Disability and rehabilitation · 2025
Avoidance and endurance coping after mild traumatic brain injury: patterns of coping and associated psychological functioning.
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Amarnath Nair Medha, Silverberg Noah D, Picon Edwina L, Debert Chantel T, Bayley Mark T, Hunt Cindy, Cairncross Molly
Аннотация
PURPOSE: According to the avoidance-endurance model of chronic pain, avoidance and endurance behaviors are distinct pathways to disability following injury. Both coping styles are associated with poor outcomes post-mild traumatic brain injury (mTBI), but whether they represent distinct pathways to disability is unclear. We assessed whether distinct patterns of avoidance and endurance coping exist post-mTBI (study 1) and examined their convergent/divergent validity in an independent sample (study 2).
METHODS: In study 1, adults (n = 554, Mage = 39.6) with mTBI completed measures of avoidance and endurance. K-means clustering was used to investigate coping patterns. In study 2, adults (n = 83, Mage = 41.6) with persisting mTBI symptoms and high avoidance/endurance behavior completed measures of avoidance, endurance, and psychological functioning. Individuals were clustered using cluster centers from study 1. Cluster differences in psychological functioning were assessed with ANOVAs.
RESULTS: Four clusters emerged in study 1: high-avoidance/high-endurance (group 1), low-avoidance/low-endurance (group 2), mid-avoidance/low-endurance (group 3), and mid-avoidance/high-endurance (group 4). In study 2, after controlling for symptom burden, group 1 had higher catastrophizing and thought suppression compared to groups 3 and 4.
CONCLUSIONS: Four poorly defined clusters were identified. The single cluster-defining factor associated with poorer psychological functioning was avoidance behavior, suggesting it may be an important treatment target.
METHODS: In study 1, adults (n = 554, Mage = 39.6) with mTBI completed measures of avoidance and endurance. K-means clustering was used to investigate coping patterns. In study 2, adults (n = 83, Mage = 41.6) with persisting mTBI symptoms and high avoidance/endurance behavior completed measures of avoidance, endurance, and psychological functioning. Individuals were clustered using cluster centers from study 1. Cluster differences in psychological functioning were assessed with ANOVAs.
RESULTS: Four clusters emerged in study 1: high-avoidance/high-endurance (group 1), low-avoidance/low-endurance (group 2), mid-avoidance/low-endurance (group 3), and mid-avoidance/high-endurance (group 4). In study 2, after controlling for symptom burden, group 1 had higher catastrophizing and thought suppression compared to groups 3 and 4.
CONCLUSIONS: Four poorly defined clusters were identified. The single cluster-defining factor associated with poorer psychological functioning was avoidance behavior, suggesting it may be an important treatment target.