Fear Avoidance Model

Original Editor - Admin Top Contributors - Kim Jackson, George Prudden and Claire Knott

Fear-Avoidance Model

Another psychological issue associated with chronic pain is catastrophizing, which is outlined through the Fear Avoidance Model.

Fear is the emotional reaction to a specific, identifiable and immediate threat, such as a dangerous injury [1].  Fear may protect the individual from impeding danger as it instigates the defensive behaviour that is associated with the fight or flight response [2].

The Fear-Avoidance Model was designed to identify and explain why chronic low back pain problems, and associated disability, develop in members of the population suffering from an onset of low back pain [3]. This model indicates that a person suffering from pain will undergo one of two different pathways (Fig.1).

Fig.1 Fear Avoidance Model

                                                            Fig.1 Fear Avoidance Model [4]

This shows that when pain/injury occurs, people will take the path of continuing their independence without negative thoughts of the pain they are suffering from, therefore leading them to accept that they have this pain that ultimately accumulates to a faster recovery. In contrast to this, a cycle can be initiated if the pain is misinterpreted in a catastrophising manner. It has been recognised that these thoughts can lead on to pain-related fear and associated safety seeking behaviours, such as avoidance. However, this could cause the pain to become worse and enter a chronic phase due to the disuse and disability.  This in turn can lower the threshold at which the person will experience pain.


  1. Rachman, S., 1998. Anxiety. Psychological Press: Hove
  2. Cannon, W. B., 1929. Bodily changes in pain, hunger, fear and rage: an account of recent researches into the functions of emotional excitement. Appleton-Century-Crofts, New York
  3. Leeuw, M., Goossens, E.J.B., Linton, S., Crombez, G., Boersma, K., Vlaeyen, J., 2007. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. Journal of Behavioural Medicine, 30(1): 77-94
  4. www.psychomaticmedicine.org (2014) Fear Avoidance Model (photograph). Available at: http://www.psychosomaticmedicine.org/cgi/content-nw/full/67/5/783/F117 (Accessed 11th January 2014)