The Deception of Avoidance: Confronting Through Exposure

In last week's episode of EZ Conversations, I had the privilege of hosting Shannon Sauer-Zavala, Ph.D. (listen here), and we covered aspects of personality traits, temperament and treatments. Dr. Sauer-Zavala talked about the common myth of individuals having fixed personalities and shed some light on how we can all evolve and grow, which can change our personality traits along the spectrum. However, Dr. Sauer-Zavala and I also talked about avoidance when it comes to anxiety and how that has the opposite effect and can make the situation more debilitating. As Dr. Sauer-Zavala mentioned in the episode, CBT is often the most effective modality and has been backed by research; one of the ways we work with clients is to expose them to the source of their anxiety.

In the groups I facilitate, avoidance is a primary theme. People struggle with sitting alone with their thoughts or working through their triggers because of the discomfort that often comes with these situations. Therefore, many people end up avoiding the situation altogether through escape behaviours. Many times, this also shows up as procrastination. It was fascinating to see that people were aware of avoidance tendencies and how they only prolonged suffering. I also re-read The Power Of Now, where Eckhart Tolle explains with profundity that when we are inseparable from the mind, we go back and forth from pain to pleasure. We lose our ability to experience our innate sense of joy, love and peace. This false sense of seeking pleasure to avoid pain in those fleeting moments is where we tend to live in avoidance. Unfortunately, we become possessed by the pain-pleasure cycle, which becomes an unconscious process. So, this week, I reflected on why we avoid these situations despite knowing they are not serving us. In this week's edition of EZ Reflections, I wanted to build on avoidance and what we can do to expose ourselves to the anxiety-provoking situations we all encounter

Why Do People Use Avoidance?

1. Short-Term Relief from Distress

Avoidance is often rooted in the desire to escape immediate emotional distress. When faced with a situation that provokes anxiety, the body’s natural fight-or-flight response kicks in. For many, the impulse to "flight" feels like the safest option, leading them to avoid the stressor. The American Psychological Association notes that this behaviour temporarily reduces negative emotions like fear, anger, and sadness. However, this short-term relief comes at a long-term cost.

2. Negative Reinforcement Loop

Avoidance provides quick relief, reinforcing the behaviour and making it more likely that the individual will avoid similar situations. This negative reinforcement loop traps people into believing that avoiding their anxiety triggers is the only way to cope. Research from Hofmann et al. (2012) highlights that while avoidance behaviours may mitigate stress temporarily, they prevent individuals from learning healthier coping mechanisms and, worse, can reinforce the idea that the anxiety-inducing situation is dangerous.

3. Fear of Confronting the Unknown

For some, avoidance is not just about avoiding physical or social situations; it can also extend to emotions. People may fear what they might uncover about themselves if they confront their anxiety directly. They worry that facing their fears might result in failure or intensify their suffering. Cognitive behavioural research, as shown in Craske et al. (2014), suggests that this fear of the unknown plays a pivotal role in maintaining anxiety disorders.

The Cost of Avoidance

Although avoidance seems like an intuitive response to discomfort, it prevents individuals from developing resilience and learning that the situations they fear are often less harmful than anticipated. Over time, avoidance increases sensitivity to anxiety triggers. When avoidance becomes habitual, it narrows a person’s world, limiting their experiences and worsening mental health overall.

Studies have shown that avoidance can lead to increased social isolation, reduced quality of life, and, in severe cases, the development of other mental health disorders, such as depression.

Exposure Therapy: The Antidote to Avoidance

1. What is Exposure Therapy?

Exposure therapy is a psychological treatment specifically designed to reduce the power of avoidance behaviours by confronting anxiety triggers in a controlled, progressive manner. The therapy is based on the principle of habituation—the idea that anxiety naturally decreases with repeated exposure to a feared stimulus.

Research has demonstrated the efficacy of exposure therapy in treating a variety of anxiety disorders, including generalized anxiety disorder, panic disorder, and PTSD. Studies by Powers et al. (2010) show that exposure-based interventions are among the most effective treatments for anxiety disorders, with long-lasting results.

The effectiveness of exposure therapy is backed by robust empirical evidence. A review published in the Journal of Anxiety Disorders (Foa & McLean, 2016) found that exposure-based therapies yielded significant improvement in individuals with anxiety disorders, with many participants maintaining their progress for up to five years after treatment.

Another study published by Harned et al. (2012) in the Behavior Therapy Journal emphasized the importance of combining exposure therapy with mindfulness-based interventions to reduce avoidance behaviours. Mindfulness helps individuals remain present during exposure sessions, leading to greater habituation and decreased reliance on avoidance.

2. How Does Exposure Work?

Exposure therapy involves gradually and systematically exposing individuals to their anxiety triggers in a safe and controlled environment. The process typically starts with less anxiety-inducing situations and builds up to more challenging scenarios. Over time, individuals learn that their fears are unfounded or manageable, leading to decreased anxiety over time.

The mechanism behind exposure therapy lies in extinction learning, where repeated exposure to a feared stimulus without negative consequences weakens the emotional response to that stimulus. A meta-analysis by Abramowitz et al. (2011) shows that exposure therapy significantly improves cognitive flexibility, allowing individuals to reassess the perceived threat of a situation and respond more adaptively.

3. The Role of Cognitive Restructuring

Exposure therapy often works in tandem with cognitive restructuring, a process that helps individuals identify and challenge irrational beliefs that fuel their anxiety. For instance, someone with social anxiety may fear rejection during a public speaking engagement. Through exposure and subsequent cognitive restructuring, the individual learns that occasional rejection is normal and manageable, reducing their fear of the situation.

References:

1. Foa, E. B., & McLean, C. P. (2016). The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: The case of OCD and PTSD. Journal of Anxiety Disorders, 41, 42-51.

2. Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2011). Exposure therapy for anxiety: Principles and practice. Guilford Press.

3. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.

4. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

5. American Psychological Association. (n.d.). Understanding and managing anxiety. Retrieved from.

6. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635-641.

7. Harned, M. S., Korslund, K. E., & Linehan, M. M. (2012). A pilot randomized controlled trial of DBT with Prolonged Exposure to treat PTSD with emotion dysregulation in suicidal and self-injuring women. Behavior Therapy, 43(3), 560-573.
   

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