S2E31 Avoidance

Brains don’t like being uncomfortable, so they’ve come up with a simple behavioral solution: avoid it! In this episode, the docs discuss the function of avoidance, provide psychoeducation about experiential avoidance and its attempts to control what’s happening inside of our bodies, and discuss the comparable Buddhist concept of aversion. Everyone avoids thoughts, feelings, other people, situations (and much more) at some point or another, so tune in to learn how to recognize avoidance and begin to turn back towards stepping into discomfort. We promise, it’ll be worth it!




Nikki: Pete, we all avoid, we all want to do the easy thing and pull the covers over our head sometimes, I know I do. How about you?


Pete: I do, that thing that you just said, I had a principal once, that was like, when we were like afraid of the night and he was like, “you are going to pull your covers over your head, and then all of a sudden the Burglar won't get you”. And I was like, “oh yeah, that's right, they wouldn’t.” They would let get me still.


Nikki: Yeah, you're like, ‘but maybe they will, I’ll still do it'. Well so for that reason Pete and I are going to be talking about avoidance today. So I think it's important to clarify what avoidance is, because of course it's a word we all kind of like say out in the world. Like we're going to avoid doing something or whatever, but from a behavioral science lens, avoidance means something really specific. So of course I'm going to jump in with some definitions, not Webster ones though.


Pete: Oh. But I have to give my Webster one. 


Nikki: Oh, fine. All right.


Pete: The action of keeping away from, or not doing something.


Nikki: Okay. I'm okay with that. 


Pete: You're not mad at that.


Nikki: Yeah, I'm not mad at that. Sometimes I like shake my fist at Webster and I'm like, they need to hire some psychologist. But, okay, that's right. So avoidance from a psychological perspective really means avoiding something that is unpleasant in some way. So we're engaging in a behavior where we're moving away from something that's unpleasant. So, as we talk about a lot on here, behavior can be both overt, so you could avoid having a conversation with someone that's difficult, that would be an overt avoidance behavior, but it can also be covert, like you can avoid something inside your body, like you could push away a memory you don't like, or you could try to push away an emotion. And we do this because when we run away from something, move away from something that's unpleasant in the short term, in the moment it feels relieving. Like we get a sense of relief and that sense of relief is very reinforcing to our brains. Our brains then learn, “Hey, that quote unquote ‘worked'. I know I'll do it again next time”. It's actually something, the behavioral term is it's negatively reinforced, negative by the way, listeners doesn't mean bad, in behaviorism, poorly named in my opinion, but negative means taking away.


Pete: It's so poorly named that we always have to do this. Negative reinforcement is the removal of a stimulus.


Nikki: Yes, the removal of a stimulus. 


Pete: Out of an environment or removing some kind of experience that's creating… 


Nikki: Discomfort, 


Pete: Discomfort. Thank you for that.


Nikki: Right, discomfort. And then reinforcement means the behavior is more likely to happen again in the future. So if we take away anxiety, anger, sadness, think of all the…a memory you don't like, a thought you don't like, your brain goes, ‘hmm, I really like that. I think I'll do that behavior again'. And then we end up kind of stuck in a pattern of avoiding things that are uncomfortable.


Pete: So, I mean, maybe we could break down some examples for like, maybe some like common…


Nikki: Throw some out, yeah.


Pete: Well, I feel like you're always better at the examples, but I mean obviously like easy ones would be like getting off of a bus when it gets really crowded or uncomfortable, or pulling off the highway because we're driving and I see a bridge coming up and I don't want to go over the bridge, but let's… a difficult conversation. So if I’m having an argument with a loved one, then maybe don't go to dinner or don't hang out or don't go to the meeting because I don't have to see them, that's avoidance. Any others? I mean, lots of others, but,


Nikki: Yeah. I was like, oh my gosh, so many. Yeah, so many ways to avoid as a human, I can't cover them all. Well avoiding vulnerability, like sharing how you…


Pete: That's big one,


Nikki: Feel with somebody. We could even say avoiding vulnerability with yourself, like not acknowledging to yourself that you feel a certain way.


Pete: So sort of like when you wanted to avoid When East Meets West, when I first presented it to you.


Nikki: That's a great examples. Check out our vulnerability episode from season one, 


Pete: Here about that one a little bit. 


Nikki: Yeah, hear more about that. Yeah, that's certainly avoidance. When people engage in unhelpful coping behaviors, like substance abuse, for example, like drinking.


Pete: That's avoidance.


Nikki: Like overeating or restricting food. Devices, turning on all the devices so you don't have to be in the moment. 


Pete: I love a good overeat. I'm just going to put that out there for everybody. 


Nikki: I love that.


Pete: A binge, again, I mean, I'm not minimizing it because it can be really challenging for some people and it does…it's really comforting. So I think if I'm having a stressful day, to avoid that, I might eat be a little extra.


Nikki: Yeah, no, absolutely. And we do other things that are about avoiding what's happening in our inside of our bodies by sometimes, like I said, suppressing emotion; we'll push things down, try to push thoughts out of our mind. We might fantasize, or imagine other things that can be avoidance. I do think it's important to acknowledge that all these behaviors Pete and I are talking about, they're not inherently avoidant. So in behaviorism, we are always clear to identify that the function of a behavior, meaning like what a behavior is intending to do for us, there's a reason why we're do, why we do things, is determined by the context. So if we go back to substance use, for example, if you have a glass of wine at the end of the day, it's not necessarily indicating that you're avoiding any something. You might just enjoy wine; you might just enjoy the sense of relaxation that the substance induces chemically. However, if you are coming home and drinking, I don't know, like five hard liquor drinks, and because you're feeling very, very anxious or very, very sad. 


Pete: I love that you just said hard liquor drinks.


Nikki: Well, trying to be general and specific at the same time here, trying to be both. That would indicate avoidance, that you're trying avoid emotion. So I do think it's important that as we're talking about this, that listeners, aren't jumping to the conclusion like, “oh no, if I do these things, I'm avoiding everything”.


Pete: Well because it's everything in moderation. 


Nikki: Correct. Well, and to that point, I'm glad you're saying that Pete, avoidance as well, like I always say to patients, like we can't be mindful a hundred percent of the time. There is a degree of like sometimes we're going to avoid things and that's okay. That's still a holistic… that's… you can still be holistically healthy and engage in avoidance behaviors cause there's no way not to.


Pete: That's right. Yeah. Well, and when you pour this second or third glass of wine, let's say in that example, what we do is we might do that mindfully, so that, like, I'll say to like say college age kids or things like, “shots never have like a good outcome”, like a shooter. Or if you're trying to break down intent, like what's the intent of a shot. 


Nikki: Right, totally. 


Pete: The intent is to get to like blackout, I mean, ‘ish'. I mean, if you're really being honest, I mean [inaudible 7:40]


Nikki: Sure, no, totally. Well, and so yeah. So bringing some mindful awareness to the process, absolutely. Though I think also maybe what I'm wanting to emphasize is that, if we go to the devices, for example, in the modern era, we all that sometimes, we all, like  


let's say…


Pete: You're really good at that. You don't do that that much.


Nikki: I mean, yes. And I mean,


Pete: Well, because you at least have this healthy relationship with social media. Because I think that's a lot of people get, that's what they get.


Nikki: That's true. But I mean, I can be on my, like, I can be like watching TV and like be on my phone and like someone sitting next to me, do you know what I'm saying? It's like, I do. I mean, I'm a person, so it's like, I definitely can struggle with that. And I think what I want to communicate is that it's having compassion for oneself that we can't eliminate avoidance behaviors from human experience. What we can do to Pete's point is become aware of them and try to reduce them overall. So it's not our main coping tool, because that’s where it becomes a problem.


Pete: Yeah. Well, because there's this APA definition of avoidance that I think you're going to like.


Nikki: Oh, yeah, I'll probably like that one, yeah. 


Pete: This one you're going to like, because it also breakdown. So the practice or an instance of keeping away from particular situations, environments, individuals, or things, because they're either; A they anticipated negative consequence of such the encounter; B, anxious or painful feelings associated with them. So psychology brings several theoretical perspectives to the study of avoidance. So it uses it as a means of coping, like you just said. It uses as a response fear or shame, that's a big one. It's existence as a personality style or predisposition, so some of us just tend to be more avoidant, and lastly, it's existent as a component of anxiety disorders.


Nikki: Yes. Thank you. I do like that. 


Pete: I knew you would, that’s why I had to read it. 


Nikki: Yeah, I'm so glad you did. Well, I think actually, because I do want to talk a little about how we target avoidance both clinically and from an Eastern lens. Well, because, mindfulness is, guess what guys, all roads lead to mindfulness, we're going to [inaudible 9:46] I think I want to throw out one more definition that's really important, which is experiential avoidance because that's a really important one. So experiential avoidance, which I think I would, I mean, I have a feeling you're going to agree with me here. All avoidance I think really is, can be characterized as experiential avoidance and experiential avoidance comes out of the most current behavioral science research and really what experiential avoidance means is the brain tries to control, fix, get rid of, problem solve, ignore, suppress any internal stimuli. And so what are internal stimuli? Well, they're the things that we don't control, like emotions that pop up, that we don't, they just show up,


Pete: Fear, shame, 


Nikki: Fear, shame. But anything, like fatigue, joy. Okay, so emotions, thoughts that show up? 


Pete: No one's really avoiding joy, but…


Nikki: Well, some people do actually.


Pete: Oh, you're right actually like depressed,


Nikki: Yeah, anything. Yeah, or like they feel guilty about feeling joy, it's like… Yeah. People, I mean brains are tricky organs.


Pete: Don’t you go talk bad about that brain; you've been good about that lately.


Nikki: I know, I'm like, “these trick hearings”. Okay, so emotions, thoughts, physical sensations, behavioral urges or memories. So these are all internal stimuli that our brains can try to fix, get rid of, control, ignore suppress. And we can experientially avoid things both with overt behaviors like we've talked about or covert behaviors. So I just think that's really important to, 


Pete: That was great 


Nikki: Oh, thank you. And also,


Pete: Where's that from, I mean, 


Nikki: What experiential avoidance? 


Pete: No, just the way that you define, I mean, I love that you broke that down to emotions, thoughts, physical sensations, behavioral urges and memory.


Nikki: Oh, it comes out of the ACT literature,


Pete: I should have known about that.


Nikki: You know it in there, I know you, 


Pete: I'm sure it's there, but it's like it, yeah. 


Nikki: I'm sure it's, and I also want listeners to know that what's really interesting is that experiential avoidance. So again, it's trying to get rid of these things. What happens is the more we try to avoid these internal experiences, we don't want, what we say in ACT is the more you don't want it, the more you got it. So it paradoxically increases it. So I tell people it's kind of like trying to put a lid on a pot of boiling water. It will keep it in initially, but then it'll blow, it'll explode.


Pete: So I say it's like putting a beach ball underwater in the outside pools.


Nikki: Oh yes. I love that one. Oh yes. I love what you say. That's another great one. 


Pete: That's a good one, yeah.


Nikki: It doesn't actually work. So the more we experientially avoid research demonstrates that it results in increased like symptoms basically, increase emotion dysregulation. So on the surface it seems like it's again, quote unquote ‘working', 


Pete: Working, yeah.


Nikki: Because we're like, ‘oh, we got to avoid that discomfort for a moment'. But it overall holistically it's actually creating suffering. 


Pete: Well, that's a beautiful way for that negative reinforcement.


Nikki: Yes, exactly. So Pete, tell us there's a little bit about how we target avoidance behaviors. Like what are some of the things that you do clinically?


Pete: Well behaviorally, if there's something you're avoiding, like you've already alluded to, then we need to do it. So I mean, what we do is like a hierarchy or just some sort of systematic approach to targeting whatever the behavior is. And so whether if it is having a difficult conversation, you might role play with it. You might imagine having the conversation, write out some of the things, you kind of get to help our clients like figure out what the feelings will be and to at least try and practice it in session, like you already also alluded to, all roads lead to mindfulness, so having a mindful approach to the avoidance, because what we're going to do is often judge ourselves. So like we're not going to go into that in this episode, I think we did an episode on shame. Did we?


Nikki: Ahh


Pete: I stumped you.


Nikki: You stumped me. No, actually, I don't think we have yet. We’ve done on…


Pete: We've done on guilt?


Nikki: We've done guilt, we did. We did it on guilt, that's right.


Pete: Yeah. So they're like cousins. And so I think we'll talk about that with noticing like, so from a mindful perspective, it's like noticing when you're avoiding something because of shame or guilt, because ultimately what you want to do is nonjudgmental experience it. Because it's your, it's that gorgeous frontal lobe that's saying, ‘Hey, you shouldn't have this or you're feeling this certain kind the way'. And so we're going to say, Hey, let's retrain that frontal lobe to then be able to like, I don't like the word tolerate, but to be able to like accept…


Nikki: Experience and accept yeah.


Pete: And experience, yeah.


Nikki: Yeah. Well, and can you also, because I think this is a really helpful place to include sort of when we're avoiding again, these internal experiences. Because what Pete's really describing, which is really important is when people are overtly avoiding something. We're going to take steps to help them come into, like if they're avoiding having a conversation with somebody or they're avoiding. We're going to lay out steps to do that, that we could actually say why, it's like, why are they not doing those things? Because they're trying to avoid something internal that they don't like, like they're afraid or they're ashamed. So this is where the mindfulness piece comes in. And we have to do a lot of that work in sessions sometimes. So can you explain a little bit more about how you help people actually move towards contacting emotions or thoughts or making space for the things that they're not accepting.


Pete: Yeah. So in session you might ask them to describe how they're feeling in their body, the physical sensations, like you just said, or the thoughts, the emotions associated with it. So that, whether that's from recounting the story or the experience, or if it's from doing a kind of visualization or a guided meditation in session around what that actually feels like in someone's body, and so sometimes, I'm sure you've had this, that clients will end up like crying in session or having that really emotive experience to just release whatever it is that they may have been holding it onto.


Nikki: Yeah. No, absolutely. And I'm really glad that you brought that up because I think this is important to say about avoidance too, is that there can often be a belief that if somebody allows for one of these internal experiences that they don't like, so a thought they don't like, a memory they don't like, an urge they don't like, an emotion or sensation, that if they allow for it, if they make space for it, that one of those memories, thoughts, emotions, urges are going to actually take over. And so that's actually what leads to trying to get rid of it, because they're like, ‘oh, if I let myself’, I think we talk about this in our sadness episode. People often are times are afraid, ‘Oh, if I let myself feel sad, I'm going to become undone'. And so there's this paradox that actually the allowing is what helps you process it, which helps you regulate it so much like the lid on a pot of boiling water. If you take the lid off, the water will boil, but it's not going to boil over, it's going to stay in the pot. And so I think this practice of targeting avoidance is also, leads to people, not only being able to learn the skills to regulate emotion, then from a cognitive perspective, they also learn feeling uncomfortable experiences in our bodies. Thoughts, memories, they're not going to actually hurt us in any way. 


Pete: I love that you just said that too, like learn and practice. You have to learn and you have to practice.


Nikki: Yes, that's right. Well, and can I ask just one last question? Because I know we're running out of time here. Of course I have all the questions for Pete. Is there anything that Buddhism has to say about avoidance? Like is there, is that sort of identified concretely at all?


Pete: I mean, I think it's about interpretation and there are these things called like the three poisons. And so I think in our English language, they are ignorance, attachments and aversion, and it's the aversion piece.


Nikki: Oh, yes.


Pete: So that's usually where you'll find some of this idea and it's, I think in Sanskrit's [inaudible 17:54] and this is the idea of aversion or hate. And so these three poisons, they lead to that duhkha, which I've talked about before, which is the suffering. So yeah, there's a place for it, because, we realize that aversion to things and we didn't say this, and so I'll ask you about values. Like maybe as we kind of wrap up, like think about also values are a big piece of how you and I treat avoidance.


Nikki: Absolutely. No, I'm really glad that you brought that up. Yeah, because, well, so I'm going to use language of what to link this here because... So from a behavioral lens, we do use the term aversive, so all the things that we're talking about, when something's unpleasant, it has an aversive, what we say, is an aversive stimulus value. And so values from an act lens, things that make us feel connected a sense of meaning purpose. Those have, this is a really dorky, behavioral word, appetitive stimulus values, which appetitive means that we want to move towards them basically. So aversive, we want to move away, that's why we avoid, appetitive, we want to move towards it. And so, how do we help treat something that in the short term we want to move away from it. Well, we help people access what they want to move towards. Like, so kind of the simple example I like to use is if you have an individual who strongly values friendship that gives them a sense of connection and meaning and warmth. And they have a lot of social anxiety, so being around people, even friends also activates a very aversive, emotional experience. Can they mindfully and dialectically hold both? Can you allow yourself to willingly experience anxiety while simultaneously engaging in a behavior, being with friends that aligns with one's values, and what do we find? That tends to be really helpful; it doesn't get rid of the anxiety a hundred percent because that's part of our brains. Though, we do you help people create more expansive lives in that way. So thanks for bringing that up. That's a really important way to end here. So for our listeners, when you’re thinking about avoidance, number one, start with knowing you're going to avoid, we all do it, it’s a part of human experience. So if you find yourself avoiding practice radical acceptance and nonjudgmental stance, as well as self-compassion, and then see if you can get curious about whether or not you can mindfully come back to approaching the thing that you're trying to avoid, making space for it and maybe reducing your avoidance behaviors overall.


Nikki: This has been when east meets west I'm Dr. Nikki Rubin


Pete: And I'm Dr. Pete Economou, be present, be brave. 


Pete: This has been When East Meets West all material is based on opinion and educational training of doctors, Pete Economou and Nikki Rubin.


Nikki: Content is for informational and educational purposes only.