thumb|400px|Fear-avoidance model The '''fear-avoidance model''' (or '''FA model''') is a psychiatric model that describes how individuals develop and maintain chronic musculoskeletal pain as a result of attentional processes and avoidant behavior based on pain-related fear.<ref name=Leeuw2007>{{Cite journal | last1 = Leeuw | first1 = M. | last2 = Goossens | first2 = M. L. E. J. B. | last3 = Linton | first3 = S. J. | last4 = Crombez | first4 = G. | last5 = Boersma | first5 = K. | last6 = Vlaeyen | first6 = J. W. S. | doi = 10.1007/s10865-006-9085-0 | title = The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence | journal = Journal of Behavioral Medicine | volume = 30 | issue = 1 | pages = 77–94 | year = 2006 | pmid = 17180640| s2cid = 207186847 | url = https://lirias.kuleuven.be/handle/123456789/26202 | url-access = subscription }}</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.|s2cid = 18667121|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|pmid = 20842017|url = https://repository.royalholloway.ac.uk/items/d8bbafd5-e62f-0359-3979-f8ebf6a80d81/9/}}</ref><ref name=Vlaeyen2000>{{Cite journal | last1 = Vlaeyen | first1 = J. W. | last2 = Linton | first2 = S. J. | title = Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art | journal = Pain | volume = 85 | issue = 3 | pages = 317–332 | year = 2000 | pmid = 10781906 | doi=10.1016/s0304-3959(99)00242-0 | s2cid = 14486753 | url = https://lirias.kuleuven.be/handle/123456789/206277 | url-access = subscription }}</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 journal | last1 = Lethem | first1 = J. | last2 = Slade | first2 = P. D. | last3 = Troup | first3 = J. D. | last4 = Bentley | first4 = G. | title = Outline of a Fear-Avoidance Model of exaggerated pain perception--I | journal = Behaviour Research and Therapy | volume = 21 | issue = 4 | pages = 401–408 | year = 1983 | pmid = 6626110 | doi = 10.1016/0005-7967(83)90009-8 }}</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|access-date=19 July 2012|publisher=Oxford University Press|isbn=978-0-19-162572-5|page=282|date=2012-01-19}}</ref> If an individual experiences acute discomfort and delays the situation by using avoidant behavior, a lack of pain increase 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|access-date=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|title = Beyond pain: the role of fear and avoidance in chronicity|last1 = Asmundson|first1 = Gordon|date = 1999|journal = Clinical Psychology Review|doi = 10.1016/S0272-7358(98)00034-8|pmid = 9987586|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|access-date = 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|first1 = Geert|last1 = Crombez|first2 = Christopher|last2 = Eccleston|first3 = Stefaan|last3 = Van Damme|first4 = Johan W. S.|last4 = Vlaeyen|first5 = Paul|last5 = Karoly|hdl = 1854/LU-2960547| s2cid=8169305 |hdl-access = free}}</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"/>
== Examples ==
=== 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 the symptoms of anxiety will lead to harmful social and physical effects. As a result, the individual delays the situation by avoiding any stimuli related to pain-inducing situations and activities, becoming restricted in normal daily function.<ref name=":0" />
=== Chronic pain === Chronic pain is another example that can originate from the drastic misinterpretation of pain as a catastrophe. As a result of this misinterpretation, the individual repeatedly avoids the pain-inducing activity and will likely overestimate any future pain from such activity. The excessive sensitivity to pain discourages the individual from exercise and weakens his or her body.<ref name=":2" />
==Criticisms==
Research involving the fear-avoidance model has led 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=":2" />
==References== {{reflist}}
Category:Psychiatric models