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By Caroline Fleck

About this blog: I am a clinical psychologist, mother, and wife committed to using my life to help the lives of those around me. In addition to seeing clients in my private practice, I contribute to various training and research initiatives in cli...  (More)

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Anxious? Try Avoiding Avoidance

Uploaded: Feb 22, 2015
Would you consider yourself an anxious person? A worrier? Maybe your anxiety is general, "are the kids alright?" "did I talk too much last night?" "am I going to get fired?" Or perhaps you find yourself worrying about specific issues, like exposure to germs, or driving. How do we know if our anxiety is extreme or not?

I encounter this question frequently in my work: Is the anxiety I'm experiencing abnormal? The interesting thing about anxiety is that it's often what we do, or don't do, with it that determines how bad it is or how bad it might become.

Specifically, anxiety is usually considered pathological if it results in efforts to avoid the source of one's anxiety. This is the case for specific phobias (such as a fear of snakes, or flying), social anxiety, and agoraphobia (fear of public places), as well as obsessive-compulsive disorders (OCD), and post-traumatic stress disorder (PTSD). Someone who has OCD that manifests in obsessions about germs, for instance, might compulsively wash their hands for hours each day in an effort to avoid contamination by germs. A sufferer of PTSD from combat trauma might avoid situations, such as crowded outdoor events, that remind them of the trauma.

Interestingly, most of the effective treatments for these conditions involve some form of exposure to the source of one's anxiety. This may seem counterintuitive - why would you intentionally expose yourself to something that causes you distress? The answer, in a word, is habituation.

Consider this example: if you walk into a haunted house and leave halfway through because it is too scary, chances are you will remain scared of that particular haunted house. If, however, you went through that same haunted house 5 times a day, everyday, for a month, by the end of the month you probably wouldn't be scared any more. You would have learned through repeated trials that the thing you fear (the haunted house) doesn't actually hurt you. Habituation is the term that defines this process: after repeated exposures to a stimulus, our emotional and physiological reactions to that stimulus decrease.

As a clinician I can think of few, if any, evidence-based psychotherapies for anxiety that do not involve some level of exposure. But what about those of us who do not suffer from an anxiety disorder per se or symptoms severe enough to warrant therapy? Not surprisingly, the principle of habituation applies even to those who only struggle with moderate or intermittent anxiety. If you get in the habit of exposing yourself to the causes of your anxiety, rather than automatically avoiding them, your anxiety will likely decrease over time.

Now, there are a couple of caveats to this:

1. You must actually stay connected with the physiological and emotional experience of anxiety rather than attempting to blunt it.

This is where exposure often goes awry for folks. Most of us aren't even aware of all of the ways in which we attempt to suppress anxiety once it surfaces. In the context of work stress, for instance, avoidance might take the form of procrastination, prioritizing busy work, or putting off meetings or deadlines. We might try to rationalize away the anxiety by telling ourselves that a bad outcome is unlikely, or that we are overreacting. Again, while these attempts to avoid anxiety might decrease it in the moment, they often amplify it over time.

2. In order for exposure to work, it's important that the stimulus not be associated with immediate or overwhelming harm to you.

If in our haunted house example, a "mummy" jumped out and broke your arm during one of the exposures, your fear of the haunted house would be reinforced. Now, most of the things we are anxious about do involve some risk of harm - we could lose our job for talking too much in meetings, or get into an accident while driving a car. That's why we're anxious about these things in the first place. However, when anxiety and worry have become chronic or overwhelming, they are often disproportionate to the actual threat. So theoretically something bad could happen, but the probability is low. And even if some harm were to come, it's often far less severe than we feared. Thus when practicing exposure, target situations that have a relatively low probability of resulting in significant harm. They may cause you to feel distressed, anxious, or overwhelmed, but they should be unlikely to result in any physical harm.

As with many of my recommendations, the first step is to cultivate awareness. To experiment with this, try simply noticing what you do or tell yourself the next time you're anxious. If you find yourself desperately trying to avoid or minimize your anxiety, consider doing the opposite: imagine, or even physically confront your fear. Allow the anxiety to wash over you. Ultimately, exposure teaches us that much of what we fear is fear itself.
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 +   1 person likes this
Posted by amfl, a resident of Shoreline West,
on Feb 25, 2015 at 9:03 pm

I really enjoyed this article. It's timely for me, as I recently started jotting down my avoidance behaviors and anxious moments and I'm seeing I avoid much more than I realized. I'm still in the "becoming aware" phase, but I'm hoping to challenge myself with "exposure" soon.

I plan to go back and read your other articles now. Thank you!

 +   1 person likes this
Posted by Caroline Fleck, a Mountain View Online blogger,
on Feb 26, 2015 at 8:24 am

Caroline Fleck is a registered user.

How great that you've been working on all of this stuff already! I continue to be surprised by how much reflection and intention can transform things. Thanks for reading!

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