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Experiential avoidance
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<h2 id="background">Background</h2> <p>EA has been popularized by recent <a href="/facts/Behavior_therapy/2N1n5BKp">third-wave cognitive-behavioral</a> theories such as <a href="/facts/Acceptance_and_commitment_therapy/fsh43Mdk">acceptance and commitment therapy</a> (ACT). However, the general concept has roots in many other theories of <a href="/facts/Psychopathology/QcHKDX2n">psychopathology</a> and intervention. </p> <h3>Phenomenological perspectives</h3> <p>Some phenomenological analyses have raised conceptual concerns about the framing of experiential avoidance in terms of negative states and their opposites. From this view, affective experiences like <a href="/facts/Pain/70E79oUn">pain</a>, <a href="/facts/Fear/BSzreRdS">fear</a>, or <a href="/facts/Anxiety/Geekl883">anxiety</a> do not have clear, structured opposites—there is no singular or coherent experiential equivalent of "anti-fear" or "anti-pain." This critique suggests that attempts to systematize internal experiences into dualities (e.g., negative vs. positive) may oversimplify the lived complexity of emotions. Such perspectives challenge the assumption that psychological well-being can be characterized as the absence of certain inner states, emphasizing instead the irreducibly nuanced and dynamic character of subjective experience.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a>: 49 </p> <h3>Psychodynamic</h3> <p><a href="/facts/Defense_mechanisms/DElFgLaE">Defense mechanisms</a> were originally conceptualized as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p> <h3>Process-experiential</h3> <p><a href="/facts/Process-experiential_therapy/JU7031bK">Process-experiential therapy</a> merges <a href="/facts/Person-centered_therapy/GULq0w4S">client-centered</a>, <a href="/facts/Existential_therapy/DaAbAxnE">existential</a>, and <a href="/facts/Gestalt_therapy/yRQVn6TN">Gestalt</a> approaches.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> Gestalt theory outlines the benefits of being fully aware of and open to one's entire experience. One job of the psychotherapist is to "explore and become fully aware of [the patient's] grounds for avoidance" and to "[lead] the patient back to that which he wishes to avoid" (p. 142).<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> Similar ideas are expressed by early <a href="/facts/Humanistic_psychology/oFQsrPwv">humanistic</a> theory: "Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be 'living' it, would have it completely available to <a href="/facts/Awareness/PazhgWFC">awareness</a>…he is more open to his feelings of fear and discouragement and pain...he is more able fully to live the experiences of his organism rather than shutting them out of awareness."<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> </p> <h3>Behavioral</h3> <p>Traditional <a href="/facts/Behavior_therapy/2N1n5BKp">behavior therapy</a> utilizes exposure to habituate the patient to various types of fears and anxieties,<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as "counter-acting" avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> </p> <h3>Cognitive</h3> <p>In <a href="/facts/Cognitive_therapy/cATAANsE">cognitive theory</a>, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> These distorted beliefs are thought to contribute and maintain many types of psychopathology.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> </p> <h3>Third-wave cognitive-behavioral</h3> <p>The concept of EA is explicitly described and targeted in more recent <a href="/facts/Cognitive_behavioral_therapy/LRALDkkU">CBT</a> modalities including acceptance and commitment therapy (ACT), <a href="/facts/Dialectical_behavior_therapy/jRwS2zQR">dialectical behavior therapy</a> (DBT), <a href="/facts/Functional_analytic_psychotherapy/QbyCLIYD">functional analytic psychotherapy</a> (FAP), and <a href="/facts/Behavioral_activation/fsXsGtIX">behavioral activation</a> (BA). </p> <h2 id="associated-problems">Associated problems</h2> <ul><li>Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.</li> <li>Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.</li> <li>Sustaining avoidance often requires effort and energy.</li> <li>Avoidance limits one's focus at the expense of fully experiencing what is going on in the present.</li> <li>Avoidance may get in the way of other important, valued aspects of life.</li></ul> <h2 id="empirical-evidence">Empirical evidence</h2> <ul><li>Laboratory-based <a href="/facts/Thought_suppression/XdmWfB84">thought suppression</a> studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a></li> <li>Studies examining <a href="/facts/Regulation_of_emotion/xQBYE50B">emotional suppression</a> and pain suppression suggest that avoidance is ineffective in the long-run.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> Conversely, expressing the unpleasant emotions can lead to improvements in the long term, even though it increases negative reactions in the short term.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a></li> <li><a href="/facts/Exposure_therapy/sB8TYx97">Exposure-based therapy</a> techniques have been shown to be effective in treating a wide range of psychiatric disorders.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a></li> <li>Numerous self-report studies have linked EA and related constructs (<a href="/facts/Avoidance_coping/Rvn5Xomn">avoidance coping</a>, <a href="/facts/Thought_suppression/XdmWfB84">thought suppression</a>) to psychopathology and other forms of dysfunction.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li></ul> <h2 id="relevance-to-psychopathology">Relevance to psychopathology</h2> <p>Seemingly disparate forms of pathological behavior can be understood by their common function (i.e., attempts to avoid distress). Some examples include: </p> <table><tbody><tr><th>Diagnosis</th><th>Example Behaviors</th><th>Target of Avoidance</th></tr><tr><td><a href="/facts/Major_depression/l2lQeWqr">Major depressive disorder</a></td><td>Isolation/suicide</td><td>Feelings of sadness, guilt, low self-worth</td></tr><tr><td><a href="/facts/Posttraumatic_stress_disorder/9etKu7bX">Posttraumatic stress disorder</a></td><td>Avoiding trauma reminders, hypervigilance</td><td>Memories, anxiety, concerns of safety</td></tr><tr><td><a href="/facts/Social_anxiety_disorder/25XIzJ0o">Social phobia</a></td><td>Avoiding social situations</td><td>Anxiety, concerns of judgment from others</td></tr><tr><td><a href="/facts/Panic_disorder/jRfhx14r">Panic disorder</a></td><td>Avoiding situations that might induce panic</td><td>Fear, physiological sensations</td></tr><tr><td><a href="/facts/Agoraphobia/l56SJ75n">Agoraphobia</a></td><td>Restricting travel outside of home or other "safe areas"</td><td>Anxiety, fear of having symptoms of panic</td></tr><tr><td><a href="/facts/Ocd/bIhDh4dz">Obsessive-compulsive disorder</a></td><td>Checking/rituals</td><td>Worry of consequences (e.g., "contamination")</td></tr><tr><td><a href="/facts/Substance_use_disorder/pSbdzb6a">Substance use disorders</a></td><td>Abusing alcohol/drugs</td><td>Emotions, memories, withdrawal symptoms</td></tr><tr><td><a href="/facts/Eating_disorder/3GwQ71sD">Eating disorders</a></td><td>Restricting food intake, purging</td><td>Worry about becoming "overweight", fear of losing control</td></tr><tr><td><a href="/facts/Borderline_personality_disorder/VFaa63gE">Borderline personality disorder</a></td><td>Self-harm (e.g., cutting)</td><td>High emotional arousal</td></tr></tbody></table> <h2 id="relevance-to-quality-of-life">Relevance to quality of life</h2> <p>Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual's life.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> That is, EA is seen as particularly problematic when it occurs at the expense of a person's deeply held values. Some examples include: </p> <ul><li>Putting off an important task because of the discomfort it evokes.</li> <li>Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.</li> <li>Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.</li> <li>Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.</li> <li>Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.</li> <li>Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling "unsafe").</li> <li>Inability to "connect" and sustain a close relationship because of attempts to avoid feelings of vulnerability.</li> <li>Staying in a "bad" relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.</li> <li>Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g., achieved through drug or alcohol abuse) or symptoms of withdrawal.</li> <li>Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.</li> <li>Engaging in self-destructive behaviors in an attempt to avoid feelings of boredom, emptiness, worthlessness.</li> <li>Not functioning or taking care of basic responsibilities (e.g., personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.</li> <li>Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.</li></ul> <h2 id="measurement">Measurement</h2> <h3>Self-report</h3> <p>The Acceptance and Action Questionnaire (AAQ)<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualized as a measure of "<a href="/facts/Psychological_flexibility/MW171b7V">psychological flexibility</a>".<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ)<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Avoidant_personality_disorder/0oYpmo4J">Avoidant personality disorder</a></li> <li><a href="/facts/Coping_(psychology)/Seg3zu9m">Coping (psychology)</a></li></ul> <h3>Opposite concepts</h3> <ul><li><a href="/facts/Acceptance/dkNgcYy8">Acceptance</a></li> <li><a href="/facts/Distress_tolerance/TSq1UDKg">Distress tolerance</a></li> <li><a href="/facts/Psychological_flexibility/MW171b7V">Psychological flexibility</a></li></ul> <h3>Related concepts</h3> <ul><li><a href="/facts/Denial/ocwhQm6V">Denial</a></li> <li><a href="/facts/Expressive_suppression/zTrkDyR2">Expressive suppression</a></li></ul> <h2 id="notes">Notes</h2> <ul><li>Chawla, Neharika; Ostafin, Brian (2007). "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review". <i>Journal of Clinical Psychology</i>. 63 (9): 871–90. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1002%2Fjclp.20400">10.1002/jclp.20400</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/17674402">17674402</a>.</li> <li>Gámez, Wakiza; Chmielewski, Michael; Kotov, Roman; Ruggero, Camilo; Watson, David (2011). "Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire". <i>Psychological Assessment</i>. 23 (3): 692–713. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1037%2Fa0023242">10.1037/a0023242</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/21534697">21534697</a>.</li> <li>Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G. (1999). <i>Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change</i>. New York: Guilford Press. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-1-57230-481-9.</li> <li>Hayes, Steven C.; Wilson, Kelly G.; Gifford, Elizabeth V.; Follette, Victoria M.; Strosahl, K. (1996). <a href="https://www.thehappinesstrap.com/upimages/experiential_avoidance.pdf">"Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment"</a> (PDF). <i>Journal of Consulting and Clinical Psychology</i>. 64 (6): 1152–68. <a href="/facts/CiteSeerX_(identifier)/SceDmd3c">CiteSeerX</a> <a href="https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.597.5521">10.1.1.597.5521</a>. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1037%2F0022-006X.64.6.1152">10.1037/0022-006X.64.6.1152</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/8991302">8991302</a>.</li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="http://www.abct.org">Association for Behavioral and Cognitive Therapies (ABCT)</a></li> <li><a href="http://www.contextualpsychology.org">Association for Contextual Behavioral Science (ACBS)</a></li> <li><a href="https://renaissance.stonybrookmedicine.edu/sites/default/files/Multidimensional%20Experiential%20Avoidance%20Questionnaire_0.pdf">Multidimensional Experiential Avoidance Questionnaire</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press. ISBN 1572304812.[page needed] <a href="1572304812" target="_blank">1572304812</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Hayes, Steven C.; Wilson, Kelly G.; Gifford, Elizabeth V.; Follette, Victoria M.; Strosahl, Kirk (1996). "Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment". Journal of Consulting and Clinical Psychology. 64 (6): 1152–68. CiteSeerX 10.1.1.597.5521. doi:10.1037/0022-006X.64.6.1152. PMID 8991302. <a href="/wiki/CiteSeerX_(identifier)" target="_blank">/wiki/CiteSeerX_(identifier)</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Losada, Andrés; Márquez-González, María; Romero-Moreno, Rosa; López, Javier (2014-10-03). "Development and validation of the Experiential Avoidance in Caregiving Questionnaire (EACQ)". Aging & Mental Health. 18 (7): 897–904. doi:10.1080/13607863.2014.896868. ISSN 1360-7863. PMID 24678984. <a href="http://www.tandfonline.com/doi/abs/10.1080/13607863.2014.896868" target="_blank">http://www.tandfonline.com/doi/abs/10.1080/13607863.2014.896868</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Chawla, Neharika; Ostafin, Brian (2007-08-02). "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review". Journal of Clinical Psychology. 63 (9): 871–890. doi:10.1002/jclp.20400. ISSN 0021-9762. PMID 17674402. <a href="https://onlinelibrary.wiley.com/doi/10.1002/jclp.20400" target="_blank">https://onlinelibrary.wiley.com/doi/10.1002/jclp.20400</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Magnus Vinding (2023). Essays on Suffering-Focused Ethics. Ratio Ethica. ISBN 9798215591673. <a href="9798215591673" target="_blank">9798215591673</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Freud, A. (1966). The Ego and the Mechanisms of Defense. New York: International Universities Press.[page needed] <a href="https://archive.org/details/egomechanism00freu" target="_blank">https://archive.org/details/egomechanism00freu</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Karon, B. P.; Widener, A. J. (1995). Bongar, B.; Beutler, L. E. (eds.). Comprehensive Textbook of Psychotherapy. New York: Oxford University Press. pp. 24–47. <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Greenberg, Leslie S.; Watson, Jeanne C.; Lietaer, Germain (1998). Handbook of Experiential Psychotherapy. Guilford Press. pp. 6–. ISBN 978-1-57230-374-4. Retrieved 15 September 2013. <a href="978-1-57230-374-4" target="_blank">978-1-57230-374-4</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Perls, F. S.; Hefferline, R. F.; Goodman, P. (1951). Gestalt Therapy: Excitement and Growth in the Human Personality. New York: Julian Press.[page needed] <a href="/wiki/Wikipedia:Citing_sources" target="_blank">/wiki/Wikipedia:Citing_sources</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Rogers, C. R. (1961). On Becoming a Person: A Therapist's View of Psychotherapy. Houghton Boston: Mifflin Company. p. 188. <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Barlow, David H. (1988). Anxiety and its Disorders. New York: Guilford Press. ISBN 0898627206.[page needed] <a href="0898627206" target="_blank">0898627206</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Craighead, W. E.; Craighead, L. W.; Ilardi, S. S. (1995). "Behavior therapies in historical perspective". In Bongar, B.; Beutler, L. E. (eds.). Comprehensive Textbook of Psychotherapy. New York: Oxford University Press. pp. 64–83. <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Baum, Morrie (1970). "Extinction of avoidance responding through response prevention (flooding)". Psychological Bulletin. 74 (4): 276–84. doi:10.1037/h0029789. PMID 5479591. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Clark, D. M. (1988). "A cognitive model of panic". In Rachman, S.; Maser, J. (eds.). Panic: Psychological Perspectives. Hillsdale: Erlbaum.[page needed] <a href="/wiki/Wikipedia:Citing_sources" target="_blank">/wiki/Wikipedia:Citing_sources</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Beck, Aaron T. (1976). Cognitive Therapy and the Emotional Disorders. Madison, CT: International Universities Press. ISBN 0823609901.[page needed] <a href="0823609901" target="_blank">0823609901</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Wegner, Daniel M.; Schneider, David J.; Carter, Samuel R.; White, Teri L. (1987). "Paradoxical effects of thought suppression". Journal of Personality and Social Psychology. 53 (1): 5–13. doi:10.1037/0022-3514.53.1.5. PMID 3612492. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Gross, James J.; Levenson, Robert W. (1997). "Hiding feelings: The acute effects of inhibiting negative and positive emotion". Journal of Abnormal Psychology. 106 (1): 95–103. doi:10.1037/0021-843X.106.1.95. 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