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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Rebecca Ready

Second Advisor

Christopher Martell

Third Advisor

Lori Astheimer

Fourth Advisor

Douglas Martini

Subject Categories

Clinical Psychology | Pain Management


Ten to 20% of individuals who sustain a concussion continue to experience symptoms outside the typical window of recovery. Pre-morbid and post-injury anxiety are risk-factors for persistent post-concussion symptoms (PCS). However, mechanisms linking anxiety and persistent PCS are unclear. The fear-avoidance model of disability could add clarity to associations between anxiety and persistent PCS. This study examined if factors of the fear-avoidance model (e.g., catastrophic thinking, fear of symptoms, anxiety sensitivity) would mediate the association between persistent PCS and maladaptive coping responses (e.g., avoidance, limiting activities) following concussion. To achieve this aim, university students (N = 43) with resolved concussion (n = 32) and persistent PCS (n = 11) completed measures of catastrophic thinking, fear of PCS, and anxiety sensitivity during a first study session. Participants returned 1-week later to report their level of physical activity since the first study session via a smartphone pedometer app and complete measures of cognitive avoidance and limiting physical activity. This study was underpowered and unable to determine if features of the fear-avoidance model were associated with avoidance and limiting behaviors in university students following concussion. However, the persistent PCS group reported higher levels of fear of PCS, catastrophic thinking, limiting behavior, and averaged fewer daily steps than the resolved group. Fear of symptoms, catastrophic thinking, and avoidance of physical activities could be potential psychotherapy targets for individuals who experience persistent PCS.