Research Updates

Research short: The only thing we have to fear is fear itself

Dr Mary Wyatt

Disability is more likely if a patient worries about their illness.

The fear avoidance scale was developed in the 1980s to provide a framework for understanding a patient’s response to pain and how it affects the outcome of their illness.

At one end of the scale is the person who copes easily, has high levels of confidence in their abilities and is generally good at problem solving. They are confident they will work out a way to deal with the particular situation, whether it is a health condition or another problem.

At the other end of the spectrum is the person who catastrophises about their problem. The situation becomes more intense and dramatic, and they are highly fearful of the consequences of their illness.

Researchers in Spain sought to understand whether coping and catastrophising, two opposite ends of the fear avoidance spectrum, influenced disability and depression in patients with whiplash.

Approximately 150 patients who had had whiplash or neck pain for less than three months were assessed. The patients completed a series of questionnaires which provided the researchers with information about their pain coping and pain catastrophising approaches.

The researchers found that catastrophising increased the likelihood of subsequent disability and depression in patients. The researchers found that pain-coping strategies helped to a limited degree, but did not completely negate the effect of catastrophising. 

This study’s importance highlights the need to ascertain whether catastrophising is occurring, and focus on managing any resulting distress. Catastrophising can be recognised when an individual uses emotive language, reports high levels of anxiety and fear about their condition, and is avoiding a number of activities that might cause some increase in their pain. People who are catastrophising require more time, more explanation, and higher levels of energy and focus from their treating practitioners. 



Nieto R. Miro J. Huguet A. & Saldana C. 


PSINET research group, Internet Interdisciplinary Institute (IN3), Universitat Oberta de Catalunya (UOC), Barcelona, Spain.


Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?


Disability & Rehabilitation. 33(5):389-98, 2011.


PURPOSE. The aim is to study how pain coping strategies and catastrophising are related to disability and depression in patients with whiplash-associated disorders (WAD). Specifically, we wanted to test if they are independent predictive variables, after controlling for pain severity, sociodemographic and crash-related variables.

METHODS.A convenience sample of 147 patients with WAD of less than 3 months of duration was recruited. They were requested to complete the Pain Catastrophising Scale, the two-item version of the Chronic Pain Coping Inventory and to report sociodemographic and crash-related information, pain intensity, disability and depression.

RESULTS.Although several pain coping strategies were related with disability in univariate analyses, only asking for assistance was a marginally significant predictive variable in a multiple regression analysis after controlling for catastrophising. Catastrophising was a significant predictive variable after controlling for pain coping strategies. With depression as the outcome, resting and task persistence were the only pain coping strategies which were related in univariate analyses. However, none of them were predictive variables after controlling for catastrophising. Again, catastrophising was a significant predictive variable after controlling for pain coping strategies.

CONCLUSIONS.Our results show that catastrophising about pain is more important than pain coping strategies in patients with WAD of a short duration. These results can contribute to the conceptual distinction between pain coping strategies and catastrophising.

Publication Type

Journal Article.

PubMed Link: