Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Psychology



First Advisor

Robert J Gatchel


Fear-avoidance (FA) is a negative coping style where patients avoid physical and social activities out of fear that their pain may increase or that they may re-injure themselves. Although fear-avoidance often increases in chronic pain patients, and is an important predictive factor of rehabilitation outcomes, few questionnaires are designed to systematically evaluate all components of fear-avoidance, especially in a Chronic Musculoskeletal Pain Disorder (CMPD) population. Therefore, the purpose of this study is to develop and validate a new patient-reported outcome (PRO) measurement of fear-avoidance, entitled the Fear-Avoidance Components Scale (FACS) in three separate populations: CMPD, psychiatric chronic pain, and a normative sample. The FACS was found to be reliable (r ≥ .90, α = ≥ .91) and valid. The five severity levels developed [Subclinical (0-20); Mild (21-40); Moderate (41-60); Severe (61-80); and Extreme (81-100) related well to objective lifting performance (p ≤ .03), as well as the TSK, a well-known FA measure, and additional PROs measuring perceived disability, insomnia, depressive symptoms, pain intensity, somatization, injustice, coping styles, and the likelihood of being diagnosed with a central sensitivity syndrome (p ≤ .01), all of which were posited to relate well to FA. In addition, admission demographic, occupational, and psychiatric diagnoses were examined, and the FACS was used to predict the one-year outcomes of work return and work retention successfully (p ≤ .05). Factor analysis supported the a priori subscales of pain-related anxiety, activity avoidance, and victimization.


Psychology | Social and Behavioral Sciences


Degree granted by The University of Texas at Arlington

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