injury pain experience no fear confrontation recovery pain catastrophizing pain-related fear hypervigilance avoidance, tension disuse, disability, depression negative affectivity, threatening illness information Vlaeyen JWS & Linton SJ Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art Pain 2000; 85: this fear-avoidance model is important for many chronic pain problems – its relevance and usefulness will vary with time, type of problem & pain sufferer

why catastrophizing persists persisting sense of threat spontaneous imagery attentional deployment safety seeking behaviours adapted from: Clark DM Behav Res Ther 1999;37:S5-27 memory processes emotional reasoning nature of threat representation

active ingredients of cognitive therapy education verbal discussion methods imagery modification attentional manipulation exposure to feared stimuli safety behaviour manipulation & numerous other methods … from: Clark DM Behav Res Ther 1999; 37: S5-27 all procedures are explicitly used to tackle distorted beliefs

maintaining factors for anxiety states appraisal of threat probability x awfulness coping + rescue physiological & biological changes potential threats situations, sensations, thoughts safety seeking behaviours avoidance, escape, within-situation, neutralisation, checking, reassurance selective attention maintenance of arousal failure to disconfirm Salkovskis PM Anxiety, beliefs & safety-seeking behaviour in: Frontiers of psycho- therapy New York: Guilford Press, 1996