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Updated: Feb 21, 2026

A Mouse Model of Single and Repetitive Mild Traumatic Brain Injury
Published on: June 20, 2017
Does the fear avoidance model explain persistent symptoms after traumatic brain injury?
Melloney L M Wijenberg1,2, Sven Z Stapert1,3, Jeanine A Verbunt4
1a Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , the Netherlands.
Background:
A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking.
Objective:
To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI.
Design:
Cross-sectional study.
Participants:
48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome.
Outcome Variables:
catastrophizing, fear-avoidance, depression and post-concussion symptoms.
Results:
High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05).
Conclusion:
The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature.
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