How expectancy violations facilitate learning to cope with pain – an experimental approach

Review written by Dr Sandy Hilton info

Key Points

  1. Expectations can be manipulated about if pain from experimental painful stimuli will increase or decrease.
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Pain is remarkable. We feel it, we remember it, and we learn from it. We develop expectations: slipping on ice can cause a painful fall, too hot of coffee will burn, washing a cat risks injury from teeth and nails, etc. Individuals suffering from chronic pain also develop expectations. Learned behaviors occur based on their experiences and on their beliefs about the future. Chronic pain can lead to overprediction of an increased pain response (1).

The authors propose that individuals who expect their pain to get worse will explain any disconfirming experience. They describe this as cognitive immunization, where expectations become immune to updating (2).

This paper explored three questions:

  1. How does the perception of pain stimuli differ based on the participants’ pain expectations?
  2. How are pain expectations updated in response to decreasing pain?
  3. How does the experience of expectation violation influence the participants’ pain tolerance and coping in terms of pain related self-efficacy?

Chronic pain can lead to overprediction of an increased pain response.
This paper shows that people were able to change their pain expectation and experience to feeling more hopeful and confident.


Participation was limited to frequent sub-clinical pain to ensure a more homogenous sample. The final number in the study was 73 participants randomized into two groups that completed baseline assessment of pain tolerance and 3 trials of thermal stimuli using

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