Triggers, Avoidance, and Worry
Most of the threats we experience in daily life come from the perceived potential loss of our status among our peers and family. This explains why the concern over what other people may think can ramp up anxiety in folks who have anxiety disorders. Concern over what others may think can elicit mild (SUDs one to three), moderate (SUDs four to six), or severe anxiety (SUDs seven to ten) in people who suffer from OCD or social phobia. People without anxiety disorders commonly have the same or similar anxiety triggers (intrusive thoughts and events) as those with anxiety disorders. However, because their anxiety baseline isn't as high, they can more easily move on without much difficulty.
In the following example, the small hill represents a low level of anxiety that the rider can climb fairly easily and move on.
For those with a higher baseline of anxiety, stressful events can result in diffuse physiological arousal and even panic attacks. This makes it almost impossible for them to set aside a threat trigger. In reaction to their intense discomfort, anxiety sufferers often engage in avoidance behavior. Instinctually, we avoid situations that we believe make us feel uncomfortable or threatened. Avoidance commonly takes the form of leaving or staying away from a situation, distracting oneself by trying to think about other things, staying busy, or engaging in worry.
Avoidance brings immediate relief but doesn't solve the problem. The paradox for the anxiety sufferer: avoidance maintains anxiety by keeping its victim from habituating or getting used to the anxiety-provoking situation. Until we face the fearful situation (climb the hill), we will contend with anxiety. This is one reason we do exposure.
In the following illustration, the cyclist represents the person suffering from anxiety. The steep hill represents the rising anxiety and discomfort, and the difficulty of the climb that motivates the avoidance. The avoidance cycle (veering off from the climb for temporary relief) represents the negative reinforcement (doing something to avoid something bad) that has the person stuck in a loop that prevents the process of climbing to the top. The square-wheeled bike represents the increased difficulty of climbing up with each avoidance when triggers inevitably return.
Avoidance Examples
- Social anxiety
- hiding in the bathroom during a party
- Health anxiety
- avoiding going to the doctor
- Generalized anxiety disorder
- worrying about an upcoming counseling appointment
- Performance anxiety
- avoiding a class presentation
- Panic disorder
- avoiding places where he/she has had a panic attack
- Post-traumatic stress
- avoiding crowded or loud venues
- Relationship obsessive-compulsive disorder
- constantly seeking reassurance
- Scrupulosity, obsessive-compulsive disorder
- balancing bad thoughts with good thoughts
- Harm obsessive-compulsive disorder
- constantly checking that hazardous appliances are off or unplugged, or hiding potentially harmful things
- Arachnophobia
- avoiding going outside in case there might be spiders
- Anxious persons
- using substances to avoid or reduce feelings of anxiety, such as alcohol, benzodiazepines, or marijuana
Exposure to the anxiety-provoking situation, the very thing we try to avoid, offers the only long-lasting relief short of being medicated indefinitely. Our bodies will not allow anxiety to continue to climb forever. It naturally peaks and drops with exposure, and we can learn that we can tolerate anxiety and that anxiety is not dangerous. The following illustration shows the benefit of the climb and the ride down the hill. We might be tired afterward, but it feels better.