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Lowering fear-avoidance and enhancing function through exposure in vivo: a multiple baseline study across six patients with back pain
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-9429-9012
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-5359-0452
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2004 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, no 1-2, p. 8-16Article in journal (Refereed) Published
Abstract [en]

This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.

Place, publisher, year, edition, pages
2004. Vol. 108, no 1-2, p. 8-16
National Category
Social Sciences Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-2817DOI: 10.1016/j.pain.2003.03.001OAI: oai:DiVA.org:oru-2817DiVA, id: diva2:134642
Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
Open this publication in new window or tab >>Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Betydelsen av rädsla och undvikande i utvecklingen av ett långvarigt smärtproblem : implikationer för sekundär prevention
Abstract [en]

This dissertation focused on the role of fear and avoidance in the development of a persistent back pain problem. The first aim of this dissertation was to study when and how cognitive, affective and behavioral factors influence one another in the development of persistent pain and disability. The moderating role of pain duration on the relationship between psychological risk factors and dysfunction was studied, as well as the interrelationships between psychological risk factors within individuals.

The results suggest that pain duration may moderate the relationship between some of the psychological risk factors and function. In study two, depression and function were interrelated independent of stages of chronicity while the strength of the relationship between fear of movement and function increased across the stages. Further, the results suggest that there may be individual variability in the importance of psychological risk factors and in how these factors are interrelated within individuals. In study one and three profiles of psychological functioning emerged that were characterized by pain-related fear with and without depressed mood, by depressed mood only, and by low pain-related fear and no depressed mood. These profiles were meaningfully related to future disability.

The second aim of this dissertation was to test a new treatment that is designed to match patients with high levels of fear and avoidance. The results of study four show that this exposure treatment can produce significant decreases in fear and increases in function.

The results of the studies in this dissertation suggest that we need to assign a key role to psychological processes such as pain-related fear, depressed mood, and avoidance in our efforts to understand the development of persistent back pain disability. The results highlight that there may be several roads towards a persistent back pain problem and that the relationship between psychological factors and disability is not static but appears to change as a function of pain duration. This suggests that we need to know more about the process of development of persistent back pain disability and that future research should incorporate the role of time, as well as take into consideration that there may be individual variability in the importance of factors and their interactions. Lastly, the results suggest that secondary prevention of persistent back pain disability could be enhanced by addressing psychological processes at a much earlier time point than is currently practiced and by customizing interventions to the characteristics of the individual patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2005. p. 71
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 5
Keyword
Psychology, pain-related fear, fear-avoidance model, back pain, disability, development, exposure, Psykologi
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-110 (URN)91-7668-433-4 (ISBN)
Public defence
2005-05-20, Aulan, B-huset, Universitetssjukhuset, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-10-18Bibliographically approved

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Boersma, KatjaLinton, Steven J.

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