Avoidance and Escape
- avoidance and escape behaviors remove the opportunity to disconfirm negative beliefs (Salkovskis, 1991);
- they reduce an individual’s opportunities to obtain positive reinforcement and thus contribute to the maintenance of low mood (Ferster, 1973; Lewinsohn, 1975);
- they reduce the number of external stimuli present in an individual’s environment (‘shrinks their world’) which may exacerbate self-focused attention and repetitive thinking (Harvey, Watkins, Mansell, & Shafran, 2004);
- according to a habituation model of anxiety the relatively brief exposure periods occasioned by escape and avoidance may server to ‘sensitize’ patients to their feared stimuli (Wilson & O’Leary, 1980).
A Guide To Emotions (Psychology Tools For Living Well)
ABC Model
Activity Diary (Hourly Time Intervals)
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Am I Experiencing Death Anxiety?
Am I Experiencing Depression?
Am I Experiencing Generalized Anxiety Disorder (GAD)?
Am I Experiencing Health Anxiety?
Am I Experiencing Panic Attacks?
Am I Experiencing Panic Disorder?
Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?
Am I Experiencing Social Anxiety?
Approach Instead Of Avoiding (Psychology Tools For Overcoming Panic)
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Audio Collection: Psychology Tools For Overcoming PTSD
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Avoidance Hierarchy (Archived)
Balance
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Changing Avoidance (Behavioral Activation)
Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)
Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)
Cognitive Behavioral Model Of Fear Of Body Sensations
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Cognitive Behavioral Model Of Panic (Clark, 1986)
Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)
Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)
Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)
Cognitive Behavioral Model Of Tinnitus (McKenna, Handscombe, Hoare, Hall, 2014)
Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide
Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook
Critical Care And PTSD
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Embracing Uncertainty
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Mastery Of Your Anxiety And Panic (Fifth Edition): Therapist Guide
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Mastery Of Your Anxiety And Worry (Second Edition): Therapist Guide
Mastery Of Your Anxiety And Worry (Second Edition): Workbook
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Starvation Syndrome – The Effects of Semi-Starvation
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Understanding Death Anxiety
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Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook
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What Are Safety Behaviors?
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Assessment
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Oxford - Agoraphobic Avoidance Scale (O-AS)
| Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. | 2023
- Scale
- Reference Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. (2023). The Oxford agoraphobic avoidance scale. Psychological Medicine, 53(4), 1233-1243.
Exercises
- Facing your fears: Exposure | Anxiety Canada
What Are Avoidance And Escape?
Disorders That May Be Maintained by Avoidance and Escape
Avoidance and escape are often maintenance factors in:
- panic disorder with or without agoraphobia
- specific phobia
- social phobia
- obsessive compulsive disorder
- post-traumatic stress disorder (PTSD) and acute stress disorder
- generalized anxiety disorder (GAD)
- pain disorder
- health anxiety
- body dysmorphic disorder
- eating disorders
- depression
- psychotic disorders
- substance abuse disorders
Helpful Questions for Assessing Avoidance and Escape
Some helpful questions for assessing avoidance and escape include:
- How do you respond when you feel threatened?
- What activities/people/places/situations/objects do you avoid?
- What does the avoidance get in the way of you doing?
- What would happen if you stopped avoiding?
Treatment Approaches That Target Avoidance and Escape
Exposure is often considered the method of choice to reduce avoidance across the anxiety disorders. Varieties of exposure techniques include in-vivo exposure, graded exposure, and interoceptive exposure. Mowrer’s two-stage model of fear and avoidance is cited as the origin of the behavioral practice of reducing avoidance (Mowrer, 1939, 1960). According to this theory, avoidance behavior is reinforced when it is followed by a reduction in anxiety.
Cognitive techniques have also been found to be highly effective treatments for anxiety, with successful treatment leading to reductions in avoidance (Kaczkurkin & Foa, 2015).
References
- Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28(10), 857–870.
- Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behaviouralprocesses across psychological disorders: A transdiagnostic approach to research and treatment. New York: Oxford University Press.
- Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346.
- Lewisohn, P. M. (1975). Engagement in pleasant activities and depression level. Journal of Abnormal Psychology, 84(6), 729–731.
- Mowrer, O. H. (1939). Anxiety and learning. Psychological Bulletin, 36, 517–518.
- Mowrer, O. H. (1960). Learning theory and behavior. New York: Wiley.
- Salkovskis, P. M. (1991). The importance of behaviourin the maintenance of anxiety and panic: A cognitive account. Behavioural and Cognitive Psychotherapy, 19(1), 6–19.
- Wilson, G. T. and O’Leary, D. (1980). Principles of behavior therapy. Englewood Cliffs, NJ: Prentice-Hall.