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.