Avoidance and Escape
- avoidance and escape behaviors remove the opportunity to disconfirm negative beliefs (Salkovskis, 1991);
- they reduce an individual’s opportunities to obtain positive reinforcement and thus contribute to the maintenance of low mood (Ferster, 1973; Lewinsohn, 1975);
- they reduce the number of external stimuli present in an individual’s environment (‘shrinks their world’) which may exacerbate self-focused attention and repetitive thinking (Harvey, Watkins, Mansell, & Shafran, 2004);
- according to a habituation model of anxiety the relatively brief exposure periods occasioned by escape and avoidance may server to ‘sensitize’ patients to their feared stimuli (Wilson & O’Leary, 1980).
Valued Domains
Fight Or Flight Response
Exploring Valued Domains
Window Of Tolerance
Assertive Communication
Vicious Cycle - Responses And Consequences
Embracing Uncertainty
Intolerance Of Uncertainty
Obsessive Compulsive Disorder (OCD) Formulation
Choosing Your Values
Activity Menu
Social Anxiety Formulation
[Free Guide] An Introduction To Values
Post-Traumatic Stress Disorder (PTSD) Formulation
Behavioral Activation Activity Diary
Behavioral Experiment (Portrait Format)
CBT Model – Maintaining Processes
Values: Connecting To What Matters
Mastery Of Your Anxiety And Worry (Second Edition): Workbook
CBT Model – Maintaining Processes – Past And Present
Fear Ladder
Health Anxiety Formulation
Vicious Cycle - Costs And Benefits
Exposure And Response Prevention
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook
Behavioral Experiment
Mastery Of Your Anxiety And Panic (Fifth Edition): Workbook
Panic Formulation
What Keeps Depression Going?
What Is Worry?
Habituation
Understanding Obsessive Compulsive Disorder (OCD)
Treating Your OCD With Exposure And Response (Ritual) Prevention (Second Edition): Workbook
Changing Avoidance (Behavioral Activation)
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide
Cognitive Behavioral Model Of Low Self-Esteem (Fennell, 1997)
Exposure Session Record
Understanding Depression
OCD Hierarchy
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CBT Appraisal Model
Understanding Social Anxiety
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Audio Collection: Psychology Tools For Overcoming PTSD
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What Keeps Social Anxiety Going?
CBT Model – Past And Present
Managing Social Anxiety (Third Edition): Workbook
Thought Suppression And Intrusive Thoughts
Exposure Practice Form
CBT Model – Here And Now
Self-Monitoring Record (Universal)
Pacing For Pain And Fatigue
Safety Behaviors
Problem Solving
Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide
Mastery Of Your Anxiety And Panic (Fifth Edition): Therapist Guide
ABC Model
Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)
Uncertainty Beliefs – Experiment Record
Autonomic Nervous System
Your Stone Age Brain
What Keeps Death Anxiety Going?
What Keeps Panic Going?
Fight or Flight (CYP)
Mastery Of Your Anxiety And Worry (Second Edition): Therapist Guide
Understanding Panic
Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook
Understanding Death Anxiety
Stages Of Social Anxiety
Managing Social Anxiety (Third Edition): Therapist Guide
Reclaiming Your Life From A Traumatic Experience (Second Edition): Workbook
A Guide To Emotions (Psychology Tools For Living Well)
Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide
Maximizing The Effectiveness Of Exposure Therapy
Facing Your Fears And Phobias
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Overcoming Eating Disorders (Second Edition): Therapist Guide
Your Stone Age Brain (CYP)
Avoidance Hierarchy (Archived)
What Keeps Fears And Phobias Going?
Panic Attack Record
Being With Difficulty (Audio)
Problem Solving (CYP)
Panic - Self-Monitoring Record
Overcoming Your Eating Disorder: Workbook
What Are Safety Behaviors?
Process Focused Case Formulation
Am I Experiencing Death Anxiety?
Understanding Fears And Phobias
Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?
Activity Diary (No Time Intervals)
Critical Care And PTSD
Mastery And Pleasure Activity Diary
Prolonged Exposure Therapy For PTSD (Second Edition): Therapist Guide
Facing Your Fears (CYP)
Transdiagnostic Processes
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Assessment
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Oxford - Agoraphobic Avoidance Scale (O-AS)
| Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. | 2023
- Scale
- Reference Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. (2023). The Oxford agoraphobic avoidance scale. Psychological Medicine, 53(4), 1233-1243.
Exercises
- Facing your fears: Exposure | Anxiety Canada
What Are 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.