Exposure In Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice

Marlies den Hollander*, Rob J E M Smeets, Thijs Meulenbroek, Charlotte C M Laake-Geelen, Vera A Baadjou, Inge Timmers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance-behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives.

Original languageEnglish
Article number270
Number of pages9
JournalPhysical Therapy
Volume102
Issue number2
Early online date27 Jan 2022
DOIs
Publication statusPublished - 1 Feb 2022

Keywords

  • Chronic Secondary Pain
  • Exposure
  • Inhibitory Learning
  • Pain Neuroscience
  • Pain-Related Fear
  • CHRONIC BACK-PAIN
  • COGNITIVE-BEHAVIORAL THERAPY
  • CASE EXPERIMENTAL-DESIGN
  • FUNCTIONAL CONNECTIVITY
  • PERCEIVED HARMFULNESS
  • COMMITMENT THERAPY
  • AVOIDANCE MODEL
  • NECK PAIN
  • ANXIETY
  • ACCEPTANCE

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