The vicious cycle of biophobia

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

Biodiversity loss is a matter of great concern among conservation scientists, but the wherewithal to reverse this trend is generally lacking. One reason is that nearly half of the world's people live in urban areas and are increasingly disconnected from nature. If there is to be broad-based public support for biodiversity conservation, the places where people live and work should be designed so as to provide opportunities for meaningful interactions with the natural world. Doing so has the potential not only to engender support for protecting native species, but also to enhance human well-being. Accomplishing these goals will necessitate conservation scientists forging new collaborations with design professionals, health practitioners and social scientists, as well as encouraging the participation of the general public.

Many researchers have claimed that the emotion of disgust functions to protect us from disease. Although there have been several discussions of this hypothesis, none have yet reviewed the evidence in its entirety. The authors derive 14 hypotheses from a disease-avoidance account and evaluate the evidence for each, drawing upon research on pathogen avoidance in animals and empirical research on disgust. In all but 1 case, the evidence favors a disease-avoidance account. It is suggested that disgust is evoked by objects/people that possess particular types of prepared features that connote disease. Such simple disgust are directly disease related, are acquired during childhood, and are able to contaminate other objects/people. The complex disgust, which emerge later in development, may be mediated by several emotions. In these cases, violations of societal norms that may subserve a disease-avoidance function, notably relating to food and sex, act as reminders of simple disgust elicitors and thus generate disgust and motivate compliance. The authors find strong support for a disease-avoidance account and suggest that it offers a way to bridge the divide between concrete and ideational accounts of disgust. (c) 2009 APA, all rights reserved.