To avoid or not to avoid, that's the question: the relationship between pain-related avoidance behaviour, pain-related fear, and pain reports

Christine (Maria) van Vliet

Research output: ThesisDoctoral ThesisMixed; collaboration

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Why is it that some people develop chronic pain after an injury, while others do not? Pain has a clear function for our survival, because it signals potential harm or danger to the body and promotes behaviours, such as avoidance and escape, to protect ourselves against these dangers. However, pain could also become a false alarm, especially in the case of chronic pain, where there is often no objectifiable injury and where pain is disconnected from its original function. This PhD research project introduced a new line of experimental work to further investigate the relationship between pain-related avoidance behaviour and pain-related fear. In a series of studies (the perception of) avoidance behaviour was experimentally manipulated and its effects on changes in fear and pain reports were tested. The results of these studies indicated that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (i.e. bidirectionality hypothesis, whereby pain-related fear leads to avoidance behaviour (one direction) and in turn, engaging in avoidance behaviour increases pain-related fear (other direction)).
Original languageEnglish
Awarding Institution
  • Maastricht University
  • KU Leuven
  • Vlaeyen, Johannes, Supervisor
  • Meulders, Ann, Co-Supervisor
  • Vancleef, Linda, Co-Supervisor
Award date11 Jan 2021
Place of PublicationMaastricht
Print ISBNs9789086665112
Publication statusPublished - 2021


  • avoidance
  • pain-related fear
  • pain
  • fear-avoidance model of chronic pain

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