Fear Avoidance Beliefs Training (FABT)

At Home for Workers’ Compensation Patients


  • Decrease Fear Avoidance Beliefs, improve function
  • Decrease medication usage
  • Decrease medical utilization for high medical utilizers, decreasing open claim time and moving patient to MMI more quickly

Program Features

  • Fear Avoidance Beliefs Training recommended in MTUS Chronic Pain Guidelines
  • Behavioral health coaches trained in motivational interviewing
  • Opioid-sparing, evidence-based pain neuroscience education program
  • Digital health tools to track patient progress

12-week program


Fun and engaging

Providers Track Patient Progress Online


  • Remotely monitor patient progress
  • Access pain educational media
  • View key analytics
  • Custom experiences for providers, clinicians, and pain coaches

Trusted by

Patient Journey


KarunaHOME patient experience

Patient engages in Fear Avoidance Belief Training (FABT) at home, while progress data is sent back to their providers.

Getting started
Patient meets with a clinician (either in person or over video chat) to determine a plan of care for Fear Avoidance Beliefs Training (FABT).

The KarunaHOME kit is then sent to the patient’s house.

Training and coaching begin
Patient begins activities and meets with coach once per week to go review goals, progress, and educational materials.


Program continues
Patient continues regular training acitivities and meets with coach once per week.
Real world application
Patient applies functional progress to real world.
Finish program
Patient finishes program and returns kit to provider.

Clinical Evidence for Karuna’s Workers’ Compensation Program


Journal articles *



controlled trials *


Meta-analyses articles *


KarunaHOME Publications


KarunaHome Functional Rehabilitation Program Whitepaper:
Clinical Evidence

Karuna Labs Inc. has developed the Karuna Virtual Embodiment Training™ (KVET™) system to address the need for alternative, non-invasive, non-pharmalogical methods to treat chronic pain. KVET™ uses a combination of movement sensors and embodied avatars that provide visual feedback during chronic pain functional rehabilitation. Our key innovation is the application of virtual reality (VR) to perform exposure therapy in a cognitive behavioral therapy protocol designed to treat chronic pain through neurocognitive retraining. Karuna Labs utilizes sensory reprocessing done through virtual reality and behavioral health coaching to unlearn chronic pain patterns.

Selected Fear Avoidance Beliefs Training (FABT)

Fear Avoidance Beliefs are associated with disability, reduced function, and impairment in chronic pain patients. FABT has demonstrated improvements in disability, function, impairment, and return to work in chronic pain patients
The Effect of a Fear-Avoidance–Based Physical Therapy Intervention for Patients With Acute Low Back Pain: Results of a Randomized Clinical Trial
Randomized Controlled Trial

Fear Avoidance Beliefs Training improves disability and pain intensity in patient’s low back pain

Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial
Randomized Controlled Trial

Fear Avoidance Beliefs Training significantly improved work related fear avoidance beliefs in workers with chronic pain

High Fear-Avoiders of Physical Activity Benefit From an Exercise Program for Patients With Back Pain
Comparative Study

Patients with high fear avoidance benefit from functional rehabilitation programs that include Fear Avoidance Beliefs Training

A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities
Randomized Controlled Trial

Chronic low back pain patients with reduced function demonstrated superior benefits over treatment as usual on function, fear, and pain

Fear-Avoidance Behavior and Anticipation of Pain in Patients With Chronic Low Back Pain: A Randomized Controlled Study
Randomized Controlled Trial

Function in chronic pain patients is significantly reduced in patients with high Fear Avoidance Beliefs

Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study
Exploratory Study

Early Fear Avoidance Training prevents the onset of chronic pain

Fear avoidance beliefs as a predictor for long-term sick leave, disability and pain in patients with chronic low back pain
Randomized Controlled Trial

High fear avoidance beliefs is associated with sustained impairments in returning to work in chronic pain patients

Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial
Randomized Controlled Trial

Therapeutic patient education

Research Pipeline


Penn Medicine

A randomized controlled trial on patients with chronic low back pain
Status: Ongoing, actively recruiting
Dr. Michael Ashburn, MD, MPH, MBA.
Director, Pain Medicine and Palliative Care Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania

Karuna Labs

A randomized controlled trial on KarunaHOME for patients with general chronic shoulder pain 
Status: Ongoing, actively recruiting
Dr. Michael Trujillo, PhD
VP of Clinical Affairs, Karuna Labs


Inpatient Trial: PRISM (Pain Relief with Individualized brain StiMulation)
Status: Ongoing, actively recruiting
Dr. Prasad Shirvalkar, MD, PhD
Neurologist and Pain Medicine Specialist UCSF Dept. of Anesthesia

Georgia State University

Validation and feasibility of KarunaHOME for use in physical therapy
Status: Ongoing, actively recruiting
Dr. Sujay Galen, PhD


Chair, Department of Physical Therapy, Georgia State University


Santa Clara University

Validating biomarkers of chronic pain and digital therapeutics


Status: Pending
Julia A. Scott, Ph.D.


Senior Research Associate BioInnovation and Design Lab, Santa Clara University


Additional Peer Reviewed Research

Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial
Randomized Controlled Trial

VR significantly reduces pain versus an active control condition in hospitalized patients (N = 120; 61 VR; 59 Control)

Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study

Findings support the feasibility of VR as an adjunct for Veterans with chronic pain.

Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial
Randomized Controlled Trial

Virtual reality had large significant effect in reducing sensitivity to pain in patients with chronic nonspecific low back pain (N = 84; 42 VR; 42 control

Effect of fully immersive virtual reality treatment combined with exercise in fibromyalgia patients: a randomized controlled trial
Randomized Controlled Trial

Immersive VR significantly improved pain, kinesiophobia, fatigue, physical activity and quality of life in fibromyalgia patients

Altered visual feedback from an embodied avatar unconsciously influences movement amplitude and muscle activity

Visual augmentation in VR induced compensation and unconscious motor adaptation

Body Movement Reduces Pain Intensity in Virtual Reality–Based Analgesia

Moving in immersive virtual reality increases the analgesic effects of VR