Fear of movement and avoidance behaviors are associated with poor responses to treatment and clinical outcomes. This study uses a clinical case to accomplish four goals: 1) demonstrate within-person discrepancies in fear and avoidance behaviors; 2) explain the importance of interpreting individual items (rather than total scores) of self-report measures of fear of movement to better guide treatment; 3) demonstrate an in-depth behavioral assessment that identifies safety behaviors; and 4) design behavioral treatments that are informed by a person-centered assessment of fear of movement and avoidance behaviors.
When performing a person-centered evaluation includes, it’s vital to understand the patient’s perspective and the specific context of their fear of movement and avoidance behaviors. Questionnaires can provide some guidance, but the total score may be misleading. A patient may score high on a specific measure, relating to an important task, but score low overall, leading the therapist to dismiss fear as a potential concern. Patient’s often present with avoidant behaviors that are context-specific, and not universal to all situations. The case presented in this paper is a perfect example.
Eva presented with low back pain and feared lumbar flexion and some activities but not others. She used safety behaviors (such as positioning her steer in a high position so she could remain upright while cycling for exercise) and avoidance behaviors (such as no longer dancing with her daughter). The cycling was modified but continued because her value of exercising with her husband outweighed her fear of pain and harm. The reverse was true for cleaning the house so that activity was discontinued. Safety behaviors may help with increasing activity in the short term but they can lead to long-term impairments by strengthening fear of the original activity. Exposure therapy (for example, purposefully lifting with a rounded back) in a controlled environment teaches someone to confront the feared movement. When they complete the tasks without the feared event occurring (spike in pain or injury), the fear reduces. A goal is to maximize expectancy violation during exposure therapy.
I encourage you to read the full article to see more specific examples of how to address fear of movement.