Graded In Vivo Exposure Treatment for Fear-Avoidant Pain Patients with Functional Disability: A Case Study

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Abstract
This single-subject study attempts to replicate the effects of in vivo exposure for pain patients with functional difficulties. Fear-avoidance is a clear risk factor related to dysfunction associated with back pain. Nevertheless, until recently treatment had not dealt specifically with the avoidance behaviour. The treatment of other phobias suggests that in vivo exposure might be an efficient means of treatment. As patients do not normally conceptualize their problem as a phobia, there have been numerous problems in developing exposure techniques. Recently, however, an in vivo exposure technique for pain-related functional problems has been described. The study described here replicates the method: 2 male chronic back pain patients with functional problems and high scores on the Tampa Scale for Kinesiophobia volunteered to participate. Hierarchies were established with the help of a "fear thermometer" and the patients were subsequently provided with 8 sessions of in vivo exposure. The results replicated the original study and showed substantial improvements for both patients as they increased their function and decreased their fear. Thus, the findings are extended to another setting: patients and therapists. It is concluded that these results warrant further investigation in larger, controlled trials. Key words: back pain, activity training exposure, fear-avoidance.