Avoidance in the Clinic: Strategies to Conceptualize and Reduce Avoidant Thoughts, Emotions, and Behaviors With Cognitive-Behavioral Therapy

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Avoidance is a common problem with clients seen in outpatient mental health clinics. Although this problem is typically viewed as a feature of anxiety disorders, it is also commonly seen in depressive disorders and in most other mental disorders, as well as in many people presenting for help with situational distress. Although avoidance is commonly considered to be a behavioral reaction to a feared or unwanted trigger, other types of avoidance such as cognitive, experiential, or emotional are also common and may coexist with behavioral avoidance. Any type of avoidance undermines positive outcomes with clients and several cognitive–behavioral therapies have been developed to target it, notably behavioral activation and exposure therapy. This article examines the problem of avoidance and discusses ways in which to assess and include it in the clinical case formulation and then to follow-up with treatment. Two client scenarios are described throughout the article to help clarify the strategies to conceptualize and treat avoidance in the clinic.

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