Avoidance and Escape

Avoidance and escape refer to behaviors where people either do not enter a situation (avoidance) or leave situations after they have entered (escape). Distraction is considered to be a subtle form of avoidance behavior. Avoidance and escape are natural mechanisms for coping with many kinds of pain and trauma. When used as part of a repertoire of other coping mechanisms, escape and avoidance can considered adaptive. However, they are considered problematic when used too frequently or when they are used to the exclusion of other strategies, and they are included as diagnostic features of a range of disorders. Clinically, avoidance and escape are considered to be problematic because:

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).

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Assessment

Oxford - Agoraphobic Avoidance Scale (O-AS) | Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. | 2023
- Scale
  Primary Link Archived Link
- 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
Primary Link Archived Link

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.

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What Are Avoidance And Escape?

Disorders That May Be Maintained by Avoidance and Escape

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Treatment Approaches That Target Avoidance and Escape

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