Anxiety and avoidance

Anxiety disorders, which include excessive worry, panic, and fear are more common that one might imagine—--they affect over 40 million Americans. Everyone has experienced periods of worry, tension, and stress which affects your mind and body. But when children and adults experience anxiety that is longstanding, it can be debilitating. 

Our body is wired to respond rapidly and effectively to external threats. The sympathetic nervous system kicks into high gear and produces rapid heartbeat, greater blood flow to the central core, and muscles primed for movement. It is a state of high alertness and is meant to be followed by either “flight or fight”. Afterwards, the parasympathetic nervous system restores us to a calm state. This survival system works very well for hunters and gatherers.

But in modern life, this system can go haywire. The flight or fight system can be turned on by simply thinking of a future threat (e.g. a worry)! This switch can become ultrasensitive.   And, in many individuals, it stays on. It is hard to turn off.

When we experience these unpleasant sensations, we want them to stop! This state of readiness is extremely uncomfortable when it isn’t followed by some sort of physical release or the eradication of the threat that triggered it.

And therein lies the problem. Anxious individuals seek to escape these very uncomfortable sensations by avoiding the situations that trigger this response. Teens and adults with social anxiety shun social situations. Individuals with fears of specific triggers (bridges, highways, driving, spiders, tight spaces, high buildings, and so on) become phobic—they avoid those activities or places.

From the perspective of reducing anxiety, avoidance works in the short run. But paradoxically, chronic avoidance of an anxiety trigger results in greater “anticipatory anxiety”. Simply thinking about the trigger results in a stronger flight or fight response. This temporary solution can foster more enduring problems. A person’s life can become small and constricted—filled with “I cants”. Self-confidence slowly erodes over time, which worsens the problem. Avoidance becomes a self-fulfilling prophecy. It makes the problem worse.

Joey, a 12-year old boy becomes anxious at school because he is afraid that he will be called on in class. When he is, his heart races, his palms get sweaty, and he feels nauseous. He starts to feel sick in the morning, just thinking about going to school. His tells his Mom he’s too sick to go to school. Soon, it becomes increasingly difficult for his parents to get him off to school. When he stays home, he feels better almost immediately because the threat and worry for that day has been eradicated. It’s easy to see how this can turn into an unhealthy pattern of behavior.

So what can we do?

• Recognize that avoidance is an unhealthy response to anxiety. By forcing ourselves to face our fear, we will experience anxiety. But if we do, that anxiety will fade. The next time we face our fearful trigger, anxiety will still be present, but slowly over time, this reaction will become less intense. And just as importantly our self-confidence will grow. Our goal is not to eradicate fear or anxiety, because that’s not possible (or completely desirable). But we don’t want to let fear prevent us from doing the things we want or need to do.
• Learn relaxation and mindfulness skills. We can learn to lessen this response through relaxation skills and mindfulness. These skills, when practiced, can be very effective.
• Seek help early. Talk to your doctor about counseling and medications. It is important to interrupt the avoidance cycle before it becomes firmly established. There are many evidence based treatments that work! But early intervention is important.