Evaluation of Exposure Instructions to Pain: Should Therapist Focus on Fear Reduction or Expectation Violation?

  • Lea SchemerEmail author
  • Karoline Körfer
  • Julia Anna Glombiewski
Original Article


Exposure elements are highly effective for the treatment of individuals with chronic pain and elevated fear-avoidance. However, different therapeutic instructions are justified by competing theories regarding underlying mechanisms. The habituation model suggests that therapists should focus on fear reduction. The inhibitory learning approach suggests that therapists should aim for maximal expectation violation. We employed a mixed 3 × 2 experimental design with the between-group factor instruction (habituation, expectation violation, control) and the within-group factor time (pretest, posttest) to provide a fine-grained analysis of both instructions. Nociceptive thermal pain was induced to female students (N = 112). Both instructions improved cognitive pain coping. Only the expectation violation instruction increased pain tolerance. Similarly, only the expectation violation instructions led to specific psychophysiological changes, characterized by a significantly higher initial increase and subsequent decrease in the skin conductance level. This study provides experimental evidence for the effectiveness of exposure-based interventions among individuals confronting acute thermal pain. Instructions addressing expectation violations appeared to produce the greatest effects. Testing concrete expectancies might further improve exposure effects. Future research needs to translate our findings into clinical practice.


Exposure therapy Therapeutic instructions Inhibitory learning approach Habituation model Experimental thermal pain 



The authors wish to acknowledge Erika Renner and Patrick Pfarrer for their diligent work during the acquisition phase.

Compliance with Ethical Standards

Conflict of Interest

Les Schemer, Karoline Körfer, and Julia A. Glombiewski declare that they have no competing interests. The study was supported by a doctoral thesis scholarship from the Philipps-University Marburg.

Ethical Approval

The study procedure was approved by the institutional ethics committee of the psychology department at the Philipps-University.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10608_2019_10070_MOESM1_ESM.docx (71 kb)
Supplementary file1 (DOCX 71 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Psychology and PsychotherapyUniversity of Koblenz–LandauLandauGermany
  2. 2.Department of Clinical Psychology and PsychotherapyPhilipps-University MarburgMarburgGermany

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