Part 1 of How It Works: Avoidance introduced the model of avoidance, and Part 2 explored the impact of “little-a” avoidance, or the safety nets we employ to help deal with distress.

In Part 3, we’ll dive into exposure therapy, the gold standard evidence-based treatment for tackling avoidance.

By now, hopefully three things are clear:

1. Most of us deal with distress, including anxiety and fear, by trying to get rid of it quickly.

2. We do so by avoiding the distressing thing all together, or by creating a system of safety nets that make the distressing thing feel more manageable in the moment.

3. Both big- and little-a avoidance are highly rewarding in the short-term, so we reach for them over and over again. But, over time, avoidance messes with our self-confidence, leaves us feeling incompetent, and makes our lives smaller and scarier.

Solution, please.

First, it’s important to realize that what goes up, must come down. Emotions cannot sustain at 100% unendingly. That’s why panic attacks, which people often describe as feeling like a heart attack, typically peak in intensity after ~10 minutes. If these symptoms continued to worsen indefinitely, they might actually be heart attacks.

I don’t say this to minimize the intensity of a panic attack or to deny that people can experience extremely heightened emotional pain for days, months, or even years on end.

Rather, it’s meant to illustrate that our belief that we can only handle a certain amount of distress is another trick that fear plays on us.

So, what would happen if we pushed past our peak distress?

This is the premise of exposure therapy. This evidence-based treatment consists of repeated exposure to the things that you have been avoiding. By allowing yourself to push past the avoidance, your mind learns a few critical lessons:

1. You can handle more distress than you think you can.

2. The thing you’re worried will happen is not actually that likely to happen.

3. Even if something bad does happen, it turns out you can handle that, too.

Now, nothing about working on our mental health is easy, and avoidance is a particularly challenging one. So I’ll give it to you straight:

You will feel worse before you feel better. If you’re pushing past the avoidance (ie, past the point of your “peak” distress), well… you’re going to feel more distress. (I’m really not one for sugarcoating.) Remember, though, that the goal is not to feel relief in the moment. The goal is to learn that you can handle a higher level of distress, and that. . .

The distress will eventually come back down again. It’s not instantaneous (or else you wouldn’t have needed to avoid in the first place). But, your distress will come back down again. Your brain needs the opportunity to learn this because, when you avoid, your brain operates from the lens of, “I can’t handle anything more than this. If it gets worse, the floodgates will open and I’ll never recover.”

Now, it’s not all doom and gloom, or else I wouldn’t provide this therapy (I’m not a sadist). The benefits?

When the distress does come down again, it won’t bring all the messy stuff with it. Rather than feel guilt, shame, regret, or disappointment for avoiding, you’ll actually feel a sense of accomplishment or pride.

And the next time around, you won’t feel as afraid. Because, this time, you actually know what to expect, and you know you can get through it without the safety nets. The scientific term for this is habituation, which simply means that we get used to something over time. The 20th time you ride a bike isn’t going to feel as scary as the first time; the 20th time you give the same talk isn’t going to be as nervewracking.

Even better? As the exposures get easier and easier, you’ll also experience so many more benefits than just the removal of fear. You feel more sure of yourself. And you start living again, possibly in ways you never could have imagined.

The fear no longer controls you.

I often say that exposure therapy is the closest thing to therapy magic. I’ve seen it quite literally change the course of people’s lives in a few months.

One of the things I love the most about it is that you’re doing the work, and I act as more of a coach who eventually steps away so you can take the helm of your own life.

And if you’re the one who got yourself better, then no one can take that away from you.

*A note on the importance of seeking ethical exposure therapy with an expertly trained professional:

Exposure therapy absolutely can be provided incorrectly, and misinformation has found its way to social media (eg, “rejection therapy”). Avoidance fights very hard to survive in the brain, and it is extremely good at doing so.

If you’re completely honest with yourself, do you tend to storytell in your therapy sessions rather than talk about what’s really causing you pain? Do you talk openly about past trauma because you know that you’re supposed to, but you feel completely numb when doing so? Maybe you focus on more manageable traumas rather than the big one? Do you laugh when the thing you’re talking about actually devastates you?

Every time your therapist does not draw attention to things like that, they are complicit in your avoidance. To unearth safety behaviors wherever they may be hiding, call out avoidance in the room, and not give into our own avoidance requires a highly skilled exposure therapist.

*Please note that information shared in this newsletter is for educational and common interest purposes only. It is not a substitute for mental health treatment, and is not intended to be used for diagnosis or individualized clinical advice. Reading this newsletter does not establish a therapist-client relationship.

If you are experiencing a mental health crisis, you can call 988 or text 741741. If you are interested in learning more about evidence-based therapy or starting therapy, you can reach out for a free consultation call.

In Part 1 of How It Works: Avoidance, we covered the significant, rapid relief we experience when we avoid, and how that powerful reward system reinforces itself over time.

Most important takeaway? Avoidance is a wolf in sheep’s clothing. It may appear helpful in the moment, but over time it hurts our self-confidence, it perpetuates anxiety, and it shrinks our lives.

In Part 2, we’ll take a closer look at the harder-to-spot, more insidious form of avoidance. This is the avoidance that shows up when you go to the work happy hour anyway – the white knuckling version of life.

“Big-A” Avoidance: Skipping the event all together.

It becomes fairly obvious that something needs to change when we frequently engage in “big-A” Avoidance, the kind where we avoid the situation entirely. For example, if we skip class every time we have to take an exam, auto-delete e-mails from our bank regarding outstanding payments, or bail last minute on our friends’ parties, we face overt consequences: failing the class, overdrawing our account, or no longer being invited out.

Because of these consequences, we hit a breaking point with this Avoidance much earlier.

The trouble is, we humans didn’t fix this by scrapping avoidance entirely. Instead, the avoidance got smarter. It figured out a way to stick around while making us think we weren’t really facing consequences.

Enter “little-a” avoidance: Having a few drinks before leaving for the event.

“Little-a” avoidance is any strategy we use to white-knuckle our way through something difficult when avoiding it entirely isn’t an option. (The clinical term, if you’re interested, is “safety behavior,” but I also like to refer to these as safety blankets or safety nets.)

These are much harder to put our finger on, in part because they’ve become so commonplace. “Little-a” avoidance might look like having a few drinks before a social outing so you loosen up, or falling asleep with Netflix on so you’re not alone with your thoughts. It could also be humor, anger, wearing a lucky outfit, over-preparing, reassurance seeking, or people pleasing.

Basically, it’s the things we do to make something uncomfortable feel more bearable.

You might be thinking, Well, if I do the thing I have to do, who cares how I got by? There are worse things than wearing an outfit that I always feel confident in.

That’s the avoidance speaking.

Only kidding (sort of). The truth is, Yes, there are far worse things, and…

“Little-a” avoidance keeps us stuck in our fear, limits our self-confidence, and is a barrier to fully experiencing our lives.

Most of what I see in my practice is little-a avoidance. So I can say with confidence that it does wear on us over time.

To better understand how, let’s consider this avoidance in the context of watching a scary movie. Say you absolutely hate the feeling of watching a scary movie and often have nightmares for days after, but you don’t want to miss out on the chance to socialize with your closest friends, who happen to be scary movie enthusiasts. If you were to watch the entire movie with a pillow over your face (little-a avoidance), what would happen?

You’d feel less distress watching the movie. A win, undeniably. Maybe you’d even sleep well afterwards.

But you’d never get used to it, never become more capable of handling it yourself. The next time you watched the movie, you’d be just as scared because you have no clue what to look out for. Although you might think that sitting through the movie makes you more confident, your brain is far more discerning. What it learns is that you only avoided the nightmares because of the pillow (the classic, It’s not me, it’s the pillow, cliche). In other words, you can’t handle it with your eyes wide open.

You might even feel more scared sitting down for the next movie. Because your brain learned that you can’t handle it on your own, your fear of scary movies may ramp over time. Will the pillow at your friend’s house be big enough to cover your eyes? What if there are no spare pillows? What about the creepy, suspenseful music – how will you be able to block that out?

Notably, you’d also miss out on all sorts of other things, the things that make a full life: sharing a moment of connection with your friends, beautiful cinematography, an opportunity to look at the particularly attractive actor starring in the horror film.

In this way, we fail to grow, to tap into our innate strength. And our lives become smaller and smaller until we find ourselves living in a pillow fort.

Now, of course, nobody has to watch the same scary movie over and over again.

…But unlike a scary movie, most of the things in our life that we little-a avoid are regular occurrences.

In part 3 of How It Works: Avoidance, we’ll take a look at how to know whether what you’re doing is avoiding or healthy coping, and what real solutions look like.

*Please note that information shared in this newsletter is for educational and common interest purposes only. It is not a substitute for mental health treatment, and is not intended to be used for diagnosis or individualized clinical advice. Reading this newsletter does not establish a therapist-client relationship.

If you are experiencing a mental health crisis, you can call 988 or text 741741.

In our ever-polarized world, all humans still have a few things in common:

We eat, we drink, we sleep, we avoid.

Dramatic, I know. But avoidance truly is that pervasive in society. If any of us were to comb through our days, we’d find countless examples of it. So let’s dig in.

All avoidance isn’t created equal.

First, important caveat: When it comes to psychology, very few things are all good or all bad, entirely helpful or entirely harmful.

Humans are complicated, and living is complicated. Nuance and context matter.

Avoidance is no different. If you’re trying to stop smoking and need to steer clear of the spot outside the office where you typically take a smoke break, by all means, avoid it.

But, here, I’ll be focusing on the harmful kind of avoidance – the kind that starts to work against our best interest. The kind we hide behind. The kind that makes our lives smaller and smaller, sometimes without us even realizing it.

This type of avoidance looks more like not having the conversation with your boss about a promotion, or insisting to your friend that everything’s okay when they’ve done something hurtful. It might even look like being the life of the party, or the parent who always volunteers to help out at school even though they’re barely holding it together.

So, if avoidance works against us, why do we keep doing it as regularly as we eat, drink, and sleep?

REASON: It’s hard to sit in our distress as it escalates, so we try to escape it. Avoidance is the quickest and most powerful way to escape.

Let’s take a look at a common experience: dreading a social gathering. If you dread going to work happy hours, for example, your distress throughout the day leading up to one may look something like this:

The dread and distress build the closer you get to the happy hour, and your mind is busy spiraling with all sorts of worries about the future. You start experiencing strong emotional and physiological reactions, like anxiety and nausea. It becomes difficult, maybe impossible, to focus.

Eventually, as the day wears on and the distress grows, it reaches a point that feels unmanageable.

CHOICE: We do the thing that makes our seemingly unmanageable distress go away as quickly as possible.

So you make a choice that makes you feel better in the moment: You decide to skip.

And your distress plummets.

All of a sudden, you feel relief – mentally, emotionally, and physiologically.

This pattern of avoidance and immediate relief is extremely rewarding, and the human brain is wired to reach for reward time and again.

Thus, avoidance reinforces itself. Eventually, it becomes second nature. And we get smarter about ways to avoid (more on that in pt. 2).

CONSEQUENCE: Avoidance catches up to us eventually, adding to our pain and hurting our self-esteem and confidence.

This would all be fantastic… if the story ended there. Unfortunately, many of us are all too familiar with what comes next: the shame, the negative self-talk, and sometimes overt consequences, like missing out on opportunities or relationships taking a hit.

The relief associated with avoidance is powerful in the short-term, but, when the dust settles, it leads to all sorts of suffering. Because of this, the anxiety doesn’t go away entirely.

And, importantly, the anxiety is just as bad the next time a work happy hour rolls around. In fact, we might even be faster to avoid the next time around because we know just how “effective” this strategy is.

That’s just the short term.

Over time, avoidance keeps us stuck in reliance, which takes a real toll on our confidence and our competence. We not only come to believe we need the avoidance to get through something anxiety-provoking, but also struggle to cope when we can’t rely on our avoidance strategy (eg, a mandatory social event at work).

What started as a good-faith effort to reduce our distress in the moment ends up being a threat to our self-esteem, growth, and a full life.

That’s important to keep in mind: It started as a good-faith effort. Lest this turn into another opportunity to pile on yourself for avoiding, remember that we all do this, and we all do it with the best intentions. Our brains are constantly making misguided attempts to do us a solid. We can be understanding of that, and start to make different choices when we catch these misfires.

In part 2 of How It Works: Avoidance, we’ll get into the sneaky ways that avoidance shows up when we can’t just skip the happy hour – what I like to call “little-a avoidance.”

*Please note that information shared in this newsletter is for educational and common interest purposes only. It is not a substitute for mental health treatment, and is not intended to be used for diagnosis or individualized clinical advice. Reading this newsletter does not establish a therapist-client relationship.

If you are experiencing a mental health crisis, you can call 988 or text 741741.

I’m a firm believer that we all have good (ie, rational) reasons for doing something. Where we get into trouble is that good reasons don’t always translate to good choices. And our choices have consequences.

Take, for example, someone who is going through a tough time at home and has become a live wire because of worry and poor sleep (reason). When they learn about a mistake at work, they become infuriated and start yelling at their direct reports (choice). Afterward, they feel shame and guilt for their behavior, and HR gets involved (consequence).

The choice?* Less than ideal.

The consequence? Fuel to the fire of our suffering.

But, the reason? Relatable and human.

We tend to focus most on the choices and the consequences in our lives – after all, those are the easiest ones to see. But, in ignoring the reason, we miss important opportunities to understand ourselves, give voice to our needs, and, dare I say, experience some validation and self-compassion.

Trying to change a behavior without filling the underlying need is hard. It leaves us wanting. And when we are able to push through and change the behavior anyway, that unmet need usually gets filled with another self-defeating choice.

Instead, we can use these “why’s” to propel us forward.

In the “How It Works” series, I’ll dig into the science, research, and theory behind our psychology. This is for those of you, who, like me, are motivated to change when you understand the underlying rationale.

Remember, these are explanations, not excuses. The work doesn’t stop at understanding why we do the things we do. Accountability matters, and changing what isn’t working for us matters.

*A note on choice: I imagine some of you had the reaction, “It hasn’t felt like much of a choice when I’ve yelled at someone in the past. My emotions got the best of me. Obviously I planned to do something different, but I couldn’t think in the moment.” I get it. When our emotions are heightened enough, or our needs strong enough, it doesn’t feel like we have control over our choices. But every single thing that we do is a choice, whether or not we’re consciously or rationally thinking about it. Acknowledging this is a hard reality check, certainly, but it’s also hopeful. If we are responsible for all of our choices, we also have the ability to do something about it. It starts and ends with us.

Please note that information shared in this newsletter is for educational and common interest purposes only. It is not a substitute for mental health treatment, and is not intended to be used for diagnosis or individualized clinical advice. Reading this newsletter does not establish a therapist-client relationship.

If you are experiencing a mental health crisis, you can call 988 or text 741741.