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)
Trauma-related thoughts or feelings.
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.