Ann Meulders

Ann Meulders
Maastricht University | UM · Department of Clinical Psychological Science

Ph.D

About

114
Publications
25,161
Reads
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2,325
Citations
Introduction
I am an Associate Professor in Experimental Health Psychology at Maastricht University and a Visiting Professor in the Research Group Health Psychology at KU Leuven. My work concerns psychological mechanisms in the transition from acute to chronic pain, with a specific focus on pain-related fear learning and avoidance. My research is funded by a NWO (Netherlands Organisation for Scientific Research) Vidi Innovational Research Grant, as well as by the FWO (Research Foundation Flanders) and RIZIV.
Additional affiliations
May 2013 - present
Position
  • EFIC Grünenthal Grant 2012
Description
  • Fear generalization as a pathway to chronic widespread pain
July 2012 - February 2013
University of South Australia
Position
  • Visiting postdoctoral Research Fellow
Description
  • Generalization of pain-related fear and anxiety using motor imagery
July 2009 - present
KU Leuven
Position
  • PostDoc Position
Description
  • Odysseus Grant ‘‘The Psychology of Pain and Disability Research Program’’ - Research Foundation, Flanders, Belgium (FWO Vlaanderen).

Publications

Publications (114)
Article
Pain-related fear and –avoidance crucially contribute to pain chronification. People with chronic pain may adopt costly avoidance strategies above and beyond what is necessary, aligning with experimental findings of excessive fear generalization to safe movements in these populations. Furthermore, recent evidence suggests that, when avoidance is co...
Article
Pain-related avoidance of movements that are actually safe (i.e., overprotective behavior) plays a key role in chronic pain disability. Avoidance is reinforced through operant learning: after learning that a certain movement elicits pain, movements that prevent pain are more likely to be performed. Proprioceptive accuracy importantly contributes to...
Article
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 return of pain-related avoidance and fear. In an operant pain-related avoidanc...
Article
Full-text available
Background Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors...
Preprint
Watching other people in pain may affect one’s own experience of pain. It is unknown whether it can also modulate secondary mechanical hypersensitivity. We have addressed this question in two experiments in healthy human volunteers. In experiment 1 we tested, on a large sample (N=83), five videos of a model demonstrating high or low pain during hig...
Article
Avoidance is a hallmark symptom and a primary maintaining factor in anxiety disorders. Theories of anxiety disorders have focused not only on overt avoidance, but also on more subtle avoidance known as ‘safety behaviours’. Safety behaviours involve behaviours which aim to reduce anxiety or prevent a feared outcome from occurring. In the long-term,...
Article
Introduction: People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage. Objectives: We ai...
Article
Objectives: The purpose of this study was to develop the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale) to measure shoulder pain-related avoidance behavior in patients with shoulder pain and evaluate and report the structural validity and internal consistency of the scale. Methods: Potential daily activities involving the should...
Article
Full-text available
When pain persists beyond healing time and becomes a “false alarm” of bodily threat, protective strategies, such as avoidance, are no longer adaptive. More specifically, generalization of avoidance based on conceptual knowledge may contribute to chronic pain disability. Using an operant robotic-arm avoidance paradigm, healthy participants (N=50), c...
Article
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Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure proto...
Article
A large body of evidence indicates how pain affects motor control, yet the way the motor system influences pain perception remains unclear. We present 2 experiments that investigated sensory attenuation of pain implementing a 2-alternative forced choice paradigm. Particularly, healthy participants received painful stimuli on a moving and nonmoving...
Article
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Excessive generalization of fear and avoidance are hallmark symptoms of chronic pain disability, yet research focusing on the mechanisms underlying generalization of avoidance specifically, is scarce. Two experiments investigated the boundary conditions of costly pain-related avoidance generalization in healthy participants who learned to avoid pai...
Article
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Background. Proprioception refers to the perception of motion and position of the body or body segments in space. A wide range of proprioceptive tests exists, although tests dynamically evaluating sensorimotor integration during upper limb movement are scarce. We introduce a novel task to evaluate kinesthetic proprioceptive function during complex...
Article
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Compared to the field of anxiety research, the use of fear conditioning paradigms for studying chronic pain is relatively novel. Developments in identifying the neural correlates of pain-related fear are important for understanding the mechanisms underlying chronic pain and warrant synthesis to establish the state-of-the-art. Using effect-size sign...
Preprint
Full-text available
Avoidance towards innocuous stimuli is a key characteristic across anxiety-related disorders and chronic pain. Insights into the relevant learning processes of avoidance are often gained via laboratory procedures, where individuals learn to avoid stimuli or movements that have been previously associated with an aversive stimulus. Typically, statist...
Article
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Background and objectives Contingency learning, i.e. learning that a cue predicts the presence (or absence) of an event, is central to the formation of beliefs regarding painfulness of body postures. Such beliefs may spread to safe cues due to compromised learning (e.g., excessive generalization, impaired safety learning), prompting avoidance and l...
Article
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Avoidance behavior is a key contributor to the transition from acute pain to chronic pain disability. Yet, there has been a lack of ecologically valid paradigms to experimentally investigate pain-related avoidance. To fill this gap, we developed a paradigm (the robotic arm-reaching paradigm) to investigate the mechanisms underlying the development...
Article
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 fe...
Article
Full-text available
Background. Maladaptive defensive responses such as excessive avoidance behavior have received increasing attention as a main mechanism for the development and maintenance of chronic pain complaints. However, another defensive response which is commonly studied in animals as a proxy for fear is freezing behavior. No research to date has investigate...
Article
Full-text available
Avoidance towards innocuous stimuli is a key characteristic across anxiety-related disorders and chronic pain. Insights into the relevant learning processes of avoidance are often gained via laboratory procedures, where individuals learn to avoid stimuli or movements that have been previously associated with an aversive stimulus. Typically, statist...
Article
Background Although pain-related avoidance is mainly intended to reduce the accompanying anticipatory fear, avoidance behavior may paradoxically increase fear when a previous avoidance response is no longer available, suggesting that there is a bidirectional relationship between pain-related fear and avoidance. Purpose We hypothesized that avoidan...
Article
Full-text available
Nocebo hyperalgesia refers to increases in perceived pain that putatively result from negative expectations regarding a nocebo stimulus (e.g., an inert treatment, compared to no treatment). The precise cognitive-emotional factors contributing to the origins of nocebo effects are poorly understood. We aimed to test the effects of experimentally indu...
Article
Background and aims: Contemporary fear-avoidance models of chronic pain posit that fear of pain, and overgeneralization of fear to non-threatening stimuli is a potential pathway to chronic pain. While increasing experimental evidence supports this hypothesis, a comprehensive investigation requires testing in multiple modalities due to the diversity...
Article
Full-text available
Background. Learning to predict threatening events enables an organism to engage in protective behavior and prevent harm. Failure to differentiate between cues that truly predict danger and those that do not, however, may lead to indiscriminate fear and avoidance behaviors, which in turn may contribute to disability in people with persistent pain....
Article
Full-text available
Human fear conditioning research since Watson's case study on "Little Albert" has vastly evolved and its impact today is reaching far beyond phobic anxiety. This review focuses on how fear conditioning research, mainly using exteroceptive conditioned stimuli (CSs) and aversive, non-noxious stimuli as unconditioned stimuli (USs), has been extended a...
Article
In exposure for chronic pain, avoidance is often forbidden (extinction with response prevention; RPE) to prevent misattributions of safety. Although exposure is an effective treatment, relapse is common. Little is known about the underlying mechanisms of return of pain-related avoidance. We hypothesized that pain-related avoidance would recover whe...
Article
Avoidance behavior is protective, yet in the absence of genuine bodily threat, it may become disabling. Therefore, we investigated whether avoidance generalizes to novel safe contexts based on the similarity with the acquisition context. Healthy participants performed arm movements using a robotic arm to reach a target. Three trajectories (T1-3) le...
Article
Avoidance is considered a key contributor to the development and maintenance of chronic pain disability, likely through its excessive generalization. This study investigated whether acquired avoidance behavior generalizes to novel but similar movements. Using a robotic arm, participants moved their arm from a starting to a target location via one o...
Article
Objectives: Body illusions have shown promise in treating some chronic pain conditions. We hypothesised that neck exercises performed in virtual reality (VR) with visual feedback of rotation amplified, would reduce persistent neck pain. Methods: In a multiple-baseline replicated single case series, 8 blinded individuals with persistent neck pain...
Article
Avoidance is considered key in the development of chronic pain. However, little is known about how avoidance behaviour subsequently affects pain-related fear and pain. We investigated this using a robotic arm reaching avoidance task to investigate this. In a between-subjects design both Experimental Group (n=30) and Yoked Control Group (n=30) parti...
Article
Background and aims Pain-related fear and its subsequent generalization is key to the development and maintenance of chronic pain disability. Research has shown that pain-related fear acquired through classical conditioning generalizes following a gradient, that is, novel movements that are proprioceptively similar to the original pain-associated m...
Article
Full-text available
Earlier research studying the effects of social threat on the experience and expression of pain led to mixed results. In this study, female participants (N = 32) came to the lab with two confederates. Both confederates administered a total of 10 painful electrocutaneous stimuli to the participant. The framing of the administration was manipulated i...
Article
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Introduction:. Research on learning in placebo and nocebo has relied predominantly on Pavlovian conditioning procedures. Operant learning procedures may more accurately model learning in real-life situations in which placebo and nocebo effects occur. Objectives:. To investigate the development and persistence of placebo and nocebo effects using an...
Article
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Fear of movement-related pain significantly contributes to musculoskeletal chronic pain disability. Previous research has shown that fear of movement-related pain can be classically conditioned. That is, in a differential fear conditioning paradigm, after (repeatedly) pairing a neutral joystick movement (conditioned stimulus; CS+) with a painful st...
Article
This review addresses recent developments in fear of movement-related pain and avoidance research, adopting a contemporary learning approach focusing on cognitive, emotional, and behavioral factors, and emphasizing the role of the motivational context including pain-avoidance goals but also other valued life goals. We particularly demonstrated the...
Article
In chronic pain, pain-related fear seems to overgeneralize to safe stimuli, thus contributing to excessive fear and avoidance behavior. Evidence shows that pain-related fear can be acquired and generalized based on conceptual knowledge. Using a fear conditioning paradigm, we investigated whether this concept-based pain-related fear could also be ex...
Conference Paper
Full-text available
Methods At first, participants were given training and testing of same and opposite relational responding in a five-member relational network (figure 1). During a subsequent conditioned fear-of-movement task, participants learned to associate an aversive electrocutaneous stimulus with a verbal stimulus (Exp 1: 100 % and Exp 2: 75% contingency). Nex...
Article
Fear-avoidance models propose that pain-related fear may spur avoidance behaviour leading to chronic pain disability. Pain-related fear elicits avoidance behaviour, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothes...
Article
It has been proposed that the definition of pain ideally recognizes not only sensory, cognitive, and emotional dimensions, but also a social dimension.107 Although it is widely acknowledged that interpersonal context modulates pain experience and communication,39,55 we still fail to understand why and how this modulation occurs. Drawing from evolut...
Article
Impaired selective fear learning has been advanced as a core mechanism involved in excessive spreading of protective responses such as pain-related fear and avoidance leading to disability in chronic pain conditions. Using the litmus test for selective learning effects, the blocking procedure, we tested the hypothesis that fibromyalgia patients sho...
Article
Full-text available
Purpose of Review Pain is an intense experience that can place a heavy burden on peoples’ lives. The identification of psychosocial risk factors led to the development of effective pain treatments. However, effect sizes are modest. Accumulating evidence suggests that enhancing protective factors might also impact on (well-being despite) pain. Recen...
Article
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Only one published study has investigated the effect of a threatening social context on the perception and expression of pain, demonstrating that social threat leads to increased pain reports but reduced non-verbal pain expression. The current study aimed to replicate and extend these findings to further explore the effects of a threatening social...
Article
The experience of unpredictable pain fluctuations can trigger anticipatory pain-related fear. When discrete predictors for pain are lacking, fear typically accrues to the broader environmental context: a phenomenon referred to as contextual pain-related fear. We examined whether conceptual similarity between discrete contexts facilitates pain-relat...
Article
Fear of touch, due to allodynia and spontaneous pain, is not well understood. Experimental methods to advance this topic are lacking, and therefore we propose a novel tactile conditioning paradigm. Seventy-six pain-free participants underwent acquisition in a predictable as well as an unpredictable pain context. In the predictable context, vibrotac...
Article
Perspective: The review revealed preliminary evidence that people with chronic pain may exhibit less differential US expectancy and fear learning. This characteristic may contribute to widespread fear-avoidance behavior. The assumption that altered classical conditioning may be a predisposing or maintaining factor for chronic pain remains to be ve...
Article
Full-text available
Background: According to current fear-avoidance models, changes in motor behaviour (e.g. avoidance) are a key component in the development and maintenance of chronic pain complaints. Yet, experimental research assessing actual behavioural changes following painful events is relatively sparse. This study investigated the effects of pain anticipatio...
Article
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Abstract The so-called ‘replicability crisis’ has sparked methodological discussions in many areas of science in general, and in psychology in particular. This has led to recent endeavours to promote the transparency, rigour, and ultimately, replicability of research. Originating from this zeitgeist, the challenge to discuss critical issues on term...
Article
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In the current paper, we present a method to construct nonparametric confidence intervals (CIs) for single-case effect size measures in the context of various single-case designs. We use the relationship between a two-sided statistical hypothesis test at significance level α and a 100 (1 - α) % two-sided CI to construct CIs for any effect size meas...
Article
Background: Generalization of fear of movement-related pain across novel but similar movements can lead to fear responses to movements that are actually not associated with pain. The peak-shift effect describes a phenomenon whereby particular novel movements elicit even greater fear responses than the original pain-provoking movement (CS+), becaus...
Article
Increasing evidence suggests that pain-related fear is key to the transition from acute to chronic pain. Previous research has shown that perceptual similarity with a pain-associated movement fosters the generalization of fear to novel movements. Perceptual generalization of pain-related fear is adaptive as it enables individuals to extrapolate the...
Article
Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus [CS+]) originally associated with pain (unconditioned stimulus), but expands to similar movements (generalization stimuli [GSs]). This spreading of fear becomes dysfunctional when...
Article
Full-text available
Learning to initiate defenses in response to specific signals of danger is adaptive. Some chronic pain conditions, however, are characterized by widespread anxiety, avoidance, and pain consistent with a loss of defensive response specificity. Response specificity depends on ability to discriminate between safe and threatening stimuli; therefore, sp...
Article
Full-text available
There is a longstanding debate whether allowing safety-seeking behaviors (SSBs) during cognitive-behavioral treatment hampers or facilitates the reduction of fear. In this meta-analysis, we evaluate the impact of SSBs on exposure-based fear reduction interventions. After filtering 409 journal articles, 23 studies were included for systematic review...
Chapter
The relationship between fear and pain is highly complex and there are many mechanisms that facilitate bidirectional influence. There are emotional, cognitive, behavioral, and psychophysiological factors that allow fear to modulate the experience of pain. In addition, the expectancy of pain as well as beliefs about pain can in turn influence fear....
Chapter
The relationship between fear and pain is highly complex and there are many mechanisms that facilitate bidirectional influence. There are emotional, cognitive, behavioral, and psychophysiological factors that allow fear to modulate the experience of pain. In addition, the expectancy of pain as well as beliefs about pain can in turn influence fear....
Article
Unlabelled: Successful adjustment to dynamic environments requires the simultaneous pursuit of multiple goals. However, the pursuit of multiple goals may bring about goal conflict. Despite evidence indicating that goal conflict can have a detrimental effect on subjective well-being, little is known about the effects of goal competition in the cont...
Article
Full-text available
Unlabelled: Cognitive-behavioral treatments for chronic pain typically target pain-related fear; exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning...
Article
Using a voluntary joystick movement task with arm movements as conditioned stimuli (CSs) a and a painful electrocutaneous stimulus as an unconditioned stimulus (pain-US), we investigated whether 1) the intention to perform a painful movement would elicit pain-related fear in healthy participants, 2) a non-painful but aversive sound-US (i.e. human s...
Article
Background: Proprioceptive imprecision is believed to contribute to persistent pain. Detecting imprecision in order to study or treat it remains challenging given the limitations of current tests. Objective: We aimed to determine whether proprioceptive imprecision could be detected in people with neck pain by testing their ability to identify in...
Conference Paper
Full-text available
Successful adjustment to complex environments requires the simultaneous pursuit of multiple goals. However, the pursuit of one goal can hamper the pursuit of another concurrent goal, bringing about goal conflicts. Despite evidence indicating that goal conflict may have a detrimental effect on subjective well-being, little is known about the effects...
Article
Objective The experiential acquisition of pain-related fear has been demonstrated by pairing a painful electrocutaneous stimulus (pain-US) with one movement (CS+) but not with another (CS-). However, it is expected that during acquisition through direct experience, pain-related fear can be intensified or weakened by verbally/visually transmitted i...
Article
The present study examined whether pain catastrophizing and pain-related fear predict the experience of pain in body regions that are not targeted by an experimental muscle injury protocol. A delayed-onset muscle soreness (DOMS)-protocol was used to induce pain unilaterally in the pectoralis, serratus, trapezius, latisimus dorsi, and deltoid muscle...
Article
Full-text available
Patients with chronic pain are often fearful of movements that never featured in painful episodes. This study examined whether a neutral movement's conceptual relationship with pain-relevant stimuli could precipitate pain-related fear; a process known as symbolic generalization. As a secondary objective, we also compared experiential and verbal fea...
Conference Paper
Full-text available
This study investigated the effects of a threatening and a safe social context on learning pain-related fear, a key factor in the development and maintenance of chronic pain. We measured self-reported pain intensity, pain expectancy, pain-related fear (verbal ratings and eyeblink startle responses), and behavioral measures of avoidance (movement-on...
Article
Recent research suggests that the mere intention to perform a painful movement can elicit pain-related fear. Based on these findings, the present study aimed to determine whether imagining a movement that is associated with pain (CS +) can start to elicit conditioned pain-related fear as well and whether pain-related fear elicited by imagining a pa...