Vlaeyen JWS Linton SJ Fearavoidance and its consequences

Vlaeyen JWS & Linton SJ Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art Pain 2000; 85: 317 -32 injury disuse, disability, depression hypervigilance avoidance, tension pain experience recovery confrontation pain-related fear pain catastrophizing negative affectivity, threatening illness information no fear this fear-avoidance model is important for many chronic pain problems – its relevance and usefulness will vary with time, type of problem & pain sufferer

why catastrophizing persists attentional deployment spontaneous imagery safety seeking behaviours adapted from: Clark DM Behav Res Ther 1999; 37: S 5 -27 persisting sense of threat memory processes emotional reasoning nature of threat representation

active ingredients of cognitive therapy all procedures are explicitly used to tackle distorted beliefs ü ü ü ü education verbal discussion methods imagery modification attentional manipulation exposure to feared stimuli safety behaviour manipulation & numerous other methods … from: Clark DM Behav Res Ther 1999; 37: S 5 -27

maintaining factors for anxiety states Salkovskis PM potential threats Anxiety, beliefs & situations, sensations, thoughts safety-seeking behaviour in: selective attention Frontiers of psychotherapy New York: Guilford Press, 1996 appraisal of threat failure to disconfirm probability x awfulness coping + rescue safety seeking behaviours avoidance, escape, within-situation, neutralisation, checking, reassurance maintenance of arousal physiological & biological changes