Avoidance: The Engine That Keeps Anxiety Going

When people think about anxiety, they often focus on fear, worry, or uncomfortable physical sensations. But underneath all anxiety disorders is a process that does most of the long-term work of keeping anxiety alive: avoidance.

Avoidance and escape are anxiety's fundamental reinforcers. They are the behaviours that teach the brain to treat anxiety as dangerous and urgent. When I work with a client with anxiety, I try to determine what is reinforcing their anxious behaviour. Understanding this mechanism is important for planning effective behavioural treatment and understanding what the challenges are likely to be.

What is meant by “avoidance”?

When psychologists talk about avoidance, they are referring to anything a person does to prevent anxiety from arising, or to make it stop once it has already begun. Avoidance can be obvious and behavioural, such as not going to certain places or situations, but it is just as often more covert. People may avoid by distracting themselves, worrying excessively, mentally rehearsing, seeking reassurance, or carefully controlling their environment. Escape is closely related and describes actions taken once anxiety is already present in a situation, with the aim of bringing the discomfort down as quickly as possible by leaving the situation. An example of this could be checking the locations of all the exits when entering a room, or sitting on the external seat of a movie theatre to make a quick escape.

Here in Christchurch, when we had a series of large and destructive earthquakes in 2010 and 2011, people performed all kinds of avoidant and escape behaviours. People literally ran out of buildings during earthquakes. They stopped coming into the city, where there was a lot of damage, and where most deaths occurred (some have not returned), many fled the city (many moving to areas even more earthquake-prone than Christchurch), and slept underneath dining tables instead of in bed. Fifteen years later, some people are still performing these avoidance behaviours.

These responses are completely understandable. Anxiety feels awful, and the nervous system is designed to move us away from perceived threat. When anxiety drops after avoidance or escape, the body experiences immediate relief. That relief acts as a powerful reinforcer (i.e., something that increases the behavioural response over time). When repeated, this relief teaches the brain that anxiety can and should be prevented or escaped, rather than tolerated.

Why avoidance strengthens anxiety

Avoidance works extremely well in the short term, and as humans, we are very much wired to pursue pleasure or relief from suffering, even if these rewards are only brief. Each time anxiety is avoided or escaped, the brain is denied the opportunity to learn that anxiety can be tolerated and that feared outcomes are often unlikely and manageable. Instead, the nervous system remains on high alert because it has not been allowed to fully experience and resolve the fear.

Over time, avoidance tends to spread outwards. More situations can become associated with danger, confidence shrinks, and the person’s world becomes smaller and smaller. This can perhaps be seen most obviously in agoraphobia, where the places that a person feels safe can dwindle to encompass only their own house, or even only a room in their house. Anxiety cannot recalibrate through avoidance; it becomes more sensitive, more reactive, and more convincing.

Why anxiety doesn’t reduce on its own

Because avoidance blocks learning that anxiety can be endured, it tends to persist rather than fade with time. People assume that if they stay away from anxiety-provoking situations for long enough, their anxiety will eventually disappear. In practice, the anxiety remains and can even get stronger. Anxiety reduces when the nervous system is allowed to activate and then settle naturally.

This is why anxiety disorders often persist for years or decades, even when people logically understand that their fears are excessive, and also why even after symptom improvement, anxiety severity can increase again if a situation is again avoided. This is why I am always more anxious about getting on a plane when there has been a long time between plane flights, and why after one or two flights, future flights evoke less anxiety (unless I don't take one for a while, and anxiety creeps back up again).

Experiential avoidance: avoiding thoughts, feelings, and sensations

Not all avoidance is about places or situations. Experiential avoidance refers to attempts to avoid internal experiences such as thoughts, emotions, memories, or bodily sensations. This is common in anxiety disorders and often goes unnoticed because it is less visible.

Examples include trying to suppress anxious thoughts, distracting from uncomfortable feelings, numbing emotions with drugs or alcohol, analysing sensations in an attempt to control them, or constantly monitoring the body for signs of danger.

While these strategies can temporarily reduce distress, they teach the brain that internal experiences themselves are threatening. This often leads to increased vigilance, stronger anxiety responses, and a growing fear of anxiety itself. Ironically, the more people try to control or eliminate their internal experiences, the more dominant those experiences tend to become.

How avoidance shows up in different anxiety disorders

Although avoidance looks different across anxiety disorders, the underlying learning process is the same.

Generalised Anxiety Disorder (GAD)

In generalised anxiety, avoidance is often mental rather than behavioural. Common forms include:

• excessive worrying as a way to feel prepared or prevent uncertainty (worry can feel helpful)

• frequent reassurance seeking from others

• avoiding decisions for fear of making the wrong one

• over-planning and mental rehearsal to prevent negative outcomes

• distracting from uncomfortable thoughts or feelings

Although worry feels active and problem-solving in nature, it often functions as avoidance. It keeps people from fully experiencing uncertainty or emotional discomfort, while reinforcing the belief that feelings of anxiety are dangerous and that constant vigilance is necessary to stay safe.

Obsessive–Compulsive Disorder (OCD)

In OCD, avoidance is closely tied to compulsions and neutralising behaviours, including:

• avoiding triggers that bring up intrusive thoughts

• performing rituals to reduce distress or prevent harm

• mental checking, reviewing, or analysing past actions

• reassurance seeking about morality, safety, or certainty

• avoiding responsibility or situations where “something could go wrong”

The short-term relief that follows compulsions strongly reinforces both the obsession and the avoidance. Unfortunately, this teaches the brain that the intrusive thought was meaningful and dangerous, rather than harmless mental noise. Intrusive thoughts can then pop up more frequently, as can the resultant compulsive behaviour.

Agoraphobia

Agoraphobia involves avoidance of situations where escape feels difficult or help might not be available. This often includes:

• avoiding public transport

• avoiding crowds or busy places

• avoiding open spaces

• avoiding travelling far from home

• avoiding being alone in unfamiliar environments

People often begin by escaping situations when anxiety spikes, then gradually stop entering those situations altogether. Over time, the nervous system decides that these environments are unsafe, leading to increasing restriction and reliance on “safe” places.

Social Anxiety Disorder

With social anxiety, avoidance can be subtle and strategic, rather than complete withdrawal. Common examples include:

• avoiding social events, meetings, or speaking situations

• staying quiet to avoid drawing attention

• avoiding eye contact

• using drugs or alcohol to reduce anxiety

• excessive preparation or rehearsal before interactions

• leaving social situations early

• mentally reviewing conversations afterwards

These behaviours temporarily reduce anxiety in the moment, but prevent learning that social situations are usually survivable and that negative evaluation is often far less severe than feared.

The alternative to avoidance

The alternative to avoidance is to learn how to respond differently to anxiety, rather than trying to eliminate it. This usually means approaching feared situations gradually and intentionally, while allowing anxiety to be present without escaping from it.

When people stay with anxiety long enough, the nervous system learns that it can settle on its own and that feared outcomes are either unlikely or tolerable. Over time, anxiety may still arise, but it can be smaller and no longer dictate behaviour.

I use cognitive behavioural therapy approaches, including acceptance and commitment therapy, to treat anxiety disorders. They focus on understanding triggers for anxiety, and learning to expose oneself to manageable levels while not avoiding or escaping.

In summary

Avoidance is not a personal failing. It is a predictable outcome of how human and animal nervous systems learn. But once it becomes clear that avoidance and escape are the main reinforcers of anxiety, the path to treatment can become clear. The goal is not to get rid of anxiety, but to stop organising life around avoiding it.

Anxiety changes not when it is avoided, but when it is allowed to be experienced and learned from. This is why I try not to use words like "control", "manage" or "reduce" when talking about anxiety. "Notice", "allow" and "approach" would be preferable.