ReviewCognitive, affective & behavioral neuroscience2024
The fear-avoidance model as an embodied prediction of threat.
Review in Cognitive, affective & behavioral neuroscience, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Kinesiophobia and its impact on shoulder function in patients following arthroscopic rotator cuff repair of the supraspinatus tendon: a cross-sectional study.BMC musculoskeletal disorders · 2026Article
- Article
- Proposing an explanatory framework based on the fear-avoidance model: a mixed-methods analysis of kinesiophobia in patients after percutaneous coronary intervention in home-based cardiac rehabilitation.Frontiers in cardiovascular medicine · 2026Article
- Article
- Effects of avoidance in German military police resilience training.Military psychology : the official journal of the Division of Military Psychology, American Psychological Association · 2026Article
- A nested case-control analysis of factors influencing preoperative hospitalization fear in pediatric patients and the alleviating effects of child-friendly visual interventions.BMC pediatrics · 2025Article
- Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study.JMIR formative research · 2025Observational
- A Qualitative Study on Barriers and Facilitators to Postpartum Cardiovascular Disease Risk Screening in Women with Hypertensive Disorders of Pregnancy: Perspectives from Patients and Healthcare Providers.International journal of women's health · 2025Article
- Hacking the Predictive Mind.Entropy (Basel, Switzerland) · 2024Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The fear-avoidance model is a well-established framework in the understanding of persistent pain. It proposes a dichotomous path: either the context is interpreted as safe; there is no fear reaction and, therefore, the individual engages in active (positive) coping; or the context is interpreted as threatening, leading to a self-reinforcing vicious circle of fear and (negative) avoidance. We propose an embodied interpretation of this phenomenon employing the joint framework of predictive coding and active inference. The key idea is that multisensory integration of exteroceptive, proprioceptive, and interoceptive sensory inputs can lead to dysfunctional experiences of threat in nonthreatening situations. Threat inference can promote fear responses, maladaptive strategies (i.e., avoidance) and self-provides evidence for threat in associated or future contexts, or both. Under this treatment, the prediction of nonrealized threat becomes self-evidencing and context-invariant, and hence self-perpetuating. Safety cues are unable to attenuate the interpretation of the negative context as the dominant inference of the context is threatful and gains more precision and becomes resistant over time. Our model provides an explanation for the emergence of a dysfunctional fear response in the clinical setting despite apparent safety based on modern concepts from theoretical (computational) neuroscience.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.