Avoidance and Trauma Therapy

What does avoidance have to do with trauma therapy? Avoidance is a common coping strategy. In psychotherapy, when we talk about avoidance we mean strategies for avoiding unwanted or uncomfortable feelings. Avoidance is a natural and understandable response to a traumatic event. Who wouldn’t want to avoid reminders of a painful and overwhelming experience? Or attempt to avoid situations because you fear something similar could occur again?

The problem is, avoidance doesn’t really work. In fact, avoidance strengthens the fear and anxiety response! The more we avoid a place, person, or even feeling, the more likely we will continue to feel anxious about it and continue avoiding it. A vicious cycle!

Ongoing avoidance is one criteria required for a diagnosis of PTSD in the DSM V:

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event:(one required)

  1. Trauma-related thoughts or feelings.
  2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

The presence of avoidance is diagnostic of PTSD and research has found that an avoidant coping style is related to increased PTSD symptom severity for sexual assault survivors.

Avoidance can happen within therapy too. Sometimes therapists collude in avoidance, for perhaps in an unconscious effort to prevent the client from feeling more pain. In trauma therapy avoidance can look like:

  • talking about any and everything but your trauma
  • minimizing the severity of your experience “other people have it worse than me”
  • forgetting to do homework in between sessions
  • forgetting or missing appointments

Trauma therapy is all about facing, being present with, and moving through your traumatic experiences instead of avoiding them. It involves processing your traumatic experiences by staying present with the associated feelings and beliefs. No small task! The payoff for this hard work  is decreasing the high intensity emotional charge while creating meaning.  A trauma-informed therapist of course understands to need to approach this work gently and with compassion. Avoidance exists for self-protective reasons. With help and support you can learn more effective ways to overcome trauma.

avoidance and trauma therapy

 

 

This entry was posted in Abuse, Mental Health, Psychologist, Sexual Abuse, Therapy, Trauma and tagged , , , , , , , . Bookmark the permalink.

12 Responses to Avoidance and Trauma Therapy

  1. betternotbroken says:

    I have been an avoider. Thank you for the validation that talking about “it” is a step towards health.

  2. I’ve tried to work on my “trauma” in therapy, but generally just end up zoning out. My brain wants to face it and also escape from it, simultaneously. (Zoning out almost always wins, because it feels good.) “Trauma” was a word my therapist used and to this day I can’t associate it with myself. It will always, with all the avoidance I can muster, be “trauma” in quotation marks. Thanks for another great article.

    • Thank you for your comments! As I hit the publish button on this one, I thought about making a clarifying point: trauma therapy is phased, and facing trauma directly is not the first step. You are so right, “zoning out”, or what I might call dissociation, works and is adaptive. Until someone learns other tools for modulating and managing strong emotion it is not possible to be present enough to face trauma material directly.

  3. So trying NOT to do this

  4. Kerro says:

    Great post again Dr K, thank you! So true … I used to avoid anything anxiety-inducing, both trauma-related and non-trauma related. I think because the “emotional charge” was the same.

    Trauma-therapy is hard, hard work, but in my experience well worth it. I still avoid some things that are trauma related but not to the same extent and not with the same “emotional charge”. Perhaps more importantly I’m able to recognize that charge and deal with it more appropriately.

    • Great to “see” you again, Kerro!

      Thanks for reflecting on and sharing your progress in this area! I truly believe it is all about progress rather than ending all avoidance. There is a time and place for everything.

  5. Dr k, i was so avoidant and minimizing that i did not recognize my own state of having been traumatized. In fact, the doctor i saw for eight years, who in subjecting me to 4-point restraints often for over 24 hours at a time, repeated and retraumatized me but insisted that i had never been subject to any major trauma even when others questioned it…it has been very difficult to come to terms with my history of multiple traumas, feeling as i do so responsible for them. Some i still cannot deal with yet to this day. But i am working on not minimizing the trauma in my life experience for once. I appreciate your pointing out that that too is a form of avoidance. Pam w.

  6. ssanquist says:

    Great post DKY! I like how you added that there are steps first before diving head first into trauma work. If you don’t have good coping skills or not able to regulate your emotions, how can you cope with going through the trauma work? Baby steps. Little doses at a time helps over the long term.
    Good to see your posts again🙂

  7. Pingback: Breaking Silence: Talking about Trauma | Dr. Kathleen Young: Treating Trauma in Tucson

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