How Does CBT Approach the Concept of Avoidance Behaviors?

A key tenet of cognitive behavioral therapy (CBT) is that people often engage in avoidance behaviors to cope with distressing thoughts or situations. For example, people with a fear of heights may hide from climbing stairs or skip work meetings to avoid speaking in public. In many cases, our attempts to avoid distressing experiences or situations only serve to increase anxiety and perpetuate the cycle. CBT aims to help people break away from these maladaptive behaviors by teaching them more productive ways to manage their worries or fears.

The aim of this study was to investigate the temporal associations between avoidance behavior and cognitions in clients with social anxiety disorder (SAD) receiving cognitive behavioral therapy in a primary care setting. Cross-lagged panel models were used to determine whether and when avoidance behaviors predicted SAD-related cognitions, and vice versa. In addition, the predictive validity of this model was examined by including depressive symptoms as a covariate.

Results suggest that SAD-related avoidance behaviors do predict SAD-related cognitions, independent of stable between-person differences in these variables. This finding underscores the importance of separating within-person and between-person effects in psychotherapy research, especially when examining treatment efficacy. Moreover, these findings suggest that targeting avoidance behaviors for primary care clients who report SAD may be vital to the optimal effect of cognitive behavioural therapy.

Concept of Avoidance Behaviors

Another important aspect of CBT is identifying and challenging negative automatic thought patterns that contribute to avoidance behaviors. For instance, people with social anxiety tend to catastrophize social situations, assuming that they will be embarrassing or uncomfortable. They may also believe that others will find them annoying or uninteresting, a belief that is largely based on their own past experiences of being judged by others.

In therapy, therapists can help individuals recognize and challenge these negative thoughts by guiding them through an exposure exercise. This is a process of gradually exposing the client to feared objects, activities, or situations. For example, a person with claustrophobia might go out to dinner and eat in an elevator instead of avoiding it altogether. In some cases, therapists will help clients confront their fears directly, such as by assisting them in giving a speech or visiting the place where they were sexually assaulted.

A therapist can also help individuals develop more helpful alternative beliefs to the negative ones they are currently having. For example, they might help them view the situation from the perspective of a supportive external source or by using an understanding intrusive thoughts worksheet.

Lastly, a therapist can teach people problem-solving skills to overcome the obstacles that might arise when facing their fears. For example, they might show them how to use a breathing technique or help them to find other methods of dealing with their anxieties without avoidance. This can include coping with unpleasant emotions such as sadness and anger. They may even try role playing to help them learn how to interact with other people in a healthy way. Ultimately, these strategies can reduce avoidance behaviors and improve overall functioning.