Last week, we focused on how avoidance not only reinforces anxiety, but it also undermines your potential.
As you commit to moving towards anxiety, uncertainty, and discomfort, there are several patterns that can undermine your best attempts at avoiding avoidance.
- Situational avoidance reinforces fear and creates demoralization.
- Experiential avoidance during situational anxiety creates habitual distance from the present moment and burnout.
- Cognitive avoidance creates habitual worry and rumination that reinforces catastrophic thinking and pervasive negative beliefs.
- Somatic avoidance creates habitual distance from the present moment and difficulty maintaining self-care.
- Emotional avoidance creates habitual distance from the present moment and difficulty experiencing intimacy and vulnerability.
- Emotion-driven behaviors are problematic avoidance behaviors such as addiction and fighting that create a new cycle of suffering.
All of these options sound like a recipe for suffering to me! We’ll discuss these in detail through 2018.
Let’s start with situational avoidance and experiential avoidance during situational anxiety.
If you don’t drive or fly because of the possibility of a panic attack or if you don’t eat a certain food or engage in certain activities because of OCD, you’re suffering from situational avoidance.
If you could “just do it,” you wouldn’t be seeking help from me. You’d be on the flight, eating that food, at that party.
Your avoidance isn’t a moral failing, a willpower problem, or a failure of character.
Most likely, you’re getting tricked by anticipatory anxiety. You might also have very high anxiety sensitivity, making situational anxiety very challenging to tolerate. You probably also have critical post-event processing, which undermines that natural euphoria that usually comes after overcoming a challenge.
The 3 stages of an anxious episode are anticipatory anxiety, situational anxiety, and post-event processing. If you panic, worry, or experience an unwanted intrusive thought during a situation, and then you engage in compulsions, worry, rumination, or mental rehearsal in an attempt to calm yourself down, you will have anticipatory anxiety before a similar situation in the future. This is just how our fear circuitry works. You have to be prepared for anticipatory anxiety and be ready to hang out with it without acting as though it is a threat or a message. If you listen to the anticipation in your body and decide that the situation is too dangerous, it will feel more and more dangerous.
You can use a hierarchy to overcome a situational fear but you don’t have to do so. For instance, once they understand anticipatory anxiety, some socially anxious people like to go straight to a social event and get as anxious as possible. Some people like to start by initiating a conversation with a ride-share driver or something like it. Choose your adventure! Regardless of your anxiety disorder or your content area, you can always either start with mild exposures and build confidence or start with big exposures and build confidence. The key is to build confidence.
More specifically, the key therapeutic elements are:
1) Trigger anticipatory anxiety.
2) Hang out in anticipatory anxiety without fueling it or acting like it is a message. (“I’m expecting to be anxious and uncertain. Uncertainty is a feeling, not a fact or prediction. My anticipatory anxiety is predictive of my past, not my future.”)
3) Attend anxiety-provoking situation (which may or may not provoke anxiety at that moment). Focus attention on the situation, rather than whether or not you feel anxious and what it means or doesn’t mean.
4) Refrain from post-event processing in the form of worry, rumination, and self-criticism. Focus attention to what went well and what you learned.
5) Do it again.
In the beginning, moving towards situations you want to avoid might not feel good. Just as exercising for the first time when you are out of shape is uncomfortable (until it isn’t), going towards anxiety-provoking situations will be uncomfortable (until it isn’t).
With this in mind, you may need a behavioral reinforcement strategy for a few weeks. Here are some examples of strategies:
- “I have a piece of chocolate after every driving exposure”
- “If I do my exposures 6 out of 7 days this week, I am buying this thing I want”
- “I will text my friend after every time I do my exposure. If I do my exposures 6 out of 7 days, she will buy me dinner. If I don’t do my exposures, I have to buy her dinner.”
There’s no right strategy here. Different people are reinforced by different incentives. Think about what is reinforcing to you, commit to it, and then live in your commitment.
Eventually, going towards anxiety-provoking situations will feel more habitual and the feeling of accomplishment and pride will be your reinforcement. Use an external behavioral reinforcer until your internal reinforcement system kicks in naturally.
Notice that self-criticism undermines the feeling of pride, which is typically the feeling that keeps people motivated to do challenging activities. It’s important to refrain from self-criticism after your exposures because:
- It hurts.
- It gives you anticipatory anxiety about similar situations in the future.
- It undermines pride, which motivates you to keep doing challenging things.
- It undermines your capacity to learn about yourself by observing your experience.
Experiential avoidance during situations
Lots of anxious people don’t actually avoid situations, but still feel stuck. If you’re in that category, you are likely avoiding experientially.
If you are on a bridge, a flight, in a presentation, at a social event, or in the presence of an OCD trigger, but you are body-checking for anxiety, worrying, ruminating, planning your escape route, or reassuring yourself that you can engage in compulsions later, you are avoiding experientially.
Your fear circuitry is smart and doesn’t care where you are. Your internal avoidance is just as reinforcing as external avoidance.
If you do lots of situational exposures, but you still feel very anxious, and often think, “why isn’t this working? what am I doing wrong?” you are probably, in reality, doing exposure incorrectly. This is still not a willpower, character, or moral problem. It’s a strategy problem. Observe and track what happens in your mind during situation anxiety so that we can identify the beliefs and habits that maintain it.
I have full confidence and unwavering belief that anxious suffering is created, maintained and intensified by avoidance and exposure relieves that suffering. If you’re still anxious, we just haven’t figured out and shifted the combination of mechanisms that maintain it for you yet.