Worry Off-Ramp Chapter 3
The exercise Chapter 2
Part 1 Anxiety, triggers, and reactions — key concepts, terms, and tools
03Chapter

Natural Avoidance and Habituation

Avoidance is self-reinforcing and simply begets more avoidance, which leaves little opportunity for habituation.

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Chapter three

Natural Avoidance and Habituation

As babies and toddlers, human beings naturally tend to reference or cling to their parents when they enter a strange environment or if approached by a stranger. You've probably witnessed this. A mother holding a baby about nine months of age is approached by an old friend–a stranger to the baby–who exclaims, “Oh, this is your baby. How cute!” As the stranger approaches, the baby turns her face into her mother's bosom. This is a natural self-protective response: avoidance.

Over time, as the baby is exposed to more strangers, her face will brighten when she gets positive attention from new adults. The baby learns through experience that these strangers won't hurt her, and she gets used to strangers making a fuss over her. We call this habituation.

Editorial figure · not from the manuscript
SUD With avoidance — the discomfort doesn't let up With exposure — each peak is lower, and it passes sooner 1st stranger 2nd 3rd 4th each new stranger, one after another →
Figure 3.1 — Habituation across repeated exposures. The baby's discomfort still rises each time a stranger makes a fuss over her, but the peak is lower and passes sooner with every repetition until her face brightens instead. Where avoidance intervenes, the discomfort has no chance to resolve, so there is nothing to get used to. Editorial diagram, drawn from the text — not an illustration called for in the manuscript.
Chapter three, continued

For those children whose anxiety is tuned up to a higher level, the discomfort doesn't let up as easily. They don't have the experience of anxiety dissipating quickly when they remain in social (or unfamiliar) situations. Therefore, they may resist going to school or spending the night away from home. They worry about bad things happening to their mothers and fathers or going home and finding their parents gone. They may seek reassurance repeatedly. Unfortunately, reassurance doesn't solve the problem any better than avoidance. The only relief they know comes from avoidance. Avoidance is self-reinforcing and simply begets more avoidance, which leaves little opportunity for habituation.

Chapter three, continued

As mentioned above, avoidance takes on many forms. Through repetition and the self-reinforcing result of short-term relief from anxiety, these behaviors can become compulsions. That is, the urge to engage in avoidance behavior grows to be strong and automatic. Safety behavior is any type of behavior you do to reduce anxiety. For some case-specific examples of safety behaviors, let's look at a fear of contamination scenario.

Core fear: Touching the doorknob will lead to fatal illnesses that can be passed on to a loved one.

To avoid or reduce the anxiety associated with this fear, this person might:

  • Wear gloves or long-sleeved shirts to avoid actually touching the doorknob with their hand.
  • Open the door with an elbow.
  • Have someone else open the door.
  • Excessively wash hands or use hand sanitizer just in case they might have touched the doorknob.

Though these actions decrease the person's anxiety around contamination, it is only temporary. In addition, it strengthens the faulty belief that touching a doorknob will lead to illnesses: “I have never given my daughter a life-threatening illness before because I always wear gloves when touching doorknobs. Therefore, it must be true that avoiding contact with doorknobs prevents illnesses.”

Chapter three, continued

With exposure, we challenge these fears while resisting and gradually eliminating safety behaviors throughout the process. Some examples of gradual exposure while resisting contamination safety behaviors include:

Editorial figure · your four steps, set as a ladder
  1. Touching the doorknob with one finger without using a sleeve or glove.
  2. Waiting a minute before washing.
  3. Grabbing the doorknob with the whole hand and waiting for longer periods of time before washing.
  4. Grabbing the doorknob and then touching the daughter with the “contaminated” hand.

The core fear sits at the base of the ladder — the fear named in the scenario above. Each step upward resists a little more of the safety behavior.

Figure 3.2 — The steps as a ladder. The four examples exactly as they appear in Workbook Revision #2, in your order, drawn to show that each one asks for more than the last. The rung numbers and the small difficulty markers are additions of this edition; the wording is untouched. If you would rather this ran as a plain bulleted list like the book, say so and it goes back.
Manuscript subheading · Exercise

Exercise: What do you do to avoid anxiety?

The prompt is exactly as written in the workbook. Nothing you type is saved, sent, or stored — closing this page clears it.

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Do you observe any avoidance activity in your own life? Are there situations, people, or events that you skirt in order to keep your stress or anxiety down? Do you use substances to relax before approaching events or situations? Do you notice any mental rituals or habits you use to keep anxiety in check? Write any avoidance behavior you notice in yourself in the space below.

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