Changing Avoidance (Behavioral Activation)
Behavioral activation (BA) is a structured psychotherapeutic approach effective for a range of disorders, including depression (Ekers et al., 2014), anxiety (Stein et al., 2021), and PTSD (Etherton & Farley, 2022). It aims to help clients engage in adaptive activities and decrease their engagement in activities that maintain their distress. Recent approaches to behavioral activation have highlighted the role of avoidance in perpetuating low mood (Martell et al., 2022). Accordingly, clients are encouraged to functionally assess their avoidance behaviors and implement alternative coping responses. This Changing Avoidance (Behavioral Activation) worksheet is designed to help clients identify and evaluate avoidance behaviors that are maintaining their difficulties (i.e. maladaptive coping) and implement more adaptive ways of coping.
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Introduction & Theoretical Background
Drawing on early behavioral theories of depression (e.g., Lewinsohn, 1974), BA assumes that depressed individuals obtain less positive reinforcement because they engage in fewer pleasant activities and enjoy them less. Modern approaches to BA expand on these ideas by adopting a functional contextualistic perspective (Hayes et al., 1999): the aim is not simply to schedule pleasurable or satisfying events (as with the activity scheduling approach used in cognitive therapy; Beck et al., 1979), but to understand the variables that generate and maintain unhelpful responses, including overt behavior and cognitive processes (Veale, 2008). Furthermore, scheduled activities in BA extend beyond rewarding ones, and may include actions related to personal goals, values, unaddressed problems, and areas of avoidance (Kanter et al., 2010).
Several variants of BA have been developed over recent decades, all of which share a basis in activity monitoring and planning (Kanter et al., 2010). For instance, Lejuez and colleagues
Therapist Guidance
Being active and doing the things that matter to you is an effective way to overcome low mood. Unfortunately, certain things can get in the way of becoming more active, including how you try to cope with feeling low. Avoidance is a coping strategy that can take many forms, including shutting down and withdrawing, procrastinating, or dwelling on problems. These ways of coping might give you a sense of relief in the short term, but they tend to prolong distress in the long run. Can we use this worksheet to explore your ways of coping?
Therapists should first use this worksheet to analyze the antecedents and consequences of avoidance patterns that appear to contribute to the client’s distress. In this context, avoidance encompasses both avoidance behaviors (i.e., acting to prevent something) and escape behaviors (i.e., taking oneself out of an undesirable situation; Martell et al., 2022). If the
References And Further Reading
- Barlow, D. H., & Craske, M. G. (2006). Mastery of your anxiety and panic. Oxford University Press.
- Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training: A manual for the helping professions. Research press.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- Clark, D. M., Salkovskis, P. M. (2009). Panic disorder: Manual for improving access to psychological therapy (IAPT) high intensity CBT therapists.
- Ehlers, A. (1993). Interoception and panic disorder. Advances in Behaviour Research and Therapy, 15(1), 3-21.
- Limmer, J., Kornhuber, J., & Martin, A. (2015). Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters. Journal of Affective Disorders, 185, 170-179.
- Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., & Salanti, G. (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis.
Psychological Medicine,