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}}</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|accessdate=19 July 2012|publisher=Oxford University Press|isbn=978-0-19-162572-5|page=282}}</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|accessdate=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|url = http://ac.els-cdn.com/S0272735898000348/1-s2.0-S0272735898000348-main.pdf?_tid=82e645a2-c8f5-11e4-8aeb-00000aab0f6c&acdnat=1426191931_813b2e82c00c9352010fb992a582c418|title = Beyond pain: the role of fear and avoidance in chronicity|last = Asmundson|first = Gordon|date = 1999|journal = Clinical Psychology Review|doi = 10.1016/S0272-7358(98)00034-8|pmid = |access-date = |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|accessdate = 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|first = Geert|last = Crombez|first2 = Christopher|last2 = Eccleston|first3 = Stefaan|last3 = Van Damme|first4 = Johan W. S.|last4 = Vlaeyen|first5 = Paul|last5 = Karoly}}</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"/>
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