How important is avoidance when it comes to anxiety? Very. Very, very, very.
To illustrate this point, consider the following story.
In a therapist manual for the treatment of anxiety disorders, anxiety experts Dr Martin Seif and Dr Sally Winston mention a story from the Talmud, a collection of Jewish laws and traditions. The Talmud refers to a man who challenged the great rabbis to teach him the Torah (Jewish scripture) while standing on one foot. Most rabbis chased him away, but one responded: ‘What is hateful to you, do not do to your neighbour: that is the whole Torah; all the rest is commentary.’
In the same way, note Seif and Winston, treating anxiety can also be reduced to a principle simple enough to learn while standing on one foot: ‘Anxiety is maintained by avoidance, and willing exposure is the active ingredient of recovery. That is essential; all the rest is commentary.’
Anxiety is easily the most common problem reported by clients at my practice, so I’ll say this: Seif and Winston are not exaggerating. Obviously, I talk with clients about a variety of issues when it comes to anxiety – psycho-education; the importance of learning to tolerate uncertainty, of resisting the temptation to ruminate and get stuck in “what if?” thinking; cognitive distortions or thinking errors such as catastrophising; positive and negative beliefs about worry; and so on.
Nevertheless, if I had 30 seconds with someone and they asked me for quick advice about anxiety, I would repeat the above-mentioned line about cutting out avoidance and willingly exposing yourself to feared situations.
Overcoming anxiety means understanding and identifying the various ways in which you avoid. Avoidance feels good in the short term, because you feel relief. As the aforementioned therapist manual makes clear, however, the long-term effect is that it reinforces, empowers and energizes anxiety, while disempowering the client. The more you avoid, the weaker you feel; thus, avoidance breeds further avoidance. Your life shrinks and your confidence shrivels.
The goal of evidence-based therapy, then, must be to reverse that trend – to empower the client and disempower the anxiety.
It’s so important to become fully aware of the extent to which avoidance plays a part in your life. Many avoidances are obvious – for example, the socially anxious person who avoids get-togethers or parties; the person with OCD whose fear of contamination leads them to avoid touching anything that may be dirty; the person who avoids flying because of their fear of flying, and so on.
However, there are all kinds of subtle avoidances that you may be less aware of. For example, a socially anxious person might go to a get-together but avoid talking with very attractive people. They might go, but make sure they are in a dark corner of the room and easily able to make a quick exit. They might stay busy behind the scenes in the kitchen, or make sure a close friend is by their side all night, or mentally rehearse their conversations in advance, or keep checking their phone to limit their interactions, or countless other more subtle avoidant safety behaviours.
Someone with OCD might avoid places, situations or people that trigger unwanted thoughts.
Someone with health anxiety might turn off the TV or radio when a health-related subject is being discussed.
A person with panic disorder might do their shopping outside of peak hours, when the supermarket is especially quiet.
A fearful flier might book a flight but make sure to get an aisle seat.
Space prohibits me from going on, but suffice to say the list of possible avoidances is an incredibly long one. It’s crucial to list all of the avoidant behaviours you can think of.
Then, aim to start cutting them out of your life.
Rome wasn’t built in a day, so I’m not asking you to start with the most intimidating situations. Instead, start small and work your way towards more difficult situations, building confidence as you do so.
Remember, managing anxiety means tackling avoidance. To repeat once more, ‘willing exposure is the active ingredient of recovery. That is essential; all the rest is commentary.’