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)
Chapter
Activity Diary (Hourly Time Intervals)
Worksheet
Activity Diary (No Time Intervals)
Worksheet
Approach Instead Of Avoiding (Psychology Tools For Overcoming Panic)
Chapter
Assertive Communication
Information Handout
Avoidance Hierarchy
Exercise
Behavioral Activation Activity Diary
Worksheet
Behavioral Experiment
Worksheet
Behavioral Experiment (Portrait Format)
Worksheet
Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)
Information Handout
Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)
Information Handout
Cognitive Behavioral Model Of Fear Of Body Sensations
Information Handout
Cognitive Behavioral Model Of Low Self-Esteem (Fennell, 1997)
Information Handout
Cognitive Behavioral Model Of Obsessive Compulsive Disorder (OCD: Salkovskis, Forrester, Richards, 1998)
Information Handout
Cognitive Behavioral Model Of Panic (Clark, 1986)
Information Handout
Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)
Information Handout
Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)
Information Handout
Cognitive Behavioral Model Of Tinnitus (McKenna, Handscombe, Hoare, Hall, 2014)
Information Handout
Embracing Uncertainty
Exercise
Emotions Motivate Actions
Information Handout
Exposure And Response Prevention
Exercise
Exposure Practice Form
Exercise
Fight or Flight (CYP)
Information Handout
Habituation
Information Handout
Health Anxiety Formulation
Information Handout
Interoceptive Exposure
Exercise
Intolerance Of Uncertainty
Information Handout
Maximizing The Effectiveness Of Exposure Therapy
Information Handout
OCD Hierarchy
Exercise
Pacing For Pain And Fatigue
Exercise
Panic Formulation
Worksheet
Process Focused Case Formulation
Worksheet
PTSD Formulation
Worksheet
Social Anxiety Formulation
Worksheet
Stages Of Social Anxiety
Worksheet
Thought Suppression And Intrusive Thoughts
Information Handout
Transdiagnostic Processes
Information Handout
Uncertainty Beliefs – Experiment Record
Worksheet
Understanding Depression
Guide
Understanding Obsessive Compulsive Disorder (OCD)
Guide
Understanding Post-Traumatic Stress Disorder (PTSD)
Guide
Understanding Social Anxiety
Guide
What Is Worry?
Information Handout
What Keeps Depression Going?
Information Handout
What Keeps Panic Going?
Information Handout
What Keeps Social Anxiety Going?
Information Handout
Your Stone Age Brain
Information Handout
Your Stone Age Brain (CYP)
Information Handout
Intervention
- Challenging avoidance and safety behaviors (health anxiety) download archived copy
- Accepting distress workbook download archived copy
- Facing your fears: Exposure download archived copy
Self-Help Programmes
Overcoming distress intolerance
- Understanding distress intolerance download archived copy
- Accepting distress download archived copy
- Improving distress download archived copy
- Tolerating distress download archived copy
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.