Leerdoelen Cognitive behavioral processes across disorders
Learning Outcomes Avoidance Behavior (week 1)
After studying the theme on behaviour (avoidance), including both the lecture (including
research presented in the lecture) and the readings, students should be able to discuss:
1. Avoidance from perspective of different therapy schools
Avoidance can be seen as a transdiagnostic process. The individual has the tendency to
avoid problems and the emotional suffering inherent to them. But when we avoid these
problems, we also avoid the growth that problems demand from us. This is why in a
mental illness you stop growing and you become stuck.
The unexpressed emotions will never die and go away. They will come forth later in a
uglier and harder way.
Existential therapy looks at the existential givens. They are the unknown/uncertainty and
the concomitant anxiety as surrounding human being. There is an absence of a solid
foundation of our meaning systems, our choices. This means we are always threatened by
chaos. This means ultimate meaninglessness and freedom and responsibility. Existential
givens -> anxiety -> defense mechanisms. We need defense mechanisms to deal with the
fear that the existential givens cause. Death is seen as being chosen, like an ultimate
rescuer. This way of looking at the world blocks the experience of really being alive.
Types of avoidance: overt escape/avoidance = individual does not enter or prematurely
leaves. Safety behavior = overt or covert avoidance/prevention of feared outcomes. Why
do it? Because it works, but only short term. It has also negative effects, it maintains or
increases the negative effect, because of the rebound effect.
2. Basic (experimental) research on avoidance and its implications for clinical disorders
The basic research of avoidance focuses on avoiding and approaching. An example is the
approach or avoidance of novel animals, seen on a computer screen. The animals that
were approached got a more positive rating and the animals that were avoided got a more
negative rating. Other experimental research is the thought suppression, but this will lead
to a big amount of rebound effect. Besides this, there will be cognitive avoidance in the
specific context.
The implications for clinical disorders is that the use of safety behaviors and avoidance
has a backfiring effect. With anxiety the individual will during exposure use safety
behaviors and when the catastrophic thoughts do not come true, they will link it with their
use of safety behaviors. With some of the disorders there is also a fear of fear and a
misinterpretation of bodily sensations.
Also, mood induction and somatic sensation.
There is also research been done about the coping styles of individuals. When the
individual uses emotion-focused coping this will involve avoidance and negatively predict
outcomes. You see this in patients with chronic pain, they are ignoring the pain, averting
attention and use self-statements to predict better psychological functioning.
, With psychotherapy there has been research with some positive findings. The amount of
self-relatedness, which means being in touch with yourself and being open to your own
feelings, is the most consistent predictor of positive outcomes.
3. A transdiagnostic role of avoidance, including the role of avoidance:
a. In DSM diagnostic criteria
The transdiagnostic role of avoidance in DSM diagnostic criteria is that the
symptom ‘avoidance’ makes it appearance more than once. Avoidance plays a big
role in social anxiety, in which the safety behaviors actually contributes to the
likelihood of feared outcome occurring. A narrowing of life is a logical
consequence of the avoidance behavior. The individual avoids, feels more fear and
will overgeneralize this fear, which leads to more avoiding. In depression there is
also avoidance, they avoid their negative thoughts about themselves and their
environment. This also contributes to the reduction of access to meaningful life.
The decreased availability of reward mediated the relationship between avoidance
and depression. In PTSD the avoidance contributes to the severity of it. There is a
sense of mental defeat after the trauma and the individual will use safety
behaviors.
b. In contributing to the development and maintenance of disorders (including how
language can increase the extent to which avoidance contributes to
psychopathology)
Avoidance contributes to the development and the maintenance of the disorder,
because the individual needs exposure to help with the disorder. The emotional
event is important and the individual needs to be conscious about what they are
feeling. The healthy change that is needed will produce painful experiences, these
experiences will be avoided and that is the main reason why avoidance leads to
pathology.
Besides this, our language can increase the extent to which avoidance contributes
to psychopathology in a way that how we predict and control our own behavior is
depended on the nature of our language. How we see our behavior or situations
can change the functions of these situations and behaviors. The report and the
reported are mutually related. Human emotions require a verbal label or an
appraisal as a cognitive component, this can mean that it alters the functions of
experiences that are so labeled.
The verbal awareness of one’s own experience can itself change the experiential
quality of what is known. The human emotions seem to require a verbal label, for
example anxiety. Aversiveness of labeled anxiety could increase greatly, because
anxiety is verbally related to humiliation.
c. In preventing the benefits of treatment
The avoidance prevents the benefit of the treatment, because during exposure
people are not trying to prove themselves that the catastrophic event did not
happen because it was never about to happen. No, they tell themselves that what
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