- Workshop Summary:
The fear-avoidance model has been studied extensively and understanding and addressing the components of it can be useful for patients struggling with fear and specifically fear of symptoms, movement, injury, postures, activities, etc. Working through this model can help patients reduce fear, regain confidence, and restore agency, as well as reduce symptoms. The fear-avoidance model includes some core components that can cause and then continue to contribute to a vicious chronic pain cycle. These components include pain catastrophizing, pain-related fear/ kinesiophobia, hypervigilance, avoidance, disuse, depression, and disability. Many of these components can be assessed for and then addressed in the treatment.
For some patients, the main threat or danger (fear) are the symptoms themselves, what they mean, the importance they take on, and the threat value they represent. For. example, prior learning, beliefs, and negative medical information like physical diagnoses and mis-interpreted scans can raise the threat value of the symptoms. This can lead to a sequelae of downstream negative effects like mental catastrophizing (thinking for the worst), excessively or intently focusing on the symptoms (hypervigilance), and then fearing the symptoms and the activities that could cause them (kinesiophobia). This can then lead to a cycle of avoidance in attempt to keep symptoms at bay. A person's world can then shrink leading to disuse, potential disability, and feelings of depression. This is the fear-avoidance cycle in a nutshell.
The goal is to first identify if these fear-avoidance components are at play in a patient. Assessing the patient can include direct enquiry and questioning, but it could also include proven and validated screening tools like the Pain Catastrophizing Scale (PCS)for example. Then the clinician or coach can look to address these fear-avoidance components, working with a number of strategies. This first would be ruling out that the symptoms are structural (physical) and then ruling in they are neuroplastic (using patient history and the FIT criteria). One could then use for example, Pain Re-Processing Therapy (PRT) to address hypervigilance and graded exposure to address avoidance.
Learning Objectives:
- To understand what the Fear-Avoidance Model is and the research that supports it in relation to chronic pain and neuroplastic symptoms.
- Learn the core components of the fear-avoidance model, what they mean, and how to assess for them in patients or clients. -
- What strategies can you use to address these components to help people reduce fear and reduce neuroplastic symptoms.
