Introduction to Avoidance and Anxiety
When something makes you anxious, avoiding it can feel like the easiest solution. You feel better for a while, but the anxiety usually comes back.
Avoidance isn’t always obvious. You may avoid people, places and situations. On the other hand, you may be avoiding your emotions. For example, you might spend hours worrying, planning, checking, or seeking reassurance without realizing you’re trying to escape uncomfortable feelings.
In my therapy practice, I often see how these habits become automatic. The more you rely on avoidance, the harder it can be to face the things that make you anxious. Many of my clients have struggled with anxiety for years and still feel stuck. Avoidance is often why.
In This Article
This is Part 2 of my two-part series on avoidance. Here, I focus on anxiety disorders and OCD; Part 1 explores avoidance in personality disorders.
In this article, you will learn:
- How avoidance shows up in anxiety disorders
- How avoidance shows up in different types of anxiety: generalized anxiety, health anxiety, OCD, panic disorder, PTSD, social anxiety, and work anxiety
- What keeps avoidance going with anxiety disorders
- How Cognitive Behavior Therapy (CBT), exposure-based approaches, and Schema Therapy can help you change avoidance
What Is Avoidance in Anxiety Disorders?
Avoidance means staying away from situations, thoughts, feelings, memories, or physical sensations that trigger anxiety. It can also involve doing things to prevent discomfort, such as overpreparing, checking, procrastinating or seeking reassurance. Sometimes you’re not avoiding a situation at all. Many of my clients are avoiding what they might feel.
How Avoidance Shows Up in Different Anxiety Disorders
Avoidance takes different forms depending on what you’re afraid of. Here’s how I see it commonly appearing across anxiety disorders and related conditions.
| Condition | What you’re avoiding | How avoidance shows up |
|---|---|---|
| Generalized Anxiety Disorder | Uncertainty, unexpected problems | Worrying, overplanning, reassurance |
| Health Anxiety | Illness, uncertainty about symptoms | Checking, research, avoiding or seeing doctors |
| Obsessive-Compulsive Disorder | Intrusive thoughts, doubt | Rituals, mental reviewing, avoiding triggers |
| Panic Disorder | Physical sensations, another panic attack | Avoiding exercise, crowds, unfamiliar places |
| Post-Traumatic Stress Disorder | Trauma reminders, painful emotions | Withdrawal, emotional numbing |
| Social Anxiety Disorder | Embarrassment, negative judgment | Avoiding people and situations, rehearsing conversations |
| Work Anxiety | Mistakes, criticism, failure | Procrastination, perfectionism, overpreparation |
Generalized Anxiety Disorder: Avoiding Uncertainty
With generalized anxiety, worrying can become a way of trying to prevent problems and avoid uncertainty. I see many people who can’t stop worry and they tell me it gets exhausting.
You might:
- Overplan activities to prevent surprises.
- Seek reassurance before making decisions.
- Mentally rehearse worst-case scenarios.
Worry can feel productive, but the more you rely on it to prepare for problems, the harder it becomes to face uncertainty without it.
Health Anxiety: Avoiding Uncertainty About Illness
Health anxiety often shows up as a need to know for sure that you’re okay. You may try to eliminate uncertainty about your health through checking and reassurance.
This can look like:
- Repeatedly check symptoms or search online.
- Ask doctors or family members for reassurance.
- Avoid medical appointments because you’re afraid of bad news.
I see the challenge as learning to tolerate uncertainty about your health without repeatedly checking or seeking reassurance, while still getting appropriate medical care.
Obsessive-Compulsive Disorder (OCD): Avoiding Triggers and Uncertainty
With OCD, you may avoid situations that trigger intrusive thoughts, images, urges, sensations, or feelings of incompleteness. You may also perform rituals to escape distress or uncertainty.
You might:
- Perform physical or mental rituals until something feels safe or just right.
- Check, review memories, or seek reassurance.
- Feel likes obsessions come out of nowhere and they are not like you
Compulsions can function as avoidance because they temporarily relieve distress. Unfortunately, I see that they also reinforce the belief that intrusive thoughts require a response.
Panic Disorder: Avoiding Physical Sensations
Panic disorder can make you wary of your own body. Many of my clients avoid activities that produce bodily sensations similar to panic.
Examples include:
- Misinterpreting feelings and think you are having a heart attack.
- Stay away from crowded places where escape feels difficult.
- Avoid places because you fear another attack.
When you avoiding these situations, it can make ordinary physical sensations seem increasingly dangerous, even when they aren’t.
Post-Traumatic Stress Disorder (PTSD): Avoiding Trauma Reminders
With PTSD, reminders of a traumatic experience can trigger painful memories or emotions, so you may go out of your way to avoid them. I find PTSD can be one of the hardest problems to work on because the trauma threatens your world view and safety.
For example, you might:
- Avoid people, places, or activities associated with the trauma.
- Push away memories or avoid discussing what happened.
- Disconnect emotionally to avoid painful feelings.
Although avoidance can feel protective, it may also keep you from processing the trauma and recognizing when you’re safe in the present. I can help you relive painful memories and reminders gradually and this can ultimately help you overcome the trauma.
Social Anxiety Disorder: Avoiding Judgment
Social anxiety may cause you to avoid situations where others could judge, criticize, or reject you. Like with other anxiety disorders, I help clients create a gradual plan to face their fears.
You might:
- Avoid social gatherings or speaking in meetings.
- Rehearse conversations to prevent judgment.
- Stay quiet or avoid eye contact to escape attention.
Even when you participate, safety behaviors such as excessive preparation can prevent you from discovering that you can handle social situations without them.
Work Anxiety: Avoiding Mistakes and Failure
Work anxiety isn’t a formal diagnosis, but it’s common. Avoidance often hides behind perfectionism, procrastination, or overpreparation.
You might:
- Delay projects because your work might not be good enough.
- Spend excessive time preparing for meetings.
- Avoid asking questions because you don’t want to appear incompetent.
I’ve worked with capable professionals whose over working looks like dedication. But when every task becomes an effort to prevent mistakes, work can become exhausting.
How Cognitive Behavior Therapy (CBT) Helps You Stop Avoiding
Cognitive Behavior Therapy (CBT) helps you recognize the thoughts and behaviors that maintain anxiety. We work on changing the anxious predictions and avoidance patterns that keep you feeling stuck. I practice CBT along with exposure therapy since this is the gold standard for anxiety disorders. I am certified in CBT.
Identifying Avoidance and Safety Behaviors
We start by identifying the ways you avoid discomfort, including subtle behaviors such as checking, overpreparing, reassurance seeking, and mental reviewing. Recognizing these patterns helps you understand what you’re doing to manage anxiety and whether it’s actually helping.
Exposure Therapy and Behavioral Experiments
Exposure therapy helps you approach situations, sensations, or thoughts you’ve been avoiding. Behavioral experiments help you test anxious predictions through experience. Exposure is gradual, collaborative, and goes at a pace you help set.
I usually help clients create a ladder of things to confront from easiest to hardest, but you can start on any rung you want. It does not need to be on order. As you approach instead of avoid, you will gain more confidence.
For example, we might practice:
- Making decisions without repeatedly seeking reassurance.
- Exercising while allowing your heart rate to increase.
- Speaking in meetings without excessive rehearsal.
- Completing work without unnecessary checking.
- Tolerating uncertainty about health without repeatedly searching for answers.
How Schema Therapy Helps with Chronic Anxiety and Avoidance
Schema Therapy helps you identify and change deeply ingrained patterns of thinking, feeling, and behaving that developed earlier in life and continue to cause problems. It focuses on understanding the emotional needs behind these patterns and developing healthier ways of responding to yourself and others. I am advanced certified in schema therapy.
Avoidance in Schema Therapy
A schema is a deeply held pattern of beliefs and emotional expectations about yourself or the world, often shaped by early experiences. In my experience, people are often relieved to learn that their avoidance began as a way to protect themselves, not as a flaw in their character.
Due to your schemas, you might avoid:
- Criticism because a defectiveness schema leaves you feeling inadequate or fundamentally flawed.
- Uncertainty because a vulnerability to harm schema makes the world feel unsafe.
- Conflict because a subjugation schema leads you to expect rejection or negative consequences when you assert yourself.
- Difficult emotions by withdrawing, distracting yourself, or emotionally disconnecting through an avoidant coping mode, a protective state you shift into when you feel overwhelmed. One example is the Detached Protector, the part of you that shuts feelings down to keep you safe.
Schema Therapy vs. Cognitive Behavior Therapy (CBT)
When you’ve struggled with anxiety for years, avoidance can become so automatic that you hardly notice it. You may understand that your fears are exaggerated and know what you need to do differently yet still find yourself falling back into the same patterns. CBT helps you recognize and change the thoughts and behaviors that keep anxiety going while Schema Therapy helps you go deeper by understanding where these reactions came from and change them with deeper work.
| At a glance | CBT | Schema Therapy |
|---|---|---|
| Focus | Current thoughts and behaviors that keep anxiety going | Longstanding emotional patterns and their early-life roots |
| Evidence and role | Strong evidence for anxiety disorders and OCD, including chronic symptoms | Useful when entrenched schemas and coping modes contribute to persistent anxiety or avoidance with a focus on personality patterns |
| Typical techniques | Thinking-trap work, exposure, behavioral experiments | CBT strategies plus imagery rescripting, mode (chair) work, behavioral pattern breaking, changing core belief |
Frequently Asked Questions About Avoidance and Anxiety
No. Avoiding genuine danger is sensible. You wouldn’t walk into a burning building to prove you aren’t afraid. Avoidance becomes a problem when it prevents you from doing things that are reasonably safe or important to your life, such as going to work, seeing friends, driving, or getting medical care. A helpful question to ask yourself is, “Is this protecting me from real danger, or just from discomfort?” If it’s mostly discomfort, avoidance is probably costing you more than it’s helping.
It can be. Repeated reassurance seeking may help you escape uncertainty while reinforcing the belief that you need it to feel safe. The relief usually doesn’t last. The doubt returns and you need more reassurance. Asking a question now and then is fine. It turns into avoidance when you feel driven to ask, search, or check to quiet your anxiety, especially if you keep asking the same thing. In therapy, we often work on tolerating the uncertainty instead of trying to eliminate it.
Anxiety may rise when you begin approaching something you fear. I’ll help you develop a collaborative plan with manageable steps and adjust it as needed. The goal isn’t to force anxiety down during each exercise. It’s to learn that you can experience discomfort, uncertainty, or feared sensations without relying on avoidance or rituals. With practice, anxiety often becomes less disruptive, even when it doesn’t disappear right away.
Yes. Some people benefit from cognitive strategies, skills, and work on longstanding emotional patterns. CBT is the gold standard across anxiety disorders and OCD. Exposure-based strategies are especially important when avoidance and rituals maintain the problem. When exposure feels overwhelming, I’ll help you with a gradual plan to approach what you fear.
Getting Help for Anxiety and Avoidance
If you’ve noticed that avoidance is limiting your life, therapy can help you understand and change these patterns.
I’m Laura Johnson, LMFT, LPCC, a Certified Cognitive Behavioral Therapist and Advanced Certified Schema Therapist specializing in anxiety disorders, OCD, and long-standing personality patterns. I provide video therapy throughout California, including San Jose, San Francisco, Sacramento, Los Angeles, San Diego and beyond. If you’d like to find out whether therapy with me is a good fit, you’re welcome to reach out to schedule a consultation.
