Avoiding Avoidance

by Charles H. Elliott, Ph.D.

Real estate agents are fond of saying that their field can be distilled into three words: location, location, location. When it comes to anxiety and obsessive compulsive disorder (OCD), we turn to three words to capture much of the problem as well: avoidance, avoidance, avoidance. People with all types of anxiety disorders generally feel driven to do everything they can to stay away from events and thoughts that tend to trigger their anxiety. In doing so, they hope to keep their anxiety and distress at bay.

And this approach works. So what’s the problem? Although avoiding what disturbs you provides relief, that relief is fleeting. And that short moment of relief ends up making you feel even more desire to avoid feeling anxious the next time. An example may help.

Ralph is a twenty four year old computer technician. He’s had contamination OCD since he was a teenager. His OCD started with worries about becoming ill from touching doorknobs. So he developed strategies for avoiding such germs; he would wear gloves, spray knobs with disinfectant, or use his shirttail to open doors. Each time he used one of these avoidance techniques he experienced brief relief. But then he started to worry about contamination from faucets, toilets, and steering wheels on cars. He used similar strategies for these new worries and felt momentary relief each time he succeeded in avoiding contact with his fears. But as the years went by, his relief experiences encouraged him to look for more sources of conceivable contaminations to avoid. His life became unglued when his concerns turned to computer keyboards, mice, and touch screens. Without treatment, Ralph’s future looks worrisome as he becomes more and more avoidant.

That’s what avoidance does to you. It makes your world smaller and fosters your fears. The more you avoid, the worse things get.

That’s why successful treatment for OCD (and other anxiety disorders) rests largely on the antithesis of avoidance–exposure and response prevention (ERP). ERP gradually guides people to come into direct contact with the things that disturb them or arouse their anxiety. At first exposure escalates feelings of distress. But with continued work, that anxiety decreases. Your world gets larger. We’ll explain more about the “response prevention” part in a subsequent blog soon.

However, if you have serious OCD or anxiety, don’t try ERP on your own. Get the guidance of an experienced mental health professional that can show you exactly how to proceed. The great news is that ERP can be extremely effective. In future blogs we’ll tell you about some other ideas for working on anxiety and OCD, but exposure techniques typically make up the foundation of most approaches.

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