Avoidance Paper 1 (Salkovskis, Clarck, Hackmann, Wells & Gelder)
Patients who had stopped their safety-seeking behaviours showed a signi cantly greater
decrease in catastrophic beliefs and anxiety
Two Process theory:
Provided the rationale for development & implementation of exposure treatments:
the theory that the development of avoidance is crucial to the persistence of classically
conditioned agoraphobic anxiety by both preventing and prematurely terminating
exposure to the CS and thereby preventing the extinction of conditioned fear responses.
Biological theories agoraphobia: agoraphobic behaviour consequence of panic attacks
or panic-like symptoms but not key factor in prolonging panic.
Avoidance behaviour is a response to panic attacks, and secondary to them.
No full panic attacks —> “panic-like symptoms” drive the avoidant behaviour
Main focus of treatment should be on panic attacks and panic-like symptoms
According to the cognitive-behavioural theory; anxiety disorders arise when situations
are perceived as more dangerous than they really are.
Once such a threat is (mis)perceived: at least 3 mechanisms may be involved in
maintenance of persistent high levels of anxiety.
• Selective attention to threat-relevant stimuli
• Physiological arousal
• Safety seeking behaviours
The Cognitive theory suggest that in phobic anxiety, safety-seeking behaviour is
particularly important in maintaining perceived threat
Cognitive hypothesis: speci c links between panic and avoidance override the e ect of
objective discon rmations. Patients don’t only avoid situation but also the feared
outcome.
Patients are often unaware of the anxiety maintaining e ects of their avoidant behaviour
Cognitive hypothesis predicts an internally logical match between beliefs (them
preventing occurrence) and behaviours during panic
Cognitive analysis of avoidance involves an analysis of what outcome the patients is
avoiding rather than just the anxiety arousal/relief associated with speci c situation
Cognitive theory predicts that safety-seeking behaviours have the e ect of maintaining
anxiety-generating beliefs because patients infer that they have prevented the occurrence
of feared catastrophes by their behaviour
Results: patients in decreased safety behaviours group experienced signi cantly less
anxiety & rated their belief in feared catastrophes as signi cantly lower.
A brief (15 min) period of exposure to agoraphobic situation during which patient actively
sought to decrease safety-seeking behaviours was associated with substantially greater
belief change and fear reduction than a comparable period of exposure during which
safety-seeking behaviours were maintained.
THUS: Safety-seeking behaviours can play a role in maintaining key threat beliefs.
A coping response: intended to control anxiety; an avoidance response to prevent
perceived danger
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, Safety-seeking behaviour can be divided into three main categories:
1. Avoidance (prevent anticipated danger)
2. Escape (from a situation when anxiety occurs)
3. Behaviours carried out within a situation (actively preventing feared catastrophe)
Avoidance Paper 2 (Moulds, Kandris, Starr, Wong)
Study: examined relationship between rumination, avoidance and depression using new
self-report measure of avoidance: Cognitive-Behavioural Avoidance Scale (CBAS).
In the sort term: avoidance functions to reduce distress; in the long term, avoidance
contributes to the maintenance of anxiety.
Thesis of Ferster’s model (1973): depressed individuals engage in avoidance and escape
behaviours (e.g., making complaints, withdrawing), in addition to reduced frequency of
positively reinforced behaviour.
Behavioural activation (BA): depression is characterised by dysfunctional patterns of
avoidance, withdrawal and inactivity. BA intervention emphasis is on teaching clients
strategies to counter their problematic behavioural patterns.
Rumination: conceptualised as an escape or avoidance behaviour
Rumination similarly functions (like other types of avoidant behaviour; social withdrawal)
to avoid active engagement with the environment and to avoid engaging in active
problem solving.
Response styles theory of depression: most in uential model of rumination. —>
duration, severity and course of depressive illness are a consequence of how one
responds to depressive symptoms. Individuals who ruminate about the causes and
implications of symptoms are more likely to because depressed and remain depressed for
longer.
Experimental studies have linked rumination to a range of cognitive correlates of
depression, including impoverished problem solving, overgeneral autobiographical
memory, and negative cognition.
Ruminative Response Scale (RRS): this measure indexes two distinct factors, labeled
by the authors as brooding and re ection.
Brooding —> tendency toward moody pondering
Re ection —> tenancy to contemplate and re ect
Treynor et al. (2003): brooding associated with greater depression concurrently and
longitudinally, re ection associated with greater concurrent depression but less over time.
Suggests: brooding may be most closely linked to maladaptive outcomes of rumination.
Avoidance theory of worry: to account for the maintenance of rumination. ‘the function
of worry is to escape aversive imagery’.
Worrisome thought is predominantly verbal (rather than image-based): by avoiding
aversive imagery, worry limits somatic and physiological arousal associated with problem
content.
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, If worries are more abstract and less concrete and speci c in nature, they are less likely to
evoke distressing imagery and in turn to evoke corresponding somatic responses.
Problems remain unsolved and worry persists.
Rumination as a cognitive avoidance strategy in PTS: individuals engage in rumination to
avoid processing their anxiety-eliciting trauma memories.
Gray’s (1982) suggestion of 2 a ect-motivational systems — the behavioural inhibition
(aversive, or punishment-driven) system, and behavioural activation (appetitive, or
reward-driven) system.
Fowles (1994) proposed that depression and anxiety are characterised by high
behavioural inhibition but low behavioural activation.
Dickson & MacLeod: counter to prediction, anxiety (but not depression) was correlated
with avoidance goals. —> inconsistent with proposal that depression is associated with
avoidance. Thus: association between avoidance and depression remains unclear
CBAS: Self-report instrument indexes avoidance across 4 factors:
• Behavioural-social
• Behavioural-nonsocial
• Cognitive-social
• Cogntiive-nonsocial
Prediction this study (Moulds, Kandris, Starr, Wong): rumination would correlate positively
with the cognitive avoidance sub scales of the CBAS.
Also hypothesised that brooding would be more strongly correlated with avoidance than
re ection.
Also a positive correlation between rumination and behavioural subscales CBAS.
Findings:
• Individuals who are more likely to engage in behavioural avoidance are more likely to
ruminate (independent of anxiety).
• Correlations between depression and CBAS were greater in magnitude than correlations
between anxiety and CBAS scores
• Suggestion: the construct of avoidance may deserve more consideration in the
conceptualisation of depressive disorders
• Brooding correlated with all of the avoidance measures, re ection only associated with
behavioural-social avoidance
Avoidance Paper 3 (Hayes, Wilson, Gi ord, Follete)
Syndrome classi cation: diagnostic system. Promise of identi cation of functional
pathological processes. —> failed
Examine the di erences between two core classi cation strategies in psychopathology —
syndromal and functional. And one possible functional diagnostic dimension:
experiential avoidance
Syndromal classi cation — whether dimensional or categorial — can be traced back to
Wundt and Galen and thus, is as old as scienti c psychology itself.
It starts with constellations of signs and symptoms to identify the disease entities that are
presumed to give rise to these constellations.
Syndromal classi cation thus starts with structure and, it is hoped, ends with utility.
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, DSM dominance has lead to worldwide adoption of syndromal classi cation as an
analytic strategy in psychopathology. Only widely used alternative is International
Classi cation of Diseases (ICD) system.
Goal of syndromal classi cation: identify collection of signs (what one sees) and
symptoms (what the client’s complaint is). The hope is that these syndromes will lead to
identi cation of disorders with a known etiology, course, and response to treatment.
Syndromal categories tend to evolve — changing their names frequently and splitting into
ner subcategories — but except for political reasons they rarely simply disappear. The
number of syndromes within DSM has increased exponentially.
Functional classi cation: start with utility by identifying functional processes with clear
treatment implications. It then works backward and returns to the issue of identi able
signs and symptoms that re ect these processes. Fundamental di erences.
Behaviours and sets of behaviours are organised by the functional processes that are
thought to have produced and maintained them.
Less direct and naive than syndromal approach, as it requires the application of
preexisting information about psychological processes to speci c response forms.
Classical functional analysis
1. Identify potentially relevant characteristics of individual client, his/her behaviour and
the context in which it occurs through broad assessment.
2. Organise the information from step 1 into preliminary analysis of client’s di culties in
terms of behavioural principles as to identify important causal relationships that might
be changed
3. Gather additional info based on step 2 and nalise conceptual analysis
4. Devise an intervention based on step 3
5. Implement treatment and assess change
6. If outcome is unacceptable, recycle back to step 2 or 3
Many problems with classical functional analysis as a functional classi cation system.
Sometimes vague, often di cult to replicate, and ideographic in the extreme.
Summary:
Syndromal classi cation tends to ignore the developmental, functional, contextual
approach to behaviour that is characteristic of much of our discipline in favour of a more
object like, pathological, medical approach.
Functional diagnostic dimensions present an alternative, of which emotional avoidance is
just one example. Functional diagnostic dimensions are not traditional disorders, nor are
they well-worked-out etiological theories. They are dimensional processes, not all-or-
nothing categories, that suggest psychological processes relevant to etiology.
As such: provide a kind of functional middle ground between mere psychological
topography on one hand or well-developed and functional psychological theories of
psychopathology on the other.
Functional diagnostic dimensions focus directly on behaviour of interest
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