Universiteit Leiden

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Research project

The role of expectancies and avoidance learning in the maintenance of somatic symptoms

Somatic symptoms, such as pain, itch, and fatigue have been shown to have a bidirectional relationship with mental symptoms. Although acute somatic symptoms serve some adaptive properties, chronic symptoms can instead lead to interference in daily activities and lower quality of life.

Gita Nadinda
NWO – Gravitation Grant

Maastricht University, Faculty of Psychology and Neuroscience, Department of Clinical Psychological Science, Experimental Health Psychology Research Group

To gain a better understanding of the mind-body relationship, a transdiagnostic approach is needed (Linton, 2013). One way to assess this transdiagnostic relationship is to view psychosomatic symptoms as a complex system of interconnected networks (Borsboom, 2017). Two psychological mechanisms that may play a key role in the connectivity between symptoms are expectancies and avoidance behavior. Expectancies have been shown to influence symptom perception (Evers et al., 2019; Peerdeman et al., 2016), while avoidance behavior has been shown to maintain negative expectancies of pain through fear-avoidance beliefs (Vlaeyen & Linton, 2012; Vlaeyen et al., 2020).


Aims for current research:

The aim of this project is to uncover behavioral and cognitive mechanisms involved in the chronification of somatic symptoms. More specifically, we will evaluate the network of patients with psychosomatic symptoms to assess the interplay between expectancies, avoidance, and related psychological constructs. The network approach will allow us to view the mind-body relation in a new perspective, thereby allowing for better understanding of the underlying psychological mechanisms in chronic symptoms. Additionally, we will investigate how expectancies can change symptom perception and avoidance behavior through various experimental studies.


Scientific relevance:

By understanding the transdiagnostic mechanisms between somatic and mental symptoms, we can identify specific processes to target to reduce the risk of symptom chronification. Additionally, as only few studies have directly assessed the relationship between expectancy and avoidance, findings of this project will add to the current knowledge on psychosomatic processes.


Study Measures:  

  • Electrical stimulation for pain and itch
  • Quantitative Sensory Testing
  • Ecological Momentary Assessment
  • Questionnaire 
  • OpenSesame/E-Prime tasks



Borsboom, D. (2017). A network theory of mental disorders. World psychiatry, 16(1), 5-13. https://doi.org/10.1002/wps.20375

Evers, A. W. M., Peerdeman, K. J., & Laarhoven, A. I. M. (2019). What is new in the psychology of chronic itch? 6. https://doi.org/10.1111/exd.13992   

Linton, S. J. (2013). A Transdiagnostic Approach to Pain and Emotion: Transdiagnostic approach to pain and emotion. Journal of Applied Biobehavioral Research, 18(2), 82–103. https://doi.org/10.1111/jabr.12007

Peerdeman, K. J., Laarhoven, A. I. M. van, Peters, M. L., & Evers, A. W. M. (2016). An Integrative Review of the Influence of Expectancies on Pain. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01270

Vlaeyen, J. W. S., & Crombez, G. (2020). Behavioral Conceptualization and Treatment of Chronic Pain. Annual Review of Clinical Psychology, 16(1), 187–212. https://doi.org/10.1146/annurev-clinpsy-050718-095744

Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 years on. PAIN, 153(6), 1144–1147. https://doi.org/10.1016/j.pain.2011.12.009

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