Fear-avoidance model: Difference between revisions

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

The '''fear-avoidance model''' (or FA model) is a model that describes how individuals develop 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=":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.|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}}</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 paindiscomfort and managesdelays the situation by using avoidant behavior, a lack of pain increase would [[Reinforcement|reinforcereinforces]] 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><ref However,name=":1">{{Cite thisjournal|url avoidant= behaviorhttp://ac.els-cdn.com/S0272735898000348/1-s2.0-S0272735898000348-main.pdf?_tid=82e645a2-c8f5-11e4-8aeb-00000aab0f6c&acdnat=1426191931_813b2e82c00c9352010fb992a582c418|title may= causeBeyond pain: the individualrole toof decreasefear exerciseand which mayavoidance in turnchronicity|last lead= toAsmundson|first increased= disability.<refGordon|date name="ZaretskyRichter2005"/> In1999|journal 1993,= WaddellClinical etPsychology al.Review|doi developed= a10.1016/S0272-7358(98)00034-8|pmid Fear= |access-Avoidancedate Beliefs= Questionnaire|last2 (FABQ)= whichNorton|first2 showed= thatPeter|volume fear-avoidance= beliefs19|issue about= physical1|pages activities= are97-119}}</ref> stronglyIncreased relatedvulnerability provides positive feedback to workthe perceived level of pain and rewards avoidant behavior for removing unwanted lossstimuli.<ref name="ZaretskyRichter2005:0" /><ref name=Vlaeyen2000":2" /><ref name=Waddell1993":3" /> 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">{{Citecite pmidweb|8455963last1 = 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|accessdate = March 20, 2015}}</ref>

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|url = http://www.ncbi.nlm.nih.gov/pubmed/22673479|journal = The Clinical Journal of Pain|date = Jul 2012|access-date = 2015-04-11|issn = 1536-5409|pmid = 22673479|pages = 475-483|volume = 28|issue = 6|doi = 10.1097/AJP.0b013e3182385392|first = Geert|last = Crombez|first2 = Christopher|last2 = Eccleston|first3 = Stefaan|last3 = Van Damme|first4 = Johan W. S.|last4 = Vlaeyen|first5 = Paul|last5 = Karoly}}</ref>f Once the avoidant behavior is no longer reinforced, the individual exits the positive feedback loop.<ref name=":0" /><ref name=":3" /> 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=":3" />

==References==

{{reflist}}

== Examples ==

[[Category:Psychiatric models]]

=== 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 symptoms of anxiety will lead to harmful social and physical effects. As a result, the individual delays the situation by avoiding many stimuli, especially those related to pain-inducing situations and activities, and becomes restricted in normal daily function.<ref name=":0" />

=== Chronic Pain ===

Another example, chronic pain can originate from the drastic misinterpretation of pain as a catastrophe. As a result, the individual repeatedly avoids the pain-inducing activity and most likely overestimates any future pain from the activity. The excessive sensitivity to pain discourages the individual from exercise and weakens his or her body.<ref name=":2" />

==Application==

Analysis of the fear-avoidance model and reduction of fear-avoidance beliefs in patients can be used in patient health recovery. The use of [[cognitive behavioral therapy]] and [[graded exercise therapy]] in conjunction with fear-avoidance models successfully reduced extreme lethargy and fear of exercise, especially in patients with [[chronic fatigue syndrome]]. Researchers found that reducing the fear of presumed harm from physical activity was key to reducing chronic fatigue and stimulating patients to resume their normal daily activities.<ref name=":3" />

==Criticisms==

Research involving the fear-avoidance model has lead 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=":3" />

==References==

{{reflist}}

[[Category:Psychiatric models]]

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