Avoidance Flashcards
Avoidance in different therapy schools
- CBT school:
avoiding problems is the primary basis for all human mental illness, Avoiding problems -> no growth, in chronic illnesses: stop growing, become stuck (M. Scott Peck), Steven Hayes (CBT) = “If you aren’t willing to have it, you will.” - Psychodynamic school:
Freud = “Unexpressed emotions will never die. They are buried alive and will come forth in uglier ways.” - Humanistic psychology:
Rogers: no avoidance -> individual gets more aware of his/her own feelings, able to take in a new situation, rather than distorting the evidence to fit a pattern which he already holds - Existential therapy:
-Existential givens: unknown/uncertainty and consequential anxiety
-human meaning systems are fragile and threatened
-Irvin D.Yalom (one of the leading existential psychotherapists)
-existential givens -> anxiety -> defense mechanisms
-absence of ultimately solid foundation of our meaning systems (and choice):
-ultimate meaninglessness
-freedom -> responsibility for choices given to others (individual,
institutions, fate, god)
-death -> specialness (narcissism), ultimate rescuer (relationships, god,
job)
-james bugental: we need defenses (spacesuit: protection, but also limitations),
“you can´t look at the sun for too long” (another philosopher)
Types of avoidance
- Overt escape/avoidance: when an individual does not enter (=avoidance), or prematurely leaves (=escape), a fear-evoking situation
- Safety behavior (within-situation safety-seeking behavior): overt or covert avoidance/prevention of feared outcomes (distraction, objects) -> work short-term
- Control(/Surpression) of certain stimuli: does not work in the long run, maintains/ increases negative affect (can’t learn that danger cue is actually safe, rebound effect), narrows life
Research on avoidance and its implications for clinical disorders
Training to avoid/approach novel animals (Huijding)
Avoidance of animals -> more negative appraisal
Behavior can influence your perception of the world
Approach: capable of dealing with it, positive
Avoidance: i must be avoiding something negative/painful
Boys: no difference, Girls: more fear response towards avoided animals
Avoidance as a transdiagnostic process
SOCIAL ANXIETY
Aiden and Biden:
- safety behaviors contribute to likelihood of feared outcome occuring
- socially anxious VS not anxious groups
- condition: elicit safety behavior or not
- DV: discussion, safety behaviorof short duration + low intimacy/disclosure
- DV: confederate liking of participant
- CONCLUSION: Positive appraisal condition: no difference Negative appraisal condition (typical situation for socially anxious people): anxious people spoke less, less likely to be intimate, Linking: positive group
- > no difference, negative Group: liked socially anxious people less
- > due to avoidance, socially anxious people contribute and create what they fear
Avoidance as a transdiagnostic process
DEPRESSION
Carvalho and Hopko:
- Assessed Depression, Avoidance and Reward probability
- CONCLUSION: Decreased availability of reward mediated relation between avoidance and depression
-> the more you avoid, the higher the depression (one
of the contributing factors: less connection to life, less rewards)
-> avoidance contributes to depression by reducing access to meaningful life
Avoidance as a transdiagnostic process
ANXIETY
- Overgeneralization of Conditioned Fear as a Marker of Panik Disorder (Lisek)
- people with panic disorders over generalized more
Avoidance as a transdiagnostic process
PTSD
Dunmore:
- Avoidance as contributing to severity of PTSD
- Assessed mental defeat (loss of psychological autonomy) and avoidance/safety
behaviors
CONCLUSION: baseline avoidance predicts increase in symptoms
How avoidance prevents the benefits of treatment
Avoidance prevents the benefits of treatment
Salkovski
- exposure intervention (decrease/maintenance of safety-seeking behaviors (SSB)
during exposure; anxiety)
- CONCLUSION: decrease of SSB -> less fear, less belief of terrible event; no avoidance
-> experience of safety, relearning
Kamphuis
- Claustrophobic participants or not; exposure with attention to the threat (is it occurring
or not), distraction
- Exposure + cognitive load
- Exposure + cognitive load + attention to threat
- CONCLUSION: after exposure -> less anxiety (especially for participants that paid
attention to threat), no avoidance -> less fear
-> avoidance impairs the effects of exposure therapy
Different theories of why exposure might me helpful
Blanchard:
- Rat Corner runs -> facing past danger step by step
- Exposure therapy works for anxiety disorders (large effects for PD/A, SAD, OCD, GAD, PTSD)
- Behavioral activation therapy
- Addiction
What changes when facing what is feared?
- Older models=changing (eliminating) the fear structure
- Newer models= fear structure/history can not be eliminated, rather new learning
-> CS = US, CS = no-US - Exposure -> Fear tolerance (Eifert)
- administration of CO2 -> evokes panic
symptoms
- acceptance/approach exposure -> less avoidance (more able to experience
negative process)- Exposure -> self-efficacy (Williams)
- benefits predicted by self-efficacy, even when controlling for anxiety
- but reduced anxiety did not predict more approach when controlling for Self-efficacy
- Exposure -> self-efficacy (Williams)
DSM diagnsotic criteria
- Organized around structure/categories of symptom clusters (= syndromal perspective) e.g. +- 300 disorders (symptom clusters) in the DSM 5
- The amount of disorders increases by DSM release
- This approach starts with signs/symptoms -> hope to get function/relation
- Limitations of syndromal/topographical classifications: 1. almost no psychological diseases have been clearly defined
2. Different topographical outcomes can come from the process (e.g fever)
Article
The relationship between rumination, avoidance and depression in a non-clinical sample
- individuals who are more likely to engage in behavioral avoidance are more likely to ruminate
- avoidance predicted unique variance in depression scores
- brooding was correlated with all of the avoidance measures, while reflection was only associated with behavioral social avoidance, brooding factor linked most closely to depression, brooding-avoidance association may be largely mediated by anxiety
- rumination: does not promote or result in avoidance of cognitive content per se, it promotes focus on this material, rumination may be an avoidant process insomuch as it limits the emotional impact of the material, rumination increases the focus on the content of the material, may function to limit contact with the environment, serves as an avoidant function
Article
Experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia
- safety-seeking behaviors play an important role in maintaining patients negative beliefs and anxiety
- patients who had stopped their safety-seeking behaviors had a significantly greater decrease in catastrophic beliefs and anxiety
- safety-seeking behaviors: 1. Avoidance of the situation, 2. Escape from the situation when anxiety occurs, 3. Behaviors carried out within a situation with the intention of actively preventing the feared catastrophe
Article
Experimental Avoidance and Behavioral Disorders: A functional dimensional approach to diagnosis and treatment
- many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories
- experiential avoidance (as a functional diagnostic dimension) has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests and clinical domains AND to lead to testable new approaches to the analysis and treatment of behavioral disorders
