Chapter 4 – Experimental learning 131 the induced nocebo responses, a 2x2 mixed model ANOVA was conducted. The analysis revealed a significant interaction between the counterconditioning and extinction groups and the reduction of nocebo responses (F (1,95) = 6.51, P = 0.012, ηp 2 = 0.06), indicating significantly higher efficacy of counterconditioning compared to extinction. Figure 3 illustrates the differences in pain ratings for the first nocebo trial of the first evocation and the first nocebo trial of the second evocation, between the counterconditioning and extinction groups. Figure 3. Comparison of nocebo magnitudes after counterconditioning and extinction. Differences in mean Numeric Rating Scale (NRS) pain ratings and standard deviations between the attenuation groups (N = 97) are depicted. Dots represent the (jittered) individual data points. Differences between the first nocebo trial of the first evocation (Nocebo Pre) and the first nocebo trial of the second evocation (Nocebo Post) illustrate the significant reduction of nocebo hyperalgesia achieved by both methods. Attenuation with counterconditioning was more effective in diminishing nocebo responses. Counterconditioning Extinction NRS score Trial Nocebo Pre Nocebo Post 7 8 9
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