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Cognitive-behavioral treatment programs have been developed to give patients with chronic pain the opportunity to reassess their beliefs about the relationship between pain and functioning and to experience that spontaneous safety behaviors – which may be adaptive in acute episodes of pain – are no longer functional when pain lasts for extended periods of time [5]. These treatment programs appear to be useful. Indeed, a recent meta-analysis of randomized controlled trials of these treatments in adults concluded that these treatments have beneficial effects on pain and mood, but also that there is ample room for improvement [3]. It is, for example, recommended that extensive and multimodal programs be replaced by a more targeted approach that focuses on specific treatments for specific outcomes – as has been done in exposurebased techniques targeting pain-related fear [2]. In addition, it is expected that treatments would have stronger effects when treatment content, dose, timing etc. are based on explicit theoretical models. In line with these ideas, a number of authors have recently called for an expanded affective-motivational approach with a prominent focus on behavior in the context of multiple goals [9,10]. In their attempt to resume daily life activities, pain patients engage in several goals, some of which are directly related to dealing with pain (e.g., to avoid further injury, take less medication, increase physical capacity), whereas others are not pain-related (e.g., being professionally successful, meeting other people, losing weight). Interrelations among these multiple goals – either conflicting or facilitating – may have implications for the initiation and maintenance of the intended goal [6]. A particularly stressful situation, for instance, occurs when the goal to satisfy others by resuming work-related activities holds the risk of increasing pain and re-injury. In contrast, the goal to protect bodily integrity by staying home may lead to social rejection. Such a conflict between two avoidance goals is much more difficult to handle than choosing between two attractive options. This situation may result in indecision and oscillation between the two goals, as is often seen in chronic pain patients. Unfortunately, unresolved pain-related goal conflicts may fuel fear [4]. An emerging and intriguing question is whether cognitive-behavioral therapies aimed at the reevaluation of major life goals and at the resolution of enduring goal conflicts help to counter fear-driven and disabling avoidance behavior [9,10]. In line with this novel treatment approach, Christiansen and colleagues (this issue) have developed and evaluated a brief goalpursuit intervention to improve physical capacity through exercising in chronic back pain patients [1]. In order to facilitate the realization of this intended goal, the following strategies were added to a standard back pain treatment (exercise therapy): (1) mental contrasting to increase the patient’s expectations about achieving the promoted goal, (2) problem solving techniques to help the patient

Becoming active again? Further thoughts on goal pursuit in chronic pain