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Behavioural and neural evidence for self-reinforcing expectancy effects on pain

Nature Human Behaviourvolume 2pages838855 (2018) | Download Citation


Beliefs and expectations often persist despite evidence to the contrary. Here we examine two potential mechanisms underlying such ‘self-reinforcing’ expectancy effects in the pain domain: modulation of perception and biased learning. In two experiments, cues previously associated with symbolic representations of high or low temperatures preceded painful heat. We examined trial-to-trial dynamics in participants’ expected pain, reported pain and brain activity. Subjective and neural pain responses assimilated towards cue-based expectations, and pain responses in turn predicted subsequent expectations, creating a positive dynamic feedback loop. Furthermore, we found evidence for a confirmation bias in learning: higher- and lower-than-expected pain triggered greater expectation updating for high- and low-pain cues, respectively. Individual differences in this bias were reflected in the updating of pain-anticipatory brain activity. Computational modelling provided converging evidence that expectations influence both perception and learning. Together, perceptual assimilation and biased learning promote self-reinforcing expectations, helping to explain why beliefs can be resistant to change.

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The single-trial behavioural and NPS data, which are needed to reproduce all behavioural and NPS analyses in the paper, are available through the Open Science Framework repository, The fMRI data, which are needed to reproduce the analyses on anticipatory brain activity, are available from the corresponding author upon request.

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We thank M. Powell and D. Ryan for assistance with data collection, and M. Roy and M. López-Solà for discussions. This research was made possible with the support of National Institutes of Health grants NIMH 2R01MH076136 and R01DA027794 (to T.D.W.), a VENI grant of the Netherlands Organization for Scientific Research (to M. Jepma), and AFOSR grant FA9550-14-1-0318 (to M. Jones). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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  1. Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands

    • Marieke Jepma
    •  & Johnny van Doorn
  2. Department of Psychology and Neuroscience and Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA

    • Marieke Jepma
    • , Leonie Koban
    • , Matt Jones
    •  & Tor D. Wager


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M.Jepma, L.K. and T.D.W. conceived and designed the experiments. M.Jepma conducted the experiments and analysed the data. L.K., J.D., M.Jones and T.D.W. provided expertise and feedback. M.Jepma, L.K., J.D., M.Jones and T.D.W. wrote the manuscript.

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The authors declare no competing interests.

Corresponding author

Correspondence to Marieke Jepma.

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