Avoidance not only reinforces anxiety, but it also undermines potential.

As you commit to moving towards anxiety, uncertainty, and discomfort, there are several patterns that can undermine your best attempts at avoiding avoidance.

● Situational avoidance reinforces fear and creates demoralization.

● Experiential avoidance during situational anxiety creates habitual distance from the present moment and burnout.

● Cognitive avoidance creates habitual worry and rumination that reinforces catastrophic thinking and pervasive negative beliefs.

● Somatic avoidance creates habitual distance from the present moment and difficulty maintaining self-care.

● Emotional avoidance creates habitual distance from the present moment and difficulty experiencing intimacy and vulnerability.

● Emotion-driven behaviors are problematic avoidance behaviors such as addiction and fighting that create a new cycle of suffering.

If you don’t drive or fly because of the possibility of a panic attack or don’t eat a certain food or engage in certain activities because of OCD, you are suffering from situational avoidance.

If you could “just do it,” you wouldn’t be seeking help. You’d be on the flight, eating that food, at that party.

Avoidance isn’t a moral failing, a willpower problem, or a failure of character.

Most likely, you are getting tricked by anticipatory anxiety. You might also have very high anxiety sensitivity, making situational anxiety very challenging to tolerate. You probably also have critical post-event processing, which undermines that natural euphoria that usually comes after overcoming a challenge.

The three stages of an anxious episode are anticipatory anxiety, situational anxiety, and post-event processing. If you panic, worry, or experience an unwanted intrusive thought during a situation, and then engage in compulsions, worry, rumination, or mental rehearsal in an attempt to calm yourself down, you will have anticipatory anxiety before a similar situation in the future. This is just how the fear circuitry works. You have to be prepared for anticipatory anxiety and be ready to hang out with it without acting as though it is a threat or a message. If you listen to the anticipation in your bodies and decide that the situation is too dangerous, it will feel more and more dangerous.

You can use a hierarchy to overcome a situational fear but you don’t have to do so. For instance, once you understand anticipatory anxiety, you might want to go straight to a social event and get as anxious as possible. You might, on the other hand, like to start by initiating a conversation with a ride-share driver or something like it. Regardless of the type of anxiety disorder or content area, you can always either start with mild exposures and build confidence or start with big exposures and build confidence. The key is to build confidence.

More specifically, the key therapeutic elements are:

1) Trigger anticipatory anxiety.

2) Hang out in anticipatory anxiety without fueling it or acting like it is a message. (“I’m expecting to be anxious and uncertain. Uncertainty is a feeling, not a fact or prediction. My anticipatory anxiety is predictive of my past, not my future.”)

3) Attend an anxiety-provoking situation (which may or may not provoke anxiety at that moment). Focus attention on the situation, rather than whether or not you feel anxious and what it means or doesn’t mean.

4) Refrain from post-event processing in the form of worry, rumination, and self-criticism. Focus attention on what went well and what you learned.

5) Do it again.

In the beginning, moving towards situations you want to avoid might not feel good. Just as exercising for the first time when you are out of shape is uncomfortable (until it isn’t), going towards anxiety-provoking situations will be uncomfortable (until it isn’t).

With this in mind, you may need a behavioral reinforcement strategy for a few weeks. Here are some examples of strategies:

● “I have a piece of chocolate after every driving exposure.”

● “If I do my exposures 6 out of 7 days this week, I am buying this thing I want.”

● “I will text my friend after every time I do my exposure. If I do my exposures 6 out of 7 days, she will buy me dinner. If I don’t do my exposures, I have to buy her dinner.”

There’s no right strategy here. Different people are reinforced by different incentives. Brainstorm what is reinforcing to you. Commit to it and then live in your commitment.

Eventually, going towards anxiety-provoking situations will feel more habitual and the feeling of accomplishment and pride will be your reinforcement. You can use an external behavioral reinforcer until your internal reinforcement system kicks in naturally.

Notice that self-criticism undermines the feeling of pride, which is typically the feeling that keeps people motivated to do challenging activities. It’s important to refrain from self-criticism after your exposures because:

● It hurts.

● It creates anticipatory anxiety about similar situations in the future.

● It undermines pride, which motivates us to keep doing challenging things.

● It undermines your capacity to learn about yourself by observing your experience.

Experiential avoidance during situations

Lots of anxious people don’t actually avoid situations, but still feel stuck. If you are in that category, you are likely avoiding experientially.

If you are on a bridge, a flight, in a presentation, at a social event, or in the presence of an OCD trigger, but you are body-checking for anxiety, worrying, ruminating, planning your escape route, or reassuring yourself that you can engage in compulsions later, you are avoiding experientially.

Your fear circuitry is smart and doesn’t care where you are. Internal avoidance is just as reinforcing as external avoidance.

If you do lots of situational exposures, but still feel very anxious, and often think, “why isn’t this working? what am I doing wrong?” you are probably, in reality, doing exposure incorrectly. This is still not a willpower, character, or moral problem. It’s a strategy problem. Observe and track what happens in your mind during situation anxiety so that you can identify the beliefs and habits that maintain it.

I have full confidence and unwavering belief that anxious suffering is created, maintained and intensified by avoidance and exposure relieves that suffering. When you are still anxious, we just haven’t figured out and shifted the combination of mechanisms that maintain it yet.

We use the term experiential avoidance rather than simply avoidance to remind ourselves of how we avoid both ourselves and the world around us. Situational avoidance is usually easy to identify. That said, many anxiety sufferers don’t avoid situations. Still, anxiety is always maintained by avoidance. We all avoid thoughts, feelings, sensations, memories, and urges with varying degrees of intensity and rigidity. The main belief that maintains experiential avoidance is that your internal experience — that is, your thoughts, feelings, sensations, memories, and urges — are a threat. Fear, shame, and self-criticism of your internal experience are interpretations that create experiential avoidance. Let’s talk more about your internal experiences and how to relate to them without avoidance.

Emotions are evolutionarily adaptive states that motivate behavior. Every emotion has or has had some utility in the evolutionary past. After the initial surge of emotion, you can choose whether you want to keep the thoughts associated with that feeling going. Your thoughts will retrigger the sensations to keep that emotion going.

You only have the opportunity to choose whether you want to keep the emotion going if you are able to identify what’s happening. Many people do not have awareness of what’s happening to them when they are experiencing an emotion. The emotion feels like reality and the act to urge feels like the only option. It’s worth it to observe your emotional states and your urges to act in the presence of emotions so that you have the chance at more flexible behaviors.

The opposite of experiential avoidance is staying with emotions. Don’t just do something, sit there! When you choose to bring attention to and stay with emotion, you know you on the right track if you can feel the emotion pass within a minute or two.

Observing with an attitude of compassion and curiosity

Thus, when you go about observing your emotional states, your attitude and intention matter. Some part of you may feel very motivated and excited by the idea of observing your thoughts and feelings. If you have suffered a lot and felt stuck in your internal experience, making a plan can fill you with hope and efficacy. There might be another part of you who doesn’t want to observe what’s happening and would prefer to hide from yourself and others. Expect that. It is a normal part of the process.

Notice that you will retrigger yourself if you add fear, shame, or self-criticism to your observation process. The moment you are triggered is an opportunity.

You have the chance to use it for greater self-understanding and eventually, calmness, compassion, and connection.

This moment is also an opportunity for you to feel more fear, more shame, helplessness, hopelessness, and worthlessness.

The attitude with which you approach the task predicts whether you grow from this moment or experience more suffering.

Therefore, when you feel fear, shame, self-criticism or any other reaction that makes it hard to stay with the emotions as emotions, use your higher intelligence and redirect yourself back to the attitude and intention you chose. After all, your fear, shame, and self-criticism are also secondary processes. If you can redirect yourself back to the initial experience during those states, you are practicing well.

Cognitive avoidance occurs when you use problematic thinking to avoid feeling or to avoid effective thinking. I’m not referring to avoiding thinking altogether. In fact, your mind might be racing when you are engaged in cognitive avoidance. I’m referring to the types of problematic thinking (that is, unproductive worry, mental compulsions, and rumination) that create distance from feelings and prevents you from effective thinking (that is, problem-solving).

Worry can occur when you have the feeling of uncertainty about an unanswerable question and you try to make the uncertainty dissipate by answering the question.

Worry is productive when the question is answerable and the attempts to answer it result in problem-solving. Worry is unproductive when the question is unanswerable and the attempts to answer it create more questions, plus worry about worry (that is, “what if I can’t stop worrying?”).

Functional cognitive avoidance (including unproductive worry, rumination, and mental compulsions) starts out as an attempt to answer uncertainty, to problem solve, or to understand something from the past when you experience uncomfortable feelings. Then, you get used to worrying or ruminating when you feel those uncomfortable feelings. Worrying and rumination in response to uncomfortable feelings begin to function as a way to avoid those feelings. Worrying and rumination then become habitual so quickly that you don’t even realize that you are avoiding your feelings.

Remember that we are always trying to find the function of a particular thought or behavior and how it relates to suffering. For instance, the function of hand washing is typically to reduce the uncertainty about the potential for being contaminated. The consequence of the behavior is that it reduces anxiety momentarily, but then primes the mind to feel anxious under similar circumstances in the future and reinforces the urge to engage in the same behavior again in the long-run.

Ideally, you can observe the function of cognitive avoidance in yourself without shame or guilt. It isn’t some type of weakness or failure. It’s just a functional behavioral pattern. That said, some behavioral patterns cause more suffering than others and thus, striving to bring awareness to and changing behavioral patterns that cause them suffering is a worthy goal.

Worry and rumination as a developmental cognitive avoidance strategy

Let’s add some context to the way cognitive avoidance may have started as a functional thinking strategy to avoid uncomfortable feelings and then became a habit that distances you from your feelings.

Although anxiety disorders are the result of biological and cognitive vulnerabilities that can occur without any traumatic history, many anxious sufferers do in fact have traumatic childhoods. One form of childhood trauma is a chronic lack of emotional attunement. When you don’t feel seen, understood, and safe to share what you’re experiencing while growing up, you are vulnerable to feeling overwhelmed by your internal life and painfully alone to handle it.

If your attempts at coping with your feelings were too rigidly over-controlled or impulsively under-controlled or some combination of both, you probably developed a chronic sense of helplessness or hopelessness about it. Then, you probably felt shame, anger, and/or resentment that you were left alone to fend for yourself. This sometimes happens even if you were surrounded by what seemed like a warm and supportive family and/or a privileged lifestyle. That’s often more confusing. The key here is the emotional attunement.

Here are some questions to ask to assess for emotional attunement in childhood:

● Did your parents or some other important adult in your life understand you and help you feel efficacious with your inner life while you grew up?

● Did they mostly provide you with safety, space, and support while you learned what you were feeling?

● Did they teach you skills to cope with your feelings over time?

● Did the important adults allow you to see and understand them in an age-appropriate way?

● Did their self-disclosures make you feel close to them without burdening you with adult concerns?

● Were you made to feel worthy of their time and attention?

If the answers to the questions above are mostly no or definitely no, it’s important for you to have a sense of compassion for your childhood and adolescent sense. The task of growing up is a tough one and you deserved more safety, support, and guidance than you received.

Under conditions like these, cognitive avoidance is so reasonable, and yet so painful. When you didn’t feel safe, you probably started to worry about the uncertainties of the future or ruminate about something painful from the past. If you weren’t emotionally safe on a chronic basis, then that worry or rumination likely became a habitual thinking pattern. When you’re in your head, thinking, you are not in your body, feeling. The painful uncertainty, fear, loneliness, anger, and shame wasn’t as physiologically painful as long as you were in your head “figuring it out.”

Just because it’s reasonable doesn’t mean it’s helpful. Ideally, you’ll develop a compassionate narrative of what your avoidance behaviors are and how they developed. As that narrative becomes clearer, I hope it helps you see that you have more flexible options in adulthood. These days, you don’t have to worry when you feel unsafe or uncertain. You don’t have to ruminate when you feel lonely. These feelings are just feelings and you are not trapped in them forever. If you bring your adult awareness to them and respond to them as feelings — rather than threats, facts, or predictions — you will gain a sense of mastery and efficacy over your internal world and you won’t have to be afraid when those feelings show up.

Worry and rumination as a cognitive avoidance created by a mental health disorder

If you feel like you were mostly seen, understood, and made to feel worthy in the eyes of important adults while growing up, you might have developed a functional habit of cognitive avoidance because of your biological vulnerabilities.

Anxiety disorders, mood disorders, ADHD, substance use and addictive disorders, and eating disorders are all conditions where sufferers have the desire to avoid thoughts, feelings, memories, and urges and they often avoid all of the above through worrying or ruminating.

Changing your problematic functional thinking patterns

Once you become aware of the functional behavioral pattern of cognitive avoidance that occurs in your thinking overall, your task is to notice when it is occurring in the present moment. Like the rest of our work, I am striving to help you become educated about the patterns, notice and label them at the moment, and try a new, more flexible option. In this case, the new, flexible behavior is to stay present with your feelings and/or shift to problem-solving rather than engaging in cognitive avoidance.

Emotions are evolutionarily adaptive states that motivate behavior. Every emotion has or has had some utility in the evolutionary past. The sensations and thoughts associated with an emotion will peak and pass within 90 seconds if we don’t add anything to them. After the initial surge of emotion, we can choose whether we want to keep the thoughts associated with that feeling going. Thoughts will retrigger the sensations to keep that emotion going.

You only have the opportunity to choose whether you want to keep the emotion going if you are able to identify what’s happening. Many people do not have awareness of what’s happening to them when they are experiencing an emotion. The emotion feels like reality and the act to urge feels like the only option. It’s worth it for you to observe your emotional states and your urges to act in the presence of emotions so that you have the chance at more flexible behaviors.

The opposite of emotional avoidance is staying with emotions. Don’t just do something, sit there! When you choose to bring attention to and stay with emotion, you can know that you are on the right track if you can feel the emotion pass within a minute or two.

Here’s an application of this process to the feeling of fear:

You feel fear as evidenced by a rapid heartbeat, sweating, feeling hot, sudden tension, or a sudden flip of your stomach. Your self-talk is: “This is fear. Fear is an emotion that peaks and passes. I don’t have to listen to the message of uncertainty associated with these sensations. I don’t have to add anxiety.”

With practice, if you don’t add to or analyze the anxious content, the sensations will pass.

Emotional acceptance v. emotional dwelling

The difference between emotional acceptance and emotional dwelling is hard to identify by behavior but feels very different in terms of its emotional texture. When you are engaging in emotional acceptance, you accept the emotion compassionately, you refrain from judgment about the emotion, you observe it curiously in your body, and you let it pass without dwelling on the thoughts you have about it. When you engage in emotional dwelling, you hope that you will not have the emotion, you judge yourself for experiencing the emotion, and you dwell in the thoughts that the emotion creates as well as what the feeling means about you. Self-monitoring either on a daily basis or when you feel an intense emotion can help you identify what emotions are most common for you and what you are doing to keep it going.

Crying

As an example, let’s discuss crying. Sometimes the behavior of crying facilitates emotional acceptance. Sometimes the behavior of crying causes people to dwell.

Crying as a behavior could be the result of many processes including:

● Sadness + no secondary process (lasts around 90 seconds)

● Sadness + Anger

● Anger + Helplessness

● Anxiety + Helplessness

When you cry, it’s an opportunity to think about emotional avoidance. You might ask yourself:

● Under what other conditions do I notice that I cry and what tends to keep crying going for me?

● If I can’t cry, is sadness an area of emotional avoidance for me?

When you are in your head trying to figure something out or distracting or numbing yourself out from what is happening in your body, you are engaging in somatic avoidance. (The word somatic means relating to the body, especially as distinct from the mind.)

You may have noticed that even if you identify as a person who is sensitive to emotions or are someone who has been in psychotherapy for a long time, you may still have trouble identifying and staying with your emotions. You might still be distant from your moment-by-moment bodily experience, your somatic experience. Two patterns are common here:

1) Individuals who are sensitive to emotions often learn and then reinforce behavioral patterns that make them experience their emotions more intensely.

Sensitive individuals are often less able to identify and allow their emotions because of the intensity of their emotions and because of the way other people respond to them.

2) Typical psychotherapy practices are very focused on the content of your thoughts.

Some theories of psychology focus on gaining insight into your narrative until you are able to come up with a different narrative that caused you less distress. Sometimes exploring how you came to understand who you are and how to respond to life in light of that narrative is helpful. But, sometimes, the more you talk in psychotherapy, the more you feel like you need to talk to feel better. It’s as if you need to just get the narrative right and if this magical therapist perfectly understood you, then you wouldn’t feel distressed anymore.

It isn’t true. We all have a variety of narratives within us from a variety of sources. Our brains take in information from the environment, our minds turn that information into a narrative. Narratives are super helpful for collaboration and problem-solving. Humans took over the planet due to our ability to generate and spread narratives. In your personal relationship with yourself, however, modern psychological theory suggests that we should never take our narratives too seriously.

Rather than getting involved with and “figuring out” exactly why your thinking or feeling whatever your thinking and feeling (that is, adding narrative), instead you can come back into your direct reality.

The nature of obsessive thoughts is that they are unwanted and intrusive. They arrive with a spike of anxiety or uncertainty and the urge to do something that makes them stop. Behavior that you feel compelled to perform, against your conscious wishes, with the sole intention of ending a thought, feeling or sensation is a compulsion.

Here is a list of common physical compulsions:

● Excessive hand washing or bathing

● Checking locks or appliances

● Checking that you haven’t made a mistake

● Checking that you did not or will not harm yourself or others

● Checking your body for sensations or your mind for thoughts and feelings

● Rereading or rewriting

● Repeating routine activities like moving a chair up and down

● Counting

● Excessive list making

● Needing to tell, ask, or confess what you are thinking

● Needing to touch or tap

● Needing to arrange or order objects

Hand washing and all other behaviors listed above becomes excessive and problematic when the function of the behavior transitions from problem-solving to anxiety reduction. When your hands are visibly dirty or your body is sweaty or smelly, washing is problem-solving. When you have the thought that you are contaminated and the feeling of anxiety and you feel compelled to wash until the anxiety is gone, washing is a compulsion. Some people follow rules like “It’s okay for me to stop washing after I repeat my ritual 3 times or after a certain amount of time.” Other people wait for the just-right feeling to stop washing. Many people who engage in compulsive behavior have rules for some situations and use their feelings as criteria for when to stop in other situations.

Here are some common misunderstandings about obsessions and compulsions:

What is problematic about rule-based or feeling-based compulsive behavior?

People who don’t engage in compulsive behavior have “flexible” behavior in the sense that the function of their behaviors is problem-solving and the solution is different every time. As an example, in some bathrooms, you have access to soap and paper towels. At other times, you don’t. Can you solve whatever the situation calls for and redirect your attention to the present moment if you aren’t able to use your rules for getting clean? The problem with using rules or just-right feelings to make decisions is that unless you rigidly narrow your life options, you will face situations where your rules don’t apply or your just-right feelings feel more and more elusive. You also miss out on the opportunity to become confident in yourself and your ability to adaptively problem solve, if you are drawing your sense of security from rules.

What’s the difference between compulsive feeling-based behavior and intuition?

Some people believe strongly in making decisions based on feelings and intuition and don’t like the idea of giving up “feeling-based” decisions. The problematic form of feeling-based decisions is when you are rigidly trying to achieve a certain feeling state, specifically the certainty feeling state. When you are open and accepting to all feeling states, then your feelings can actually be data and you can make intuitive decisions based on the information you receive from your feelings. If you are trying to control your behavior to achieve certain feeling states and calling that intuition, it will be hard for you to develop a deep confidence in your ability to respond well to all feeling states.

What’s the difference between addictive behavior and compulsive behavior?

Compulsive behavior is differentiated from addictive behavior based on its function. Addictive behavior may also eliminate or reduce thoughts, feelings, or sensations, but its primary function is to achieve the state to which one is addicted. Just like compulsive behavior, addictive behavior is defined by impairment and distress. Washing your hands is workable until your hands are dry and sore. Eating sugar or drinking alcohol can also be workable behaviors, until they are not. In both compulsive behavior and addictive behavior cycles, you will feel an urge to engage in the behavior. When you have an addictive urge, you typically want to engage in the behavior, although you might not want the consequences of the behavior. For example, you want the drink or the cigarette, but you don’t want the health or social consequences of drinking and smoking. Comparatively, when you have the urge to compulse, you don’t want to engage in the compulsion. You feel compelled to do it either out of fear of the potential consequences of not compulsing or because of the anxiety you’d have if you didn’t compulse.

What do you mean by flexible, adaptive problem solving, rather than compulsing?

How do you know when to stop washing your hands? Ideally you stop washing your hands when your hands aren’t dirty, as opposed to when your anxiety is gone or after you followed your rule. Fear of contamination is an easy example to explain. Can you see the parallels to other content areas like fear of harm to self or others or perfectionism about performance, emotions, relationships, and life choices? In all cases, we’re trying to problem solve, rather than reduce anxiety.

How do you know whether you made a mistake or hurt someone? Well, did you hurt someone? Make a decision about this question and live in it rather than replaying it until you have certainty.

How do you know whether you are spending your time, energy, and resources correctly or with the right person or people? First, there isn’t a right answer to this question. Second, any answer can be workable. Are you willing to accept your actual life choices in the presence of uncertainty? Notice how many opportunities for happiness open up when you give yourself permission to be present in your actual life rather than trying to figure out whether that is the right decision.

Mental compulsions

A mental compulsion is a compulsive thought pattern that you feel compelled to engage in with the function of reducing anxiety or uncertainty, just like physically counting or checking.

The texture of mental compulsions is uncomfortable, sticky, and anxiety-provoking. You don’t really choose to think like this, although it may feel like you want to keep doing it, because of how you’ll feel if you don’t do it. It’s different than worrying, where you’ll notice more what-if thinking about the future. It’s different from ruminating, where you’ll notice negative self-beliefs, self-criticism, and guilt and shame. It sounds more like, “I’m afraid of this very specific possibility and I’m going to think about it in a really specific way to make my fear and uncertainty go away.”

If you mentally compulse a lot, you probably have rules for how to cut it short. An example is replaying a drive or some other experience quickly and in a certain way to get the feeling of certainty that you didn’t hurt anyone. Even if this doesn’t take up a lot of time or energy, every time you engage in this type of compulsive thinking, you miss an opportunity for more flexible problem solving and you miss an opportunity for an increase in self-confidence. Plus, you reinforce the idea that you have to think like this in similar situations in the future.

To overcome it, go back to the basics with exposure and response prevention. Once you figure out what triggers your mental compulsions, you’ll want to expose yourself to that trigger on purpose and then specifically refrain from your mental compulsion by redirecting your attention. If it feels anxiety-provoking to distract yourself away from your mental compulsion, you’re doing the exposure correctly.

To understand rule-based behaviors, let's discuss the opposite. People who don’t engage in avoidant and compulsive behavior have “flexible” behavior in the sense that the function of their behaviors is problem-solving and the solution is different every time. As an example, in some bathrooms, you have access to soap and paper towels. At other times, you don’t. Can you problem solve with whatever the situation calls for and redirect your attention to the present moment if you aren’t able to use your rules for getting clean? The problem with using rules or just-right feelings to make decisions is that unless you rigidly narrow your life options, you will face situations where your rules don’t apply or your just-right feelings feel more and more elusive. You also miss out on the opportunity to become confident in yourself and your ability to adaptively problem solve, if you are drawing your sense of security from rules.

How do you know when to stop washing your hands? Stop washing your hands when your hands aren’t dirty, as opposed to when your anxiety is gone or after you followed your rule. Fear of contamination is an easy example to explain. Can you see the parallels to other content areas like fear of harm to self or others or perfectionism about performance, emotions, relationships, and life choices? In all cases, we’re trying to problem solve, rather than reduce anxiety.

How do you know whether you made a mistake or hurt someone? Well, did you hurt someone? Make a decision about this question and live in it, rather than replaying it until you have certainty.

How do you know whether you are spending your time, energy, and resources correctly or with the right person or people? First, there isn’t a right answer to this question. Second, any answer can be workable. Are you willing to accept your actual life choices in the presence of uncertainty?

You might not be avoiding what you value altogether, but you might be experientially avoiding all the thoughts, feelings, and sensations that arise when you follow your values. Notice how many opportunities for happiness open up when you give yourself permission be present in your actual life rather than trying to figure out whether that is the right decision.

Emotion-driven behaviors are behaviors that increase the intensity of an emotion, despite their intention to decrease the emotion. Think anger and addiction and ineffective interpersonal strategies.

Sensitive individuals are often less able to identify and allow their emotions because of the intensity of their emotions and because of the way other people respond to them.If you felt very strong, confusing feelings while growing up, due to trauma or your biological vulnerabilities, it was unlikely that you had the cognitive skills to understand what was happening and the emotional intelligence to regulate yourself. Many adults also don't know how to regulate strong emotions effectively. The adults in your life may have tried to make your feelings go away by ignoring you or yelling at you. The urge to either over-control or under-control your feelings under these conditions is very common. Many people have a combination of both. Over-control of emotion includes suppression, withdrawal, compulsions, and perfectionistic control behaviors of your thoughts, feelings, and body (examples: compulsive exercise or restrictive diets). Under-control of emotion includes anger outbursts, self-medicating with alcohol and drug use, and problematic interpersonal strategies like passive aggression. In general, anxiety disorders can be seen as disorders of over-control. It's common for people to have both problematic over-control emotion regulation strategies and problematic under-control emotion regulation strategies.

Managing Anger

Let's discuss anger. You might think, “I feel angry all the time. I definitely know what anger is.” Just because you’re aware of anger, doesn’t mean you are responding to it effectively. If, in the presence of the sensations that trigger angry feelings and thoughts, you fuel your anger by building a case against the target of your anger in your mind, your sensations will become more intense and your feelings will feel more justified. You will become more sensitive to anger and quicker to anger. Your new, more flexible option would be to practice doing the opposite of your angry urges when anger occurs. More specifically, bring attention to your tense muscles and actively relax then. Bring attention to the way you are fueling your angry thoughts and shift your attention either to another topic or to a new perspective related to the topic about which you are angry. Even in the cases where your anger is justified — that is, when you or someone else has been violated or disrespected — fueling your anger will not help you respond effectively. Notice the feeling of anger is present and calm yourself down so that you can use your mind to decide the most effective course of action.

Notice that this is both similar and different compared to how we manage anxiety. Experiencing anxiety doesn’t have to be good or bad. It can be neutral, just another experience within your body. If you know what to do to relate to it effectively, your response can become something you are proud of that makes you feel efficacious.

If you are sensitive and bombarded with anxiety, uncertainty, guilt, disgust, shame, and anger on a very regular basis, it is very unlikely that you will be able to figure out how to respond to it effectively on your own. Responding effectively is the opposite of intuitive. Your anxiety says, “Alert! Danger! Threat!” and you must say, “This is fine. This not a threat to me.” Your anxiety says, “Urgent! Respond faster!” and you must slow down and do nothing. Some people realize this on accident. For instance, they feel anxious in a meeting, but they get stuck there and get distracted, and dissipates. So, that lucky person learned, “It’s okay to feel anxious. I’ll just hang out and wait for it to pass or redirect my attention and I’ll be fine.” The sensitized person doesn’t often have this fortunate outcome and needs to be much more aware, much more intentional, and much more strategic.

All this to say, if you have been very sensitive and avoided anxious triggers and then people yell at you about it, your emotions have probably become very intense and staying with them is not intuitive.

Plan for opposite action

To shift into more flexible behaviors, make a plan for opposite action during emotional states where you have a pattern of making your emotion more intense:

“When I have the experience of anxiety, I slow down and redirect my attention from catastrophic thoughts.”

“When I have the experience of anger, I relax my body and redirect my attention away from building a case against the object of my anger.”

“When I have the experience of guilt, I assess whether I’ve done something against my values and whether there is something I can do to make amends. If I’ve done something against my values, I decide what I can do to make amends. If I have not done something against my values, I allow the feeling of guilt and redirect my attention away from self-criticism.”

“When I have the experience of shame, I notice that my shame wants me to hide and isolate. I think who I can connect with and make a plan to connect and share my shame. I set a time (later, when I am not feeling shame) to think critically about the parts of my life narrative that contribute to my experience of shame so that I have the chance to change beliefs that maintain my shame."

Sometimes acting in accordance with your values and experiential avoidance will be the same behaviors. The difference between values-driven action and avoidance is the attitude. Workable behavior is a dynamic adaptation based on your context, rather than rigid, rule-based behavior.

Anxious sufferers want to know what they need to do in order to cure or overcome their anxiety. A one-size-fits-all strategy doesn’t work because anxiety uniquely shifts based on the function of your behavior in a dynamic way. The meaning your mind gives to your behavior and its consequences is more predictive of an increase or decrease in anxiety over time than the behavior itself.

As an example, acting polite, bubbly, grateful, and thoughtful can be values-driven. It can be a challenging exposure and a confidence boost to act in these ways with friends or family no matter how anxious or depressed you feel. And, if you act this way frequently, rigidly, across many areas of your life and in all of your relationships, this value-driven behavior will become an avoidance behavior. What started as a behavioral activation technique (“act as though you aren’t anxious or depressed and do the activity anyway”) becomes avoidance if it is your only strategy. If it’s your only strategy, your lack of authenticity and vulnerability about what you’re thinking and feeling will make you feel distant from yourself and others.

To continue to the example, sometimes it will be workable to act as though you don’t feel anxious or depressed and engage in your life regardless of how you feel. Sometimes it will be workable to change your plan and do less than you were planning in order to accommodate your symptoms of anxiety, OCD, and depression. Sometimes it will be workable to confide in a person who has earned the right for your vulnerability about your anxiety and depressive symptoms. Sometimes it is more workable to keep your private experience to yourself. We’re striving for adaptive, workable behavior that is responsive to dynamic environmental cues, rather than systems and rules.

Rigid behaviors are often the result of rigid environments. Use your observations of rigid strategies as data and find the opportunity for variability in your environment. Here are some ideas to help you become more flexible:

● If you frequently keep your suffering to yourself, is there a friend or family member who seems to be a better listener than others?

● If you frequently seek reassurance from others, can you turn your reassurance seeking into a game you are trying to win? Try setting a reasonable number for how many times you will seek reassurance this week and then beat it by seeking reassurance less than that number.

● What types of rigid behaviors do you engage in? Is there a behavior you are willing to shift?

Avoidance behaviors vs. preferences

Some anxiety sufferers definitely know that they avoid. Situational avoidance (that is, not going somewhere because you feel anxious) is usually obvious. Sometimes people think, “I just don’t like ____ (crowds, parties, driving, flying) ____ and that’s why I don’t do it.” Sometimes that is true and refraining from such activities is not an avoidance behavior.

Now we’re talking preferences vs. avoidance behaviors.

Having a preference for something typically doesn’t cause impairment. If I don’t eat chocolate because I don’t like it, that’s a preference. There are lots of other options for what I can eat and I’m not impaired if I don’t eat it. A key distinction for a preference is that you could do it if you needed to do it to achieve some other value.

Comparatively, anxious avoidance doesn’t feel like a choice. If you anxiously avoid, it probably feels like a no-win situation. You want to engage in the activity, but you don’t want to feel anxious. If you engage, you will feel anxious. You can’t do the activity without feeling anxious. You avoid the activity.

People in this position typically hate it. You hate that you’re missing what you want to do. You hate your anxiety for getting in the way. It’s very demoralizing.

Depending on how long you’ve experienced this demoralization and whether or not it happened developmentally across your childhood, you may start to think that your avoidance is your preference. For instance, if you’ve experienced chronic social anxiety, you may start to think that you actually don’t like people. If you’ve experienced chronic fear of driving you may start to think that staying close to home works fine for you. If it’s actually your preference and not avoidance, you should be able to do it as necessary. If you can get to another neighborhood or country, but you don’t prefer it, then great, you don’t need exposure.

This concept speaks to why it's helpful to go beyond your realistic preference during exposure work. You might never need to sit on the floor in a bathroom in real life, but if you have contamination fears, you’d do this type of exposure to teach yourself that you can. Once you are confident that you are willing to engage in your values-driven behavior regardless of how you feel, you will have better clarity about your actual preferences.