Pain and avoidance: The potential benefits of imagining your best possible self

Positive affect is hypothesized to improve safety learning taking place during extinction (i.e., the core mechanism of exposure treatment), therefore improving the maintenance of treatment outcomes. We investigated whether positive affect during extinction attenuates the subsequent return of pain-related avoidance and fear. In an operant pain-related avoidance conditioning paradigm, sixty healthy volunteers performed arm-reaching movements using a robotic arm. During acquisition, they learned to avoid an easy but painful movement (T1) by choosing more effortful movements that were sometimes (T2) or never (T3) painful. Then, the Positive affect group wrote about and imagined their best possible self, which is known to induce positive affect, whereas the Control group wrote about and imagined a typical day. During extinction with response prevention (RPE), participants were only allowed to perform T1, which was no longer paired with pain. Next, two painful stimuli were presented when participants were not moving (i.e., reinstatement manipulation). During test, all movements were available, and we examined whether fear and avoidance of the previously painful movements would re-emerge. Pain-related avoidance returned in both groups, but the two groups did not differ herein. The Positive affect group reported increased positive affect, though not more than the Control group. Nevertheless, they generalized the learned safety of T1 to the other movements during RPE, whereas they also retrospectively rated the pain as less intense and less unpleasant. These results add to the literature of positive affect as a resilience factor.