No differences in return of pain-related fear after extinction and counterconditioning

Extinction-based protocols such as exposure-in-vivo successfully reduce pain-related fear in chronic pain conditions, but return of fear and clinical relapse often occur. Counterconditioning is assumed to attenuate return of fear, likely through changing the negative affective valence of the conditioned stimulus (CS). We hypothesized that counterconditioning would outperform extinction in mitigating return of pain-related fear and decrease CS negative affective valence. Healthy participants performed a conditioning task, in which 2 joystick movements (CSs+) were paired with a painful electrocutaneous stimulus (unconditioned stimulus; pain-US), whereas 2 other movements (CSs-) were not. Subsequently, in the extinction group, 1 CS+ was extinguished (pain-US omission) and the other not, whereas in the counterconditioning group, 1 CS+ was presented with a US of opposite valence (reward-US) and the other was paired with both USs. We tested reinstatement of pain-related fear after 2 unsignalled pain-US presentations. Results showed no group differences in fear reduction and no differences in CS affective valence changes between the extinguished and counterconditioned CS. Remarkably, none of the groups showed reinstatement. Overall, counterconditioning did not appear to be more effective than extinction in reducing pain-related fear and its return. (PsycInfo Database Record (c) 2022 APA, all rights reserved).