The role of avoidance of emotional material in the anxiety disorders

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Abstract

Many psychotherapeutic traditions have conceptualized clinical levels of anxiety as resulting from the avoidance of threatening or emotional material. In this paper, we examine behavioral models of avoidance of emotions and emotional material, integrating findings that support established behavioral theories of emotional avoidance and anxiety, and that extend these theories to further explain the intense, intrusive, and interfering nature of clinical anxiety. Research on the suppression and avoidance of emotional material suggests that emotional avoidance and thought suppression may not only hinder the learning process and maintain anxious responding, but may also (a) paradoxically heighten anxious responding to threatening cues and (b) interfere with emotion functionality, thereby further impeding adaptive responding. Findings are discussed in terms of future research and implications for clinical treatment of anxiety disorders.

Section snippets

Behavioral theories of emotional avoidance and anxiety

Recognition of the role of avoidance in behavioral models of anxiety came with Mowrer's (1960) two-factor theory of fear acquisition and maintenance. Until this point, behaviorists had focused on the role of classical conditioning in fear associative learning (Wolpe, 1958), but had failed to explain the resilience of clinical levels of fear and anxiety despite the easy extinction of even the strongest levels of fear in laboratory settings (Annau & Kamin, 1961). Mowrer (1960) proposed that once

The consequences of emotional avoidance: basic research

These behavioral models explain how emotional avoidance may interfere with extinction of learned emotional associations (thereby maintaining anxiety levels), and may elicit behaviors that interfere with or limit the range of behavioral responses (leading to diminished behavioral flexibility and diminished quality of life, as is seen in many anxiety disordered clients). However, a body of research suggests that emotional avoidance may have additional negative consequences that may further

Emotional avoidance and the anxiety disorders

Individual differences in the suppression/avoidance of emotions are related to a range of poor mental health outcomes. The tendency to avoid emotional expression has been associated with self-reports of less positive and more negative affect, poorer interpersonal functioning (including experiencing more emotional distance and receiving less social support from others; Gross & John, 2003), and higher levels of arousal when exposed to threat (Notarius & Levenson, 1979). Further, the tendency to

Future research

There is promising theoretical and empirical evidence of a link between an emotionally avoidant stance and the experience of clinical anxiety. However, more work is needed to better understand the outcomes associated with avoidance of aspects of the emotional response, and how these may be implicated in various forms of anxiety. This young literature is plagued by definitional and methodological challenges, difficulties in determining developmental/causal pathways, and measurement dilemmas.

Clinical implications

Because the construct of avoidance has been highlighted in behavioral models of anxiety acquisition and maintenance for more than five decades, psychotherapies employing exposure to and approach of fear-eliciting stimuli have been developed for diverse forms of anxiety [including phobia (e.g., spider phobia, Öst, 1996), panic (e.g., Barlow, Craske, Cerny, & Klosko, 1989), PTSD (Foa, Rothbaum, Riggs, & Murdock, 1991), and social anxiety (Heimberg, Liebowitz, Hope, & Schneier, 1995)]. While these

Acknowledgements

We thank Amy Wagner for her helpful comments on an earlier draft of this manuscript. Preparation of this paper was supported in part by National Institute of Mental Health Grant MH68962 to the first author.

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