The many faces of avoidance in anxiety issues: How to identify and overcome them

In my last article, I discussed the importance of overcoming avoidance to success in addressing anxiety issues. In this article, I will discuss the different forms avoidance can take in different anxiety issues and how to overcome it in each case.

Avoidance is one of the defining features of issues involving anxiety. The link between anxiety and avoidance is pretty straightforward: If someone experiences anxiety at a level which is too intense to be managed effectively, that person will naturally tend to avoid situations and behaviours which bring about these levels of anxiety. In my work as a Calgary psychologist and a Cochrane psychologist, I have seen this connection displayed by my clients in anxiety counselling.

In my last article, I discussed the pros and cons of relying on avoidance as a strategy to manage anxiety and indicated that overcoming avoidance with gradual exposure reduces the intensity of anxiety on a lasting basis. In this article, I will focus on the different forms avoidance can take depending on the particular anxiety issue along with strategies to overcome each form of avoidance with gradual exposure. If you are suffering from an anxiety issue, please contact a psychologist who can help you to implement these strategies.

Generalized anxiety

Trying not to think about events you’re worried are going to happen and what you’re afraid will occur if they do happen are hallmarks of avoidance in generalized anxiety. Thinking about such events in a constructive and non-catastrophic way is the key to overcoming avoidance to address generalized anxiety. This involves getting specific about what you are afraid is going to happen, accurately determining with the available evidence the likelihood of these events happening, and preparing steps you can take to cope effectively with these events if they were to happen.

Social Anxiety

Avoiding or leaving social situations can give temporary relief from social anxiety but does not address the issue. Gradually spending more time in social situations armed with coping skills is the key to allowing social anxiety to diminish on a lasting basis. Physical relaxation skills like diaphragmatic breathing and cognitive skills to help you feel less bothered by thoughts of real or imagined judgments and criticisms are coping methods which can help you to remain in social situations so that gradual exposure can effectively address your social anxiety.

Phobias

When a person has a fear of a specific situation or stimulus, they will tend to avoid being in that situation or in the presence of that stimulus to lower their anxiety. However, this only reduces the anxiety on a temporary basis as long as they stay away from the situation or stimulus. Gradually exposing yourself to the situations and stimuli you fear using coping skills will allow the anxiety you associate with those situations and stimuli to reduce on a lasting basis. Physical relaxation skills like diaphragmatic breathing and cognitive skills to help you counteract catastrophic thoughts and images fuelling your anxiety about the situations and stimuli are key coping methods.

Panic Disorder

Someone suffering from panic disorder engages in avoidance by preventing their experience of the physical sensations which lead to their panic attacks. For example, someone whose panic attacks are associated with increased heart rate and shortness of breath may avoid exerting themselves so that they do not have these sensations and the ensuing panic attacks. Although this may be an effective short-term strategy to prevent panic attacks from occurring, it constitutes avoidance because it interferes with the steps that are necessary to eliminate their experience of panic attacks on a permanent basis. These steps involve experiencing the physical sensations while substituting non-catastrophic explanations for the sensations in place of the catastrophic explanations which fuel the panic attacks. A psychologist can help you implement this ‘sensation induction’ procedure.

Obsessive-compulsive disorder (OCD)

Avoidance in OCD takes the form of compulsive behaviours like checking, counting and hand-washing. Performing these behaviours gives temporary relief from anxiety resulting from the disturbing thoughts known as obsessions. However, temporarily reducing anxiety with compulsions also results in the anxiety returning each subsequent time the obsessions occur. This is followed by the compulsive behaviours returning and typically taking up so much time that they interfere with your life. ‘Exposure and response prevention’ (ERP) is the go-to treatment of OCD which focuses on overcoming avoidance of the anxiety associated with the obsessions. ERP allows the person to address the anxiety associated with obsessions on a lasting basis by challenging the overly negative nature of the thoughts which comprise the obsessions. Doing this cognitive restructuring work in conjunction with gradual exposure to situations which trigger the obsessions allows the anxiety to decrease on a lasting basis and puts an end to the compulsive behaviours.

Health Anxiety

Regularly checking oneself for symptoms of possible conditions or diseases and seeking reassurance from doctors and others lowers health anxiety temporarily. However, checking and reassurance-seeking constitute avoidance behaviours because they consistently lead to a return of anxiety regarding one’s health followed by more checking and reassurance-seeking. Stopping this checking and reassurance-seeking facilitates a lasting reduction in health anxiety by allowing the person to face and challenge the overly negative nature of their thoughts regarding physical sensations and symptoms they experience.

Post-traumatic stress disorder (PTSD)

Although it is beneficial to avoid thinking or talking about traumatic events from your past when you need to focus on people and activities in the present, trying never to think or talk about these events and constantly trying to avoid encountering situations, people and other stimuli which are associated with the trauma constitute avoidance which contributes to and perpetuates PTSD. Allowing yourself to overcome this avoidance with gradual exposure under the guidance of a therapist in trauma counselling will allow the anxiety associated with the trauma to decrease on a lasting basis.

May you identify and address avoidance in whatever anxiety issues you are facing,

-Dr. Pat