Original ReportBetween the Devil and the Deep Blue Sea: Avoidance-Avoidance Competition Increases Pain-Related Fear and Slows Decision-Making

- Competition between outcomes of behavioral actions affects pain-related responding.
- Avoidance-avoidance competition instills the most fear and avoidance.
- Approach-approach competition instills the least fear and avoidance.
- Choosing between 2 negative outcomes increases choice latency.
- A situation with positive and negative outcomes increases decision latency.

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 context of pain. This experiment investigated whether different types of goal competition increase pain-related fear and slow pain-related decision-making. Forty-six participants completed a cross-directional movement task in which they learned to associate movements in 1 direction (eg, left) with pain, and movements in the opposite direction (eg, right) with safety; and that movements in other directions (eg, up and down) were associated with reward and loss of reward, respectively. In the test phase, both phases were combined, creating different types of goal competition. The results showed that participants were most afraid of movements associated with 2 concurrent avoidance goals, and the least afraid of movements associated with approach-approach competition. Additionally, participants were slower in making a choice when presented with an avoidance-avoidance competition compared with approach-approach and avoidance-approach competition. These findings suggest that avoidance-avoidance competition increased fear and slowed decision-making compared with other types of competition.PerspectiveThis study provides experimental evidence for the differential effects of various goal conflicts on pain-related fear and decision-making. This knowledge may improve our understanding of patients' behavior when experiencing goal conflict and may contribute to improving treatments by addressing multiple goals patients are pursuing, and not just pain avoidance/reduction.