Die Entstehung, Aufrechterhaltung und Therapie chronischer Schmerzen im Kontext von Erwartungsverletzungen

Expectations regarding the harmfulness of movements (threat beliefs) play a crucial role in the formation and maintenance of chronic pain and thus pose a starting point for optimizing exposure therapy. The role of expectations in the context of chronic pain and how changes in pain-related expectations are processed is not well understood yet. The aim of this dissertation was therefore to investigate the influence of expectations on the formation and maintenance of chronic pain conditions and the utilization of expectations in psychological treatment for chronic pain. In a longitudinal prospective survey, the influence of expectations concerning one’s self-concept in the development of chronic pain disorders was examined in patients with acute pain (N = 30). The expectation of not being able to meet one’s own expectations due to the pain (= self-enmeshment with pain) predicted pain-related disability after three months over and above pain catastrophizing and pain-related fear. In an experimental paradigm with a longitudinal follow-up, subjects with subclinical pain disorders (N = 73) were examined to study whether pain-related expectations were adjusted when disconfirming experiences are made repeatedly. Participants who expected increasing pain reported a greater expectation violation due to decreasing heat stimulus than participants who expected decreasing pain. Contrary to our hypothesis, a stronger expectation adjustment was found in the group with induced lower initial expectations. Regardless of the experimental condition, the extent of the expectation violation correlated with an expectation change and a generalization of the learning experience to a generalized pain-related self-efficacy. In a third, also experimental and longitudinal study with healthy female subjects (N = 116), we investigated whether the efficacy and cost-effectiveness of pain exposure can be optimized by a therapeutic instruction based on expectation violation compared to a therapeutic instruction based on habituation. While the exposure criterion in the expectation violation condition was achieved after significantly fewer sessions than in the habituation condition, the two conditions did not differ with respect to change in pain-related outcome measures (pain tolerance and cognitive coping). The effect was stable over a one-week follow-up. In sum, the results of the present dissertation provide evidence that expectations are relevant in the formation and maintenance of chronic pain conditions by influencing pain perception and persistence against disconfirming experiences. Directly addressing idiosyncratic threat beliefs and therapeutic guidance to test those beliefs seems to optimize exposure-based approaches. Relevant implications for prevention and intervention can be drawn (e.g., for the need of cognitive interventions prior to exposure).