136 lower. It is also visible that this persisted as a learned effect, at the start of the second evocation, when all groups received moderate pain. This reduced nocebo response illustrates the higher effectiveness of counterconditioning in diminishing the previously induced nocebo hyperalgesia. Additionally, the attenuation slopes illustrate that participants in the partial reinforcement-extinction and partial reinforcement-counterconditioning groups consistently provided higher pain ratings than participants in the corresponding continuous reinforcement groups, despite the fact that they were receiving pain stimulations of the same intensity (low pain in the counterconditioning and moderate pain in the extinction groups). This points to a tendency for resistance to attenuation after partial reinforcement as compared to after continuous reinforcement, already during learning. However, during the second evocation, the difference between partial reinforcement and continuous reinforcement did not reach significance in the extinction groups. Figure 6. Pain ratings for only the nocebo trials after the end of induction, across all active conditioning groups. Numeric Rating Scale (NRS) pain ratings during nocebo trials illustrate the time-course of attenuation. The dotted vertical line indicates the thermode moving point. In evocations, all stimuli were administered at the same intensity.
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