Got Anxiety? Avoidance: When the solution becomes the problem
February 4, 2015
Those who frequently experience emotions such as anxiety or fear are very much aware that their default response to any situation or object that typically triggers anxious arousal is to do whatever it takes to avoid such triggers.
This strategy seems to make a lot of sense, since avoidance always leads to lessened anxiety, in the short-term. Please note the words "short-term" in the previous sentence.
When confronted with anxiety triggers, avoidance behaviors can be displayed in a number of different formats, from direct, to very subtle.
However, they typically include direct and intentional attempts to physically avoid the situation or object that triggers anxiety.
For example, a college student with Social Anxiety related to public speaking will avoid registering for any course which involves requiring a class presentation.
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This same person may also avoid eye contact during social conversations, speak quietly or avoid conversations lasting more than just a minute or two.
Someone with a phobia of dogs will avoid visiting pet stores, having dinner at a friend's home who owns a dog, etc.
An individual with Panic Disorder may avoid grocery stores, movie theaters, driving alone in a car, or other settings where quick escape routes are not readily accessible.
This same individual may also use more subtle forms of avoidance such as not engaging in sexual activities, physical exercise or sitting in hot sauna, all of which may result in sudden physiological changes including increased heart rate, sweating and other bodily changes associated with panic attacks.
A person with Obsessive-Compulsive Disorder, whose intrusive thoughts involve stabbing a baby with a sharp object, may avoid babysitting her granddaughter unless her husband agrees to be with her.
She may also avoid being alone with the baby in her kitchen due to the presence of knives and other sharp objects.
SHORT-TERM SOLUTIONS VS. LONG-TERM PROBLEMS
The primary reason why people avoid situations or objects which trigger their anxious thoughts and physical arousal is because avoidance results in immediate short-term relief from these anxious feelings, as well as the possibility of needing to deal with their predicted catastrophic outcomes.
Due to the immediate benefit of using avoidance strategies, this type of response pattern becomes the norm when encountering anxiety triggers.
Unfortunately, these short-term solutions lay the foundation for long-term problems, as discussed next.
NEGATIVE CONSEQUENCES OF AVOIDANCE
I'm accustomed to teaching patients a set of skills directed at changing the relationship they have with their anxiety.
I remind them that the use of avoidance behaviors consistently results in the following negative consequences:
Fear Pathways are Strengthened: Whether avoiding driving alone on a highway, or interacting with a feared animal, responding in this manner does not allow for the opportunity to discover that one's catastrophic predictions concerning the outcome of dealing with the feared situation did not occur. Thus, following each occurrence of avoidance, neurological fear pathways (memories) are strengthened, and safety pathways are weakened.
New Leaning is Prevented: People engage in avoidance strategies primarily because they perceive a situation as posing some type of physical or psychological threat. In the case of Panic Disorder, the feared stimulus concerns sudden changes in bodily sensations (increased heartbeat, dizziness), which is perceived as threatening to the individual's health. With respect to Social Anxiety, the feared situation is some type of personal interaction, which could result in the threat of negative evaluation from others. In either case, avoidance prevents the individual from learning that the situation is actually safe, not dangerous, and that the threat is perceived, not real.
Self-Esteem is Lowered: At the end of the day, no one feels good about themselves when reviewing the various times they intentionally avoided a situation perceived as anxiety provoking. Our self-worth is based largely on our achievements; tasks which we approached, not avoided. My definition of courage is, "being scared to death, and doing it anyway."
Research studies over the past several decades consistently demonstrate that Cognitive-Behavior Therapy (CBT) remains the most effective treatment for anxiety disorders.
Exposure Therapy sessions represent the Behavior Therapy component concerning this form of treatment. Briefly, Exposure involves direct (or imagined) interaction with the feared situation, in a gradual manner, while concurrently implementing various cognitive strategies.
Think of Exposure Therapy as short-term pain (highly anxious feelings) resulting in long-term gain (re-establishing control of your life).
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California and is co-executive director of the Center for Anxiety & Chronic Worry, with offices in Incline Village. He may be reached for comment at firstname.lastname@example.org; visit anxietytreatment inclinevillage.com to learn more.