Fear-avoidance model: Difference between revisions

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[[File:Fear-avoidance model.jpg|thumb|400px|Fear-avoidance model]]

The '''fear-avoidance model''' is a model that describes how individuals develop of chronic [[Human musculoskeletal system|musculoskeletal]] [[pain]] as a result of avoidance of activities based on [[fear]].<ref name=Leeuw2007>{{Cite doi|10.1007/s10865-006-9085-0}}</ref><ref name=Vlaeyen2000>{{Cite pmid|10781906}}</ref> Introduced by Lethem et al. in 1983, this model helped explain how these individuals experience pain despite the absence of [[pathology]].<ref name=Vlaeyen2000/><ref name=Lethem1983>{{Cite pmid|6626110}}</ref><ref name="From Acute to Chronic Back Pain">{{cite book|title=From Acute to Chronic Back Pain|url=http://books.google.com/books?id=sXTZCLGjQ0cC&pg=PT282|accessdate=19 July 2012|publisher=Oxford University Press|isbn=978-0-19-162572-5|page=282}}</ref> If an individual experiences acute pain and manages the situation by using avoidant behavior, a lack of pain increase would [[Reinforcement|reinforce]] this behavior.<ref name="ZaretskyRichter2005">{{cite book|author1=Herbert H. Zaretsky|author2=Edwin F. Richter|author3=Myron G. Eisenberg|title=Medical Aspects Of Disability: A Handbook For The Rehabilitation Professional|url=http://books.google.com/books?id=qBt94ToEExkC&pg=PA223|accessdate=19 July 2012|date=21 June 2005|publisher=Springer Publishing Company|isbn=978-0-8261-7973-9|pages=223–4}}</ref> However, this avoidant behavior may cause the individual to decrease exercise which may in turn lead to increased disability.<ref name="ZaretskyRichter2005"/> In 1993, Waddell et al. developed a Fear-Avoidance Beliefs Questionnaire (FABQ) which showed that fear-avoidance beliefs about physical activities are strongly related to work loss.<ref name="ZaretskyRichter2005"/><ref name=Vlaeyen2000/><ref name=Waddell1993>{{Cite pmid|8455963}}</ref>

The '''fear-avoidance model''' (or '''FA model''') is a psychiatric model that describes how individuals develop and maintain chronic [[Human musculoskeletal system|musculoskeletal]] [[pain]] as a result of attentional processes and [[Avoidance coping|avoidant behavior]] based on pain-related [[fear]].<ref name=Leeuw2007>{{Cite journal | last1 = Leeuw | first1 = M. | last2 = Goossens | first2 = M. L. E. J. B. | last3 = Linton | first3 = S. J. | last4 = Crombez | first4 = G. | last5 = Boersma | first5 = K. | last6 = Vlaeyen | first6 = J. W. S. | doi = 10.1007/s10865-006-9085-0 | title = The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence | journal = Journal of Behavioral Medicine | volume = 30 | issue = 1 | pages = 77–94 | year = 2006 | pmid = 17180640| s2cid = 207186847 | url = https://lirias.kuleuven.be/handle/123456789/26202 | url-access = subscription }}</ref><ref name=":0">{{cite journal|last1 = Pincus|first1 = Tamar|last2 = Smeets|first2 = Rob J.E.M.|last3 = Simmonds|first3 = Maureen J.|last4 = Sullivan|first4 = Michael J.L.|s2cid = 18667121|title = The Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model|journal = The Clinical Journal of Pain|date = November 2010|volume = 26|issue = 9|pages = 739–746|doi = 10.1097/AJP.0b013e3181f15d45|pmid = 20842017|url = https://repository.royalholloway.ac.uk/items/d8bbafd5-e62f-0359-3979-f8ebf6a80d81/9/}}</ref><ref name=Vlaeyen2000>{{Cite journal

| last1 = Vlaeyen | first1 = J. W.

| last2 = Linton | first2 = S. J.

| title = Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art

| journal = Pain

| volume = 85

| issue = 3

| pages = 317–332

| year = 2000

| pmid = 10781906

| doi=10.1016/s0304-3959(99)00242-0

| s2cid = 14486753

| url = https://lirias.kuleuven.be/handle/123456789/206277

| url-access = subscription

}}</ref> Introduced by Lethem et al. in 1983, this model helped explain how these individuals experience pain despite the absence of [[pathology]].<ref name=Vlaeyen2000/><ref name=Lethem1983>{{Cite journal

| last1 = Lethem | first1 = J.

| last2 = Slade | first2 = P. D.

| last3 = Troup | first3 = J. D.

| last4 = Bentley | first4 = G.

| title = Outline of a Fear-Avoidance Model of exaggerated pain perception--I

| journal = Behaviour Research and Therapy

| volume = 21

| issue = 4

| pages = 401–408

| year = 1983

| pmid = 6626110

| doi = 10.1016/0005-7967(83)90009-8

}}</ref><ref name="From Acute to Chronic Back Pain">{{cite book|title=From Acute to Chronic Back Pain|url=https://books.google.com/books?id=sXTZCLGjQ0cC&pg=PT282|access-date=19 July 2012|publisher=Oxford University Press|isbn=978-0-19-162572-5|page=282|date=2012-01-19}}</ref> If an individual experiences acute discomfort and delays the situation by using avoidant behavior, a lack of pain increase [[Reinforcement|reinforces]] this behavior.<ref name="ZaretskyRichter2005">{{cite book|author1=Herbert H. Zaretsky|author2=Edwin F. Richter|author3=Myron G. Eisenberg|title=Medical Aspects Of Disability: A Handbook For The Rehabilitation Professional|url=https://books.google.com/books?id=qBt94ToEExkC&pg=PA223|access-date=19 July 2012|date=21 June 2005|publisher=Springer Publishing Company|isbn=978-0-8261-7973-9|pages=223–4}}</ref><ref name=":1">{{Cite journal|title = Beyond pain: the role of fear and avoidance in chronicity|last1 = Asmundson|first1 = Gordon|date = 1999|journal = Clinical Psychology Review|doi = 10.1016/S0272-7358(98)00034-8|pmid = 9987586|last2 = Norton|first2 = Peter|volume = 19|issue = 1|pages = 97–119}}</ref> Increased vulnerability provides [[positive feedback]] to the perceived level of pain and rewards avoidant behavior for removing unwanted stimuli.<ref name=":0" /><ref name=":2" /> If the individual perceives the pain as nonthreatening or temporary, he or she feels less anxious and confronts the pain-related situation.<ref name=":3">{{cite web|last1 = Selby|first1 = Edward|title = Avoidance of Anxiety as Self-Sabotage: How Running Away Can Bite You in the Behind|url = https://www.psychologytoday.com/blog/overcoming-self-sabotage/201005/avoidance-anxiety-self-sabotage-how-running-away-can-bite-you|website = Psychology Today|access-date = March 20, 2015}}</ref>{{ums|date=November 2017}}

Avoidant behavior is healthy when encouraging the individual to avoid stressing injuries and permitting them to heal.<ref name=":1" /> However, it is harmful when discouraging the individual from activity after the injury is healed.<ref name=":1" /> The resulting hypervigilance and disability restricts normal use of the tissue and deteriorates the individual physically and mentally.<ref name=":2">{{Cite journal|title = Fear-avoidance model of chronic pain: the next generation|journal = The Clinical Journal of Pain|date = Jul 2012|issn = 1536-5409|pmid = 22673479|pages = 475–483|volume = 28|issue = 6|doi = 10.1097/AJP.0b013e3182385392|first1 = Geert|last1 = Crombez|first2 = Christopher|last2 = Eccleston|first3 = Stefaan|last3 = Van Damme|first4 = Johan W. S.|last4 = Vlaeyen|first5 = Paul|last5 = Karoly|hdl = 1854/LU-2960547| s2cid=8169305 |hdl-access = free}}</ref> Once the avoidant behavior is no longer reinforced, the individual exits the positive feedback loop.<ref name=":0" /> In 1993, Waddell et al. developed a Fear-Avoidance Beliefs Questionnaire (FABQ) which showed that fear-avoidance beliefs about physical activities are strongly related to work loss.<ref name=Vlaeyen2000/><ref name="ZaretskyRichter2005"/>

== Examples ==

=== Anxiety sensitivity ===

[[Anxiety sensitivity]] is the fear of the symptoms of [[anxiety]]. An example of the fear-avoidance model, anxiety sensitivity stems from the fear that the symptoms of anxiety will lead to harmful social and physical effects. As a result, the individual delays the situation by avoiding any stimuli related to pain-inducing situations and activities, becoming restricted in normal daily function.<ref name=":0" />

=== Chronic pain ===

[[Chronic pain]] is another example that can originate from the drastic misinterpretation of pain as a catastrophe. As a result of this misinterpretation, the individual repeatedly avoids the pain-inducing activity and will likely overestimate any future pain from such activity. The excessive sensitivity to pain discourages the individual from exercise and weakens his or her body.<ref name=":2" />

==Criticisms==

Research involving the fear-avoidance model has led some to question its accuracy in representing or predicting the actual avoidance of physical activity due to [[negative reinforcement]]. In certain cases, the individual completely avoids anxiety-inducing behavior, so that the fear response never becomes directly involved. Other factors affecting the perceived level of danger and spatial awareness further complicate the model. While the fear-avoidance model may be simplistic for every situation involving fear, discomfort, and/or chronic pain, its effectiveness is generally acknowledged for diagnosing and understanding how humans positively or negatively react to fear and anxiety.<ref name=":2" />

==References==

{{reflist}}

[[Category:Psychiatric models]]