Avoidance and endurance coping after mild traumatic brain injury are associated with disability outcomes.

Abstract

Objective: Fear-avoidance and endurance behavior are well-established maladaptive coping styles in several chronic health conditions. There is also emerging evidence that both fear-avoidance and endurance coping are associated with poor outcome from mild traumatic brain injury (mTBI). The current study sought to characterize the early trajectories of avoidance and endurance behavior and confirm their association with disability outcomes. Method: Adults with mTBI (N = 88) completed measures of avoidance, endurance, and postconcussive symptoms at clinic intake (M = 40.2 days since injury). Avoidance and endurance measures were readministered 1 month later (N = 79), and a measure of perceived functional disability (World Health Organization Disability Assessment Schedule 2.0) was completed 3 months after clinic intake (N = 69). Results: Avoidance and endurance coping were weakly positively correlated with each other at intake (r = .28) and at 1 month postintake (r = .28). Change scores on these two measures over time were not significantly correlated (r = .04). Avoidance coping tended to decrease over time (95% CI [0.6, 2.5]; p = .002), whereas changes in endurance coping were variable. In generalized linear modeling, higher avoidance and endurance at clinic intake and increasing (or less rapidly decreasing) levels of these coping styles over 1 month was associated with greater perceived disability ratings at 3 months, even after controlling for postconcussion symptom severity at intake. Conclusion: These findings suggest that avoidance and endurance behavior are distinct coping styles with unique trajectories during the subacute recovery period. The results also support the need for psychologically informed early interventions that target specific profiles of maladaptive coping to mitigate risk for poor outcomes post-mTBI.

The relationship of cogniphobia to performance validity and symptom validity in neuropsychological assessment.

“…The strong predictive effects of Avoidance on both performance and SVT are expected, given that Avoidance also predicted presence of clear external incentive, which is a salient component of malingering and other noncredible presentations. Overall, these findings are consistent with the fear-avoidance model (Vlaeyen et al, 1995;Vlaeyen & Linton, 2000), which suggests a strong role for fear leading to avoidance (in this case of cognitive tasks, including PVTs) and with prospective studies demonstrating a causal role for fear-avoidance in clinical outcomes (Cassetta et al, 2021;Silverberg et al, 2018). However, due to the cross-sectional design of the present study, future studies with longitudinal designs are needed to determine the causal nature of the relationship between cogniphobia subcomponents and validity testing outcomes.…”

The role of psychological flexibility in recovery following mild traumatic brain injury.

“…Our results suggest that psychological flexibility may be one such mechanism. Fear avoidance has also been proposed as a mechanism that could contribute to mTBI recovery (Cassetta et al, 2021; Silverberg et al, 2018; Wijenberg et al, 2017). Fear avoidance postulates that anxiety may lead to symptom amplification due to misattribution of symptoms and elimination or reduction of activities.…”

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

“…Psychological factors, such as preinjury mental health problems and postinjury emotional distress, can strongly influence recovery from mTBI. 10 34 Certain maladaptive (unhelpful) illness beliefs (e.g., catastrophizing) 35 and behavioral coping styles (e.g., avoidance) 36 37 38 also predict higher symptom burden and disability. These psychosocial risk factors are modifiable and can be targeted with psychologically informed interventions to mitigate poor outcomes.…”

“…62 63 64 One such promising avenue is providing rehabilitation that targets specific modifiable behavioral coping styles, such as fear avoidance. 36 37 65 Fear avoidance behavior is a coping style in which people avoid or escape from activities or situations that might exacerbate their symptoms. Fear avoidance behavior predicts disability and higher symptom burden in post-acute mTBI.…”