystick
arm movement was successfully acquired by repeatedly pairing this joystick movement
with a painful electrocutaneous stimulus (unconditioned stimulus; pain-US) and this
fear was subsequently extinguished using a Pavlovian extinction procedure. During
extinction, a Safety Group and Reward Group both pressed a safety button, while a
third Control group did not.
Results: Pain-US expectancy and fear of movement-related pain ratings show a
gradual fear reduction in the Control Group, but a return of fear when the button is
pressed to avoid the pain-US (Safety Group). When the same button is used to attain a
reward (Reward Group), subsequent return of fear is attenuated. Additionally, we
investigated the reliability of the return of fear in the Safety Group and Reward Group,
using a customized Reliable Change Index. This index confirms that the return of fear
was only reliable in the Safety Group, and that this return of fear is associated with
more perceived control over the nonoccurrence of the pain-US when pressing the
Discussion: These results highlight the importance of motivational context in
understanding the role of safety-seeking behavior in exposure-based therapies.