Threat appraisal and avoidance after traumatic brain injury: why and how often are activities avoided?

OBJECTIVE: Goldstein emphasized the anxiety-related avoidance of activities after brain injury, but such avoidance has rarely been systematically investigated. This study aimed to compile a list of specific threat appraisals that may lead to avoidance and to obtain data on the frequency with which these appraisals and consequent avoidance occur.

DESIGN: Survey.

METHOD: Qualitative methodology was used to obtain an account of threat appraisals. These data were then used to compile two questionnaires that asked about the experience of these appraisals and consequent avoidance. Fifty individuals with a TBI completed the questionnaires.

RESULTS: A varied list of threat appraisals was obtained. Appraisals and consequent avoidance were frequent in the sample. Males and those whose TBI resulted from an assault reported more avoidance.

CONCLUSIONS: A core aim of rehabilitation is to facilitate participation in valued roles and activities. Threat appraisals and avoidance deserve more attention in research and practice because they may constitute a significant obstacle to achieving this.