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).
Fight Or Flight Response
Assertive Communication
Window Of Tolerance
Embracing Uncertainty
[Free Guide] Understanding Post-Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD) Formulation
Intolerance Of Uncertainty
Activity Menu
Social Anxiety Formulation
Post-Traumatic Stress Disorder (PTSD) Formulation
Behavioral Activation Activity Diary
Mastery Of Your Anxiety And Worry (Second Edition): Workbook
Behavioral Experiment
Vicious Cycle - Responses And Consequences
Behavioral Experiment (Portrait Format)
Valued Domains
CBT Model – Maintaining Processes – Past And Present
What Keeps Depression Going?
Exposure And Response Prevention
Understanding Obsessive Compulsive Disorder (OCD)
Fear Ladder
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide
Values: Connecting To What Matters
Cognitive Behavioral Model Of Low Self-Esteem (Fennell, 1997)
What Is Worry?
Panic Formulation
CBT Model – Maintaining Processes
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook
Choosing Your Values
Understanding Health Anxiety
Understanding Depression
Exploring Valued Domains
Changing Avoidance (Behavioral Activation)
Reclaiming Your Life From A Traumatic Experience (Second Edition): Workbook
Activity Planning
[Free Guide] An Introduction To Values
Habituation
Managing Social Anxiety (Third Edition): Workbook
Exposure Session Record
OCD Hierarchy
CBT Model – Here And Now
Audio Collection: Psychology Tools For Overcoming PTSD
Understanding Social Anxiety
Behavioral Activation Activity Planning Diary
Treating Your OCD With Exposure And Response (Ritual) Prevention (Second Edition): Workbook
Interoceptive Exposure
What Keeps Social Anxiety Going?
Activity Diary (Hourly Time Intervals)
Vicious Cycle - Costs And Benefits
Thought Suppression And Intrusive Thoughts
Autonomic Nervous System
Understanding Post-Traumatic Stress Disorder (PTSD)
Mastery Of Your Anxiety And Panic (Fifth Edition): Workbook
CBT Model – Past And Present
Exposure Practice Form
Mastery Of Your Anxiety And Panic (Fifth Edition): Therapist Guide
Problem Solving
CBT Appraisal Model
Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook
Self-Monitoring Record (Universal)
Safety Behaviors
Your Stone Age Brain
Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide
Mastery Of Your Anxiety And Worry (Second Edition): Therapist Guide
Fight or Flight (CYP)
Pacing For Pain And Fatigue
Uncertainty Beliefs – Experiment Record
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)
What Keeps Panic Going?
ABC Model
Stages Of Social Anxiety
Prolonged Exposure Therapy For PTSD (Second Edition): Therapist Guide
Understanding Panic
Overcoming Eating Disorders (Second Edition): Therapist Guide
What Keeps Death Anxiety Going?
Overcoming Your Eating Disorder: Workbook
Managing Social Anxiety (Third Edition): Therapist Guide
Facing Your Fears And Phobias
Understanding Death Anxiety
A Guide To Emotions (Psychology Tools For Living Well)
Your Stone Age Brain (CYP)
Maximizing The Effectiveness Of Exposure Therapy
Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide
What Keeps Fears And Phobias Going?
Activity Diary (No Time Intervals)
What Are Safety Behaviors?
Critical Care And PTSD
Avoidance Hierarchy (Archived)
Problem Solving (CYP)
Understanding Fears And Phobias
Process Focused Case Formulation
Panic Attack Record
Panic - Self-Monitoring Record
Being With Difficulty (Audio)
Am I Experiencing Generalized Anxiety Disorder (GAD)?
Activity Selection
Facing Your Fears (CYP)
Starvation Syndrome – The Effects of Semi-Starvation
Mastery And Pleasure Activity Diary
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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.