Experiential avoidance
Encyclopedia
Experiential avoidance has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run. The process of EA is thought to be maintained through negative reinforcement—that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the behavior will persist. Importantly, the current conceptualization of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.
. However, the general concept has roots in many other theories of psychopathology and intervention.
theory outlines the benefits of being fully aware and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid” (p. 142). Similar ideas are expressed by early humanistic
theory: “Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness” (p. 188).
, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.
, Dialectical Behavior Therapy (DBT), Functional Analytic Psychotherapy (FAP)
, and Behavioral Activation (BA)
.
Avoidant coping
Thought suppression
(low) Distress tolerance
(non) Acceptance
Psychological (in) flexibility
Background
EA has been popularized by recent third-wave cognitive-behavioral theories such as Acceptance and Commitment Therapy (ACT)Acceptance and Commitment Therapy
Acceptance and commitment therapy or ACT is a cognitive–behavioral model of psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological...
. However, the general concept has roots in many other theories of psychopathology and intervention.
Psychodynamic
Defense mechanisms were originally conceptualized as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.Process-Experiential
GestaltGestalt therapy
Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating...
theory outlines the benefits of being fully aware and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid” (p. 142). Similar ideas are expressed by early humanistic
Humanistic psychology
Humanistic psychology is a psychological perspective which rose to prominence in the mid-20th century, drawing on the work of early pioneers like Carl Rogers and the philosophies of existentialism and phenomenology...
theory: “Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness” (p. 188).
Behavioral
Traditional behavior therapy utilizes exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.Cognitive
In cognitive theoryCognitive therapy
Cognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...
, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.
Third-Wave Cognitive-Behavioral
The concept of EA is explicitly described and targeted in more recent CBT modalities including Acceptance and Commitment Therapy (ACT)Acceptance and Commitment Therapy
Acceptance and commitment therapy or ACT is a cognitive–behavioral model of psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological...
, Dialectical Behavior Therapy (DBT), Functional Analytic Psychotherapy (FAP)
Functional Analytic Psychotherapy
Functional analytic psychotherapy is an approach to clinical psychotherapy that uses a radical behaviorist position informed by B.F. Skinner's analysis of verbal behavior....
, and Behavioral Activation (BA)
Behavioral activation
Behavioral activation is a third generation behavior therapy for treating depression. It is one of many functional analytic psychotherapies which are based on a Skinnerian psychological model of behavior change, generally referred to as applied behavior analysis...
.
Problems Associated with EA
- Distress is an inextricable part of life, therefore, avoidance is often only a temporary “solution.”
- Avoidance reinforces the notion that discomfort/distress/anxiety is “bad,” or “dangerous.”
- Sustaining avoidance often requires effort and energy.
- Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
- Avoidance may get in the way of other important, valued aspects of life.
Empirical Evidence
- Laboratory based thought suppressionThought suppressionThought suppression is the process of deliberately trying to stop thinking about certain thoughts . It is often associated with obsessive–compulsive disorder, in which a sufferer will repeatedly attempt to prevent or "neutralize" intrusive distressing thoughts centered around one or more obsessions...
studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
- Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing unpleasant emotion results in short-term increases in arousal, but long-term decreases in arousal.
- Exposure-based therapyExposure therapyExposure therapy is a technique in behavior therapy intended to treat anxiety disorders and involves the exposure to the feared object or context without any danger in order to overcome their anxiety. Procedurally it is similar to the fear extinction paradigm in rodent work...
techniques have been shown to be effective in treating a wide range of psychiatric disorders.
- Numerous self-report studies have linked EA and related constructs (avoidant copingAvoidance copingAvoidance coping, or escape coping, is a kind of generally maladaptive coping, characterized by the effort to escape from having to deal with a stressor.Post Traumatic Stress Disorder symptoms are thought to be the precursor to avoidance coping...
, thought suppressionThought suppressionThought suppression is the process of deliberately trying to stop thinking about certain thoughts . It is often associated with obsessive–compulsive disorder, in which a sufferer will repeatedly attempt to prevent or "neutralize" intrusive distressing thoughts centered around one or more obsessions...
) to psychopathology and other forms of dysfunction.
Relevance to Psychopathology
Seemingly disparate forms of pathological behavior can be understood by their common function (i.e., attempts to avoid distress). Some examples include:| Diagnosis | Example Behaviors | Target of Avoidance |
|---|---|---|
| Major depressive disorder | Isolation/suicide | Feelings of sadness, guilt, low self-worth |
| Posttraumatic stress disorder | Avoiding trauma reminders, hypervigilance | Memories, anxiety, concerns of safety |
| Social phobia Social anxiety disorder Social anxiety disorder , also known as social phobia, is an anxiety disorder characterized by intense fear in social situations causing considerable distress and impaired ability to function in at least some parts of daily life... |
Avoiding social situations | Anxiety, concerns of judgment from others |
| Panic disorder Panic disorder Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks... |
Avoiding situations that might induce panic | Fear, physiological sensations |
| Agoraphobia Agoraphobia Agoraphobia is an anxiety disorder defined as a morbid fear of having a panic attack or panic-like symptoms in a situation from which it is perceived to be difficult to escape. These situations can include, but are not limited to, wide-open spaces, crowds, or uncontrolled social conditions... |
Restricting travel outside of home or other "safe areas" | Anxiety, fear of having symptoms of panic |
| Obsessive-compulsive disorder | Checking/rituals | Worry of consequences (e.g., “contamination”) |
| Substance use disorders Substance use disorder Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder".... |
Abusing alcohol/drugs | Emotions, memories, withdrawal symptoms |
| Eating disorders Eating disorder Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific... |
Restricting food intake, purging | Worry about becoming “overweight,” fear of losing control |
| Borderline personality disorder Borderline personality disorder Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the... |
Self-harm (e.g., cutting) | High emotional arousal |
Relevance to Quality of Life
Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:- Putting off an important task because of the discomfort it evokes.
- Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
- Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
- Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
- Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
- Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
- Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
- Staying in a “bad” relationship to try and avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
- Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g., achieved through drug or alcohol abuse) or symptoms of withdrawal.
- Not attending an important graduation, wedding, funeral, or other family event in order to try and avoid anxiety or symptoms of panic.
- Engaging in self-destructive behaviors in an attempt to avoid feelings of boredom, emptiness, worthlessness.
- Not functioning or taking care of basic responsibilities (e.g., personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
- Spending so much time attempting to avoid discomfort, that you have little time for anyone or anything else in your life.
Related Concepts
Defense mechanismsAvoidant coping
Avoidance coping
Avoidance coping, or escape coping, is a kind of generally maladaptive coping, characterized by the effort to escape from having to deal with a stressor.Post Traumatic Stress Disorder symptoms are thought to be the precursor to avoidance coping...
Thought suppression
Thought suppression
Thought suppression is the process of deliberately trying to stop thinking about certain thoughts . It is often associated with obsessive–compulsive disorder, in which a sufferer will repeatedly attempt to prevent or "neutralize" intrusive distressing thoughts centered around one or more obsessions...
(low) Distress tolerance
(non) Acceptance
Acceptance
Acceptance is a person's agreement to experience a situation, to follow a process or condition without attempting to change it, protest, or exit....
Psychological (in) flexibility