It’s normal for human beings to seek pleasure and avoid pain. Some of the ways in which we seek to avoid pain are adaptive or healthy. For example, many of us take precautions with our bodies in terms of dietary and lifestyle choices to avoid health problems, or we visit the dentist to avoid painful, sore teeth.
But avoidance becomes tricky and potentially problematic when it is applied to our inner world. The elaborate ways we turn away from and avoid difficult emotions can get us into trouble that can wind up worse than the emotions from which we were running.
There are several different types of avoidance. In their book, “Mind and Emotions: A Universal Treatment for Emotional Disorders,” Matthew McKay, Patrick Fanning, and Patricia Zurita Ona write about five types of avoidance.
Here’s what they are and what they look like in patients.
According to McKay and colleagues, situational avoidance is the most commonly used kind of avoidance. If a patient habitually avoids social activities, or leaves a job every time there is someone there he doesn’t like, the client is using situational avoidance.
People who use situational avoidance may fear certain individuals or kinds of people, locations that make them feel panicked or anxious, different kinds of animals, foods, activities, or social situations.
2. Cognitive avoidance
Cognitive avoidance is about avoiding internal events such as unpleasant or distressing thoughts or memories. With this type of avoidance, people usually take actions to suppress or reject the experience of certain kinds of thoughts that feel unpleasant or overwhelming. Strategies to avoid unwanted internal events may involve consciously telling oneself not to think about something, or taking action to “numb out” to the unwelcome thoughts. Cognitive avoidance can also show up as worry and rumination.
“You might handle your anxiety about the future and various risks in your life by constantly worrying about what might happen, running various scenarios over and over in your mind in the hope that constant vigilance will somehow prevent anything bad from happening,” write McKay, Fanning, and Ona.
Sometimes cognitive avoidance looks like trying to replace undesirable thoughts with other stuff—like daydreams, repetitive phrases, even prayers. Positive affirmations are often helpful for people, but saying them compulsively can be a way to avoid distressing thoughts or memories rather than work with them in a way that may provide long-lasting relief.
3. Protective avoidance
McKay and colleagues discuss protective avoidance as the use of excessive safety behaviors that might include checking, cleaning, over preparing, or perfectionism. Clients who present with symptoms of obsessive compulsive disorder and eating disorders often utilize protective avoidance strategies. But there is a curious flip side of protective avoidance as well. Procrastination is also considered a form of protective avoidance.
4. Somatic avoidance
Anyone who has ever experienced anxiety knows that it is typically a combination of mental and physical symptoms. Tightness in the chest, shallow breathing, increased heart rate and sweaty palms may all show up along with distressing thoughts when a person feels anxious. Other emotional challenges—like depression, anger, grief, and heartbreak—also come with noticeable somatic symptoms.
“With somatic avoidance, you try not to experience internal sensations associated with emotional distress, such as feeling hot, being out of breath, or getting fatigued or exhausted. You might even avoid normally pleasant sensations, such as sexual arousal or excitement about an upcoming event, because they feel similar to being anxious,” the authors write.
5. Substitution avoidance
Substitution avoidance is essentially trying to replace one feeling with another. A person might replace grief with anger, or another emotion that feels more tolerable for her at the time. Numbing out is also a form of substitution avoidance. For instance, patients who are unable to cope with difficult emotions might binge on food, substances, sex, pornography, shopping, or gambling as a way to distract.
Avoidance is so natural and common that it can take complex forms and look completely different from one situation to the next. Avoidance isn’t always maladaptive, but in many cases involving internal events, it is not sustainable in the long run and can actually make things worse. Understanding the ways clients may be habitually turning away from or rejecting difficult emotions is a great place to start in helping them to develop more adaptive responses to distress.