Do fear avoidance beliefs increase persistent postconcussion symptoms? An experimental vignette study.

INTRODUCTION

There is substantial burden associated with mild traumatic brain injury (mTBI), particularly for people who experience persistent postconcussion symptoms (PPCS). Research has explored the role in PPCS of fear avoidance as a psychogenic contributing factor; however, understanding remains limited. The present study employed experimental methods to investigate the strength and direction of the relationship between fear avoidance and PPCS.

METHOD: Participants (N = 143) were randomly assigned to a fear avoidance (n = 74) or control group (n = 69). They viewed a mTBI vignette with or without statements activating fear avoidance beliefs and then reported anticipated PPCS. Participants additionally reported levels of anxiety and depression as a proxy for premorbid distress. Standardized questionnaires were used for all measurements.

RESULTS

After controlling for emotional distress, participants in the fear avoidance group reported significantly higher PPCS than control participants. Although the proportion of variance explained was modest (8%), this finding provides novel experimental evidence that fear avoidance has an explanatory role in simulated PPCS.

CONCLUSION

This study lends empirical support to theoretical models that implicate fear avoidance beliefs in the development and maintenance of PPCS, and further consideration of these beliefs as a treatment target.