Does the fear avoidance model explain persistent symptoms after traumatic brain injury?

Melloney L. M. Wijenberg, Sven Z. Stapert, Jeanine A. Verbunt, Jennie L. Ponsford, Caroline M. Van Heugten

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36 Citations (Scopus)


Background: A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking. Objective: To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI. Design: Cross-sectional study. Participants: 48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome. Outcome variables: catastrophizing, fear-avoidance, depression and post-concussion symptoms. Results: High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05). Conclusion: The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature.

Original languageEnglish
Pages (from-to)1597-1604
Number of pages8
JournalBrain Injury
Issue number12
Publication statusPublished - 5 Oct 2017
Externally publishedYes


  • Catastrophizing
  • chronic phase
  • fear avoidance behaviour
  • persistent symptoms
  • post concussional syndrome
  • Traumatic brain injury

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