Anxiety: avoidance

Question 1

What is avoidance in relation to anxiety disorders?

Answer 1

• Avoidance is the core component to anxiety disorders
• Relational to external stimuli or internal experiences
• Commonst coping mechanism to reduce classically conditioned fear and anxiety

Question 2

How does avoidance manifest in GAD, SAD, and panic disorder?

Answer 2

• GAD: Worry is used to distract from:
  
  • More distressing experiences (Borkovec, 2004)
  • Intolerance to uncertainity (Dugas, 2005)
  • Worry itself (Wells, 1995)
  • Emotion (Mennin et al, 2004)
• SAD: Safety behaviours (eye contact and verbal limitations) to mask percieved sources of embarrassment
• Panic disorder: interoceptive avoidance (prevention of somatic experiences)

Question 3

Outline the short and longterm effects of avoidance in anxiety disorders

Answer 3

• Anxiety, often due to exaggerated perceptions, prevents exposure to alternative outcomes that challeng and replace orignal conditioning via extinction learning
• Short-term reductions in distress negatively reinforce avoidance behaviour (Salters et al, 2004)
• Long-term avoidance exacerbates the distress that avoidance to suppossed to prevent

Question 4

How does longterm avoidance generally worsen distress?

Answer 4

• Thought suppression is used during cognitive distress
• Evidence suggests a paradoxical rebound effect
  
  • ​Increases thought frequency
  • Particularly during cognitive overload (Salters et al, 2014)
• Physiological arousal can both improve and worsen during avoidance
• GAD (Wells, 1995) and PD (Clark, 1986) are anxiety disorders where physiological arousal is often catastrophically misinterpreted to maintain the conditions
• Emotional avoidance creates a similar paradoxical effect
  
  • ​Increased emotional experience
  • Diminishes adaptive learning, further reducing potential for extinction learning
  • Associated with poor interpersonal function and higher arousal to threat
  • Prevents formation of protective social interactions, communication skills, and problem solving (Salters et al, 2014)

Question 5

Discuss the impact of avoidance on GAD

Answer 5

• Worry as a distraction is self-reported as the only distinguishing factor between sub-clinical and clinical GAD (Borkovec, 1995)
• Metacognitive model (Wells, 1995) states that GAD develops once ‘worry about worry’ occurs, as the primary worries are seen as both helpful and damaging
• Worry is associated with insecure attachement and exploitability, increasing perceptions of generalised threat

Question 6

Discuss the impact of avoidance on SAD

Answer 6

• Thought suppression and catastrophic thinking especially relevant in individuals that believe their anxiety is visible
• Cognitive bias attributes safety behaviours as the reason for successful social interactions
• These are postively reinforced
• Avoiding eye contact and limiting verbalisation often equate to disinterest or dissatisfaction
  
  • ​Subsequently reducing likelihood of successful social engagement (Spence & Rapee, 2016)
• Link between emotional distress and physiological arousal
  
  • ​Any distress can create visible embarrassing features (blushing, shaking)
  • SAD aims to fundamental avoid these
• Emotional suppression
  
  • ​Reduces centre of attention
  • Prevention expression of needs and formation of protection relations

Question 7

Discuss the impact of avoidance on Panic Disorder

Answer 7

• Clark’s (1986) model of panic: catastrophic misintepretation of even the mildest somatic symptoms
• Interoceptive avoidance includes avoiding exercise to prevent tachycardia, creates many restrictions and dysfunction
• Also extends to strong emotions (anger, excitement) that generate physiological arousal (Salters et al, 2014)
• Alexithymia (difficulty expressiong emotion, instead communication with physiology) may develop
• Emotional distress therefore becomes another source of catastrophic misinterpretation