When do we not face our fears? Investigating the boundary conditions of costly pain-related avoidance generalization

Avoidance of objectively safe movements and activities is central to chronic pain disability55, which often profits from psychological treatments, such as Cognitive Behavioral Therapy39, rather than purely biomedical ones14, 15. Avoidance of pain-associated movements/activities after healing prevents disconfirmation of threat, leading to a self-sustaining cycle of fear and avoidance55. Furthermore, avoidance often spreads to movements resembling the original pain-associated movement, that were never paired with pain themselves (avoidance generalization)12.

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