Importance of avoidance and endurance in post-COVID syndrome Can dysfunctional patterns be changed?

[SNT Gatchaman]

Bedeutung von „avoidance“ und „endurance“ beim Post-COVID-Syndrom
Kupferschmitt, Alexa; Herrmann, Christoph; Jöbges, Michael; Kelm, Stefan; Sütfels, Gerhard; Loew, Thomas H.; Hasenbring, Monika; Köllner, Volker

BACKGROUND
The importance of dysfunctional coping strategies in the chronification of pain is well documented. The avoidance endurance model (AEM) has proven to be well-suited which, according to initial clinical experiences, is also well-suited to depicting dysfunctional illness behavior in post-COVID syndrome (PCS, COVID coronavirus disease). The aim of this study is to demonstrate which patterns occur and how frequently in PCS patients and whether they change in the context of multimodal rehabilitation.

METHOD
As part of the PoCoRe multicenter study, N = 721 PCS rehabilitation patients were examined with respect to illness behavior according to the AEM at the start and end of rehabilitation. Frequency analyses, χ2-tests and Sankey diagrams were used.

RESULTS
At the start of rehabilitation around 68% of PCS patients exhibited dysfunctional illness behavior, of which 45.5% were dysfunctional endurers (distress endurance response), in 22.3% fear avoidance was present, in 21.6% eustress endurance and in 10.5% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 11.3% towards adaptive response and by 10.6% to eustress endurance, which mainly comes from the former distress endurance types (−13.9%). Fear avoidance decreased by approx. 12%. Within the individual AEM reaction patterns, dysfunctional patterns can change in favor of functional patterns as well as functional patterns in favor of dysfunctional patterns.

CONCLUSION
The clear predominance of dysfunctional patterns in this highly chronified sample suggests that the avoidance endurance concept is also relevant in the chronification of fatigue in PCS. In contrast to chronic pain patients, however, the endurance patterns clearly predominate here. There was a clear shift towards the functional pattern during rehabilitation, which speaks in favor of modifiability; however, around 10% of patients developed in an unfavorable direction, which should be taken into account in treatment planning and investigated further.

Link | PDF (Der Schmerz) [Paywall, Article in German]

 

[Sean]

 

[rvallee]

It's like enshittification except it started terrible and it just gets worse for zero benefits to anyone. Literally no one benefits from this, but it's happening anyway.

 

[Trish]

I tried to find something about the Avoidance-Endurance model and found this article from 2022 about chronic back pain by a bunch of psycologists and rehab people in Austria and the USA:
Perceived psychosocial stressors and coping resources in chronic low back pain patients as classified by the avoidance-endurance model

Introduction​

The Avoidance-Endurance model (AEM) distinguishes between four different pain coping patterns in persons afflicted with low back pain (LBP): patients with fear-avoidance (FAR), eustress-endurance (EER), distress-endurance (DER), and adaptive pain response patterns (AR) (1).

The three maladaptive pain response or pain coping patterns (FAR, EER, DER) constitute a risk factor for pain chronification. Differences in the pain response are likely driven by differences in coping with pain-related fear, pain-related cognition, and affective responses (2).

Patients with FAR tend to employ catastrophizing thoughts, which correspond with an increased fear of pain and the avoidance of specific movements or activities, while patients with EER or DER tend to suppress thoughts of fear and pain or distract themselves, which allows them to maintain activities despite experiencing pain (1).

Patients with EER are typically in a more positive mood, whereas those with DER demonstrate a more negative mood in response to pain (1, 2). By contrast, patients who demonstrate an adaptive coping style regarding pain are able to observe bodily signals and deal with them in a flexible way, neither avoiding nor persisting too much in their activities despite pain. Patients with such adaptive coping techniques are less at risk for pain chronicity.