Avoidance

Avoidance is a fundamental defence mechanism inherent in human nature, and serves as a ‘protective shield’ against potential dangers and threats. While this instinctive response is designed to keep us safe, there are instances where avoidance can transform into a maladaptive behaviour (a behaviour that works against us).

Avoidance, in the context of PTSD and C-PTSD, refers to a deliberate effort to avoid or attempt to avoid

• distressing thoughts, feelings, or memories related to the traumatic event
• people, places, situations, or other related things associated with the traumatic event

Avoidance with PTSD or C-PTSD can take various forms, both subtle and overt.

• Staying away from places, events, or objects that are reminders of the experience
• Avoiding any situations that bear a resemblance to the traumatic event.
• Feeling that you need to keep yourself busy all the time
• Using alcohol or drugs to avoid memories
• Feeling emotionally numb or cut off from your feelings
• Feeling numb or detached from your body
• Being unable to remember details of the trauma
• Social withdrawal: isolating from friends, family, or social gatherings.

Avoidance symptoms may cause people to change their routines.

To those on the outside, avoidance may appear as simple reluctance or hesitation. It can manifest as a consistent refusal to engage in certain activities or a tendency to decline social invitations. The person with PTSD or C-PTSD might come across as aloof or detached, creating a barrier that, although unintentional, distances them from others.

Understanding that avoidance is not a mere choice, but rather a coping mechanism, is crucial for those supporting individuals with PTSD or C-PTSD. Approaching the situation with empathy and patience can create an environment where the person feels understood rather than judged.

How avoidance can make things worse

This avoidance acts as a protective mechanism, an instinctual response to avoid the pain and discomfort associated with reliving traumatic events, however, this ‘protection’ can actually worsen symptoms as it can end up turning into an avoidance cycle:

1. When someone experiences something that triggers them, or reminds them of a trauma, the body produces a cascade of mental and physical symptoms, like racing thoughts and a fast heart rate.
2. The person doesn’t like the way these distressing symptoms feel, so they naturally find themselves trying to avoid them.
3. They successfully avoid the uncomfortable symptoms by avoiding the triggers, and it brings them short-term relief.
4. In the process, they teach the brain that these triggers and the sensations they cause are dangerous and that they can’t tolerate the emotions, so they further avoid other emotions and situations to be ‘safe’.

In many cases with PTSD and C-PTSD, the more someone avoids their triggers and reminders of the trauma, the worse the symptoms and avoidance become. It’s thought the act of avoidance (particularly your emotions) might get in the way of properly dealing with the memories and lessening the strong emotions connected to them.

Avoiding these memories can slow down the natural healing process, preventing the decrease of heightened stress reactions over time. It can also make the person think that the memories are still dangerous, reinforcing the symptoms of PTSD.

The Internal Struggle

From the perspective of someone dealing with PTSD or C-PTSD, avoidance is often a double-edged sword. On one hand, it offers a temporary reprieve from the distressing emotions and memories associated with the trauma. However, on the other hand, it can perpetuate a cycle of isolation, hindering the individual’s ability to reintegrate into daily life.

In the mind of someone with PTSD or C-PTSD, avoidance can feel like a form of self-preservation. The rationale might be, “If I stay away from this place or situation, I won’t have to confront the pain it brings.” It’s a protective mechanism that, in the short term, feels like the safest option for maintaining emotional equilibrium.

The Impact of Avoidance

While avoidance may provide a temporary sense of relief, its long-term consequences can be profound. Prolonged avoidance can lead to social isolation, strained relationships, and a limited quality of life. Avoiding necessary activities or responsibilities may also hinder personal and professional growth.

In a recent study conducted in 2022, researchers looked into the connection between avoidance, trauma-related shame, and PTSD symptoms among 60 women with interpersonal trauma. The findings revealed that avoidance correlated with heightened trauma-related shame and more severe PTSD symptoms.

Consistently steering away from perceived threats may also rewire our brains to perceive non-threatening situations as potentially dangerous. Another study from 2022 examined the impact of avoidance on interpreting social cues unrelated to trauma. Participants with PTSD showed a tendency to avoid even looking at individuals displaying “sad” expressions, despite the expressions not inherently signalling a threat.

Over time, the persistent effort to avoid distressing thoughts, emotions, and situations can hinder the ability to carry out necessary tasks or get pleasure from enjoyable activities.

Breaking the cycle of avoidance

While avoidance is frequently associated with PTSD and C-PTSD, it is also prevalent in various other anxiety disorders, such as panic disorder, Obsessive-Compulsive Disorder (OCD), phobias, and other conditions. Effective treatment for avoidance symptoms associated with PTSD and C-PTSD involves a multi-faceted approach that addresses both the emotional and cognitive aspects of the condition. It’s important to note that individual responses to treatment can vary, and a tailored approach is often necessary.

Here are several therapeutic options that can help people with PTSD or C-PTSD, but among the therapeutic options, prolonged exposure (PE) therapy stands out as particularly effective in addressing avoidance in PTSD.

Prolonged Exposure Therapy involves gradual exposure to trauma-related thoughts, feelings, memories, or situations within a controlled and supportive environment. The goal is to reduce anxiety and fear associated with triggers by providing a safe space for individuals to process and integrate their traumatic experiences.

Mindfulness-based interventions, such as Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT), can also help individuals develop awareness of their thoughts and emotions without judgment. Mindfulness practices can be particularly beneficial in reducing avoidance and increasing emotional regulation.

Art and Expressive Therapies such as art, music, or writing therapy, can provide alternative ways for individuals to express and process their emotions. These therapies offer non-verbal channels for exploring and communicating difficult feelings, especially ones you may be trying to avoid.

It’s crucial for people with PTSD or C-PTSD to work closely with mental health professionals to determine the most appropriate and effective treatment plan for their specific needs. A collaborative and personalised approach often gets the best results in addressing avoidance symptoms and fostering long-term healing.

Conclusion

Understanding avoidance as a symptom of PTSD and C-PTSD is crucial for both those experiencing it and those supporting them. By acknowledging the complexities surrounding avoidance, we can create a more empathetic and informed approach to helping ourselves and others on their journey towards healing.