Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury

Background: Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. Method: Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current postconcussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). Results: A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (8 = 0.45, p = .01), as well as stress (8 = 0.07, p = .01) and PTSD symptoms (8 = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. Conclusions: Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.