Avoidance and endurance coping after mild traumatic brain injury: patterns of coping and associated psychological...

According to the avoidance-endurance model of chronic pain, avoidance and endurance behaviors are distinct pathways to disability following injury. Both coping styles are associated with poor outcomes post-mild traumatic brain injury (mTBI), but whether they represent distinct pathways to disability is unclear. We assessed whether distinct patterns of avoidance and endurance coping exist post-mTBI (study 1) and examined their convergent/divergent validity in an independent sample (study 2).

In study 1, adults (n = 554, M_age = 39.6) with mTBI completed measures of avoidance and endurance. K-means clustering was used to investigate coping patterns. In study 2, adults (n = 83, M_age = 41.6) with persisting mTBI symptoms and high avoidance/endurance behavior completed measures of avoidance, endurance, and psychological functioning. Individuals were clustered using cluster centers from study 1. Cluster differences in psychological functioning were assessed with ANOVAs.

Four clusters emerged in study 1: high-avoidance/high-endurance (group 1), low-avoidance/low-endurance (group 2), mid-avoidance/low-endurance (group 3), and mid-avoidance/high-endurance (group 4). In study 2, after controlling for symptom burden, group 1 had higher catastrophizing and thought suppression compared to groups 3 and 4.

Four poorly defined clusters were identified. The single cluster-defining factor associated with poorer psychological functioning was avoidance behavior, suggesting it may be an important treatment target.