Avoidance in Panic Disorder
Have you heard of the fight or flight response? In a nutshell, when your mind perceives danger, a variety of systems across your mind and body leap into action. These systems prepare your entire self in incredible ways to ‘fight’ or ‘flee’ the danger (or lesser discussed possibilities like ‘freezing’). The fight or flight response exists for a useful reason: quickly orienting and responding to dangers has kept us safe (and alive!) throughout human history. However, panic can co-opt the typical process. By encouraging you to ‘flee’ safe experiences, a behavior called avoidance in panic disorder can start a vicious cycle of escalating anxiety.
What is avoidance?
In psychology, avoidance means staying away from particular experiences, situations, people, feelings, etc. Avoidance within the context of mental health problems is often contributing to those problems in key ways. Avoidance is particularly relevant to panic attacks and panic disorder. When you experience a panic attack, by definition you are feeling an intense surge of anxiety and distress. For most people, it feels natural to want to reduce that anxiety in any way possible. As a result, they begin to avoid possible triggers of their panic attacks: public transportation, driving, activities that make their heart race. Besides my examples, there are probably thousands of possible triggers for unique people.
Avoidance worsens panic over time
Avoidance in panic disorder teaches your brain a harmful lesson. In the short term, avoidance feels great. By not riding that bus, you may avoid not only worrying about panic, but actual panic attacks! Sounds great, right? Unfortunately, in the longer-term, think about what your brain may be learning. What may have been mild hesitations (“Riding the bus make me feel uneasy”) turn into stronger, harmful beliefs (“If I ride the bus, I might have a heart attack…I will definitely panic…there is no way I can ride the bus!”). Over time, avoidance creates higher levels of panic. And those high levels of panic? They feel like they can only be solved by – you guessed it – further avoidance. The bottom line: avoidance teaches you that situations are dangerous and must be avoided, reinforcing itself. The diagram at the top of the page illustrates this vicious cycle of panic and avoidance.
Avoidance may be “avoiding” your awareness
A tricky aspect of avoidance in panic disorder is how routine avoidance behaviors become. You can become so used to avoidance that you barely realize you are doing it! Think about when you first learned to ride a bike (sorry to non-bike riders!). Many initial rides were marked by an intense awareness of your hands and legs, your precise feelings of balance, and repeated scanning all over your body. The more you learned, the less you probably thought about these aspects. As an experienced bike-rider, you probably now focus your attention on the route, sights, and sounds. Avoidance behaviors work the same way – experienced ‘avoiders’ often need to take a step back to see the avoidance behaviors that they no longer notice. An important part of therapy is identifying these relatively automatic behaviors.
Treatment”short-circuits” avoidance in panic disorder
For a more information about general panic treatment, please read my blog entry on panic attacks. In terms of avoidance, a key component of many panic treatments involves reengaging with avoided areas. Just as avoidance teaches your brain that experiences are dangerous and to be avoided, practice teaches a powerful alternative lesson: you can approach those same experiences safely. Practice allows you to reverse the vicious cycle to your advantage. By willingly engaging with greater short-term panic, you are reducing panic in the longer-term. While scary, this repeated practice works: exposing yourself to your fears with professional support is an effective treatment.
I hope this post is useful for learning about how avoidance figures into panic disorder and its treatment. If you are interested in online therapy for panic, research suggests it is effective. Contact me for a free consultation and we can discuss whether counseling would be a good fit at this time.