Confronting avoidance worksheet

Looking for an ACT avoidance worksheet? This guide to confronting avoidance gives therapists practical tools and strategies for supporting clients struggling with avoidance behaviors. 

Avoidance is a common coping mechanism that therapists encounter. 

This guide to confronting avoidance provides therapists with an overview of avoidant behaviors, including tips for confronting avoidance and a free downloadable ACT avoidance worksheet for clients. 

What are avoidance behaviors?

First, what is avoidance? Avoidance is a behavior used to elude feelings of stress, fear, or to dodge difficult or unpleasant situations. 

It is also considered a maladaptive coping strategy to protect or avert a perceived threat rather than face it. 

For example, someone with social anxiety might avoid attending a party where they would need to interact with unfamiliar people, which could cause them to feel socially awkward. 

Instead, they decide to cancel at the last minute and stay home to avoid the anticipated discomfort, even though this behavior reinforces their anxiety and limits their ability to build social skills.

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There are five types of avoidance behaviors:

1. Situational avoidance

This includes steering clear of specific places or scenarios that trigger discomfort, such as social gatherings, due to fear of judgment. 

Avoidance actions might also include avoiding eye contact, crowded spaces, and other situations or conflicts that may cause anxiety. 

Common avoidance conflict patterns can involve behaviors like ambivalence, procrastination, passive-aggression, rumination, ignoring calls and text messages, using substances, or engaging in disordered eating to “numb” difficult emotions.

2. Cognitive avoidance 

Suppressing or diverting attention from distressing thoughts or memories might involve distracting activities to avoid confronting painful emotions like dissociation, obsessive compulsive disorder (OCD) behaviors, or excessive worrying. 

3. Protective avoidance 

This includes engaging in behaviors to prevent perceived threats, such as excessive checking or other compulsions, seeking reassurance, and needing to have keepsakes or a protective item with you all the time.

4. Somatic avoidance 

This type of avoidant behavior involves avoiding activities that produce physical sensations similar to anxiety symptoms, such as skipping exercise to prevent an increased heart rate, avoiding dating in fear of falling in love, or actions to prevent other sensory overwhelm like sudden temperature changes.

5. Substitution avoidance 

This type of avoidance may involve external or internal actions to replace distressing activities with more comfortable ones, such as staying home and watching TV instead of attending a social event.

It’s worth noting that while avoidance may be a behavioral trait, it may also be characteristic of specific mental health disorders, including obsessive-compulsive disorder, social phobias, post-traumatic stress disorder, and attention-deficit hyperactivity disorder. 

Tips for confronting avoidance

There are several ways therapists can challenge avoidance or equip clients with tools for confronting avoidance in their relationships.

Some tips for confronting avoidance include:

• Cognitive reframing: Support clients in reframing their perception of the avoidance fear to reduce perceived negativity.
• Enhance decision-making skills: Provide psychoeducation to clients about weighing pros and cons effectively.
• Exposure therapy: In cases involving anxiety, therapists may use exposure-based interventions to overcome feared situations and reduce avoidance behaviors.
• Use ACT avoidance skills: Acceptance and commitment therapy can help clients recognize avoidance by naming their emotions, accepting and making room for their feelings, and expanding their awareness. You may also use skills like urge surfing, kind hands, dropping an anchor, or the wave technique to reinforce values-based action for confronting avoidance. The ACT avoidance worksheet explains some of these skills in more detail.
• Use assertive communication skills: Therapists can demonstrate assertive communication strategies to help clients improve communication in their relationships and reduce avoidance behaviors, like passive or aggressive communication.

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How to use the ACT avoidance worksheet

You can download and use the ACT avoidance worksheet in several ways:

1. During a session, illustrate tips for confronting avoidance
2. Empower the client to use the ACT avoidance strategies at home 
3. Give the client the handout to remind them of avoidance strategies

Sources

• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
• Harris, R. (2021). Trauma-focused ACT: A practitioner’s guide to working with mind, body, and emotion using acceptance and commitment therapy. New Harbinger Publications.
• Krypotos, A.M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers in Behavioral Neuroscience.
• McKay, M., Fanning, P., & Ona, M. (2011). Mind and emotions: A universal treatment for emotional disorders. Oakland, CA: New Harbinger Publications, Inc.
• U.S. Department of Veterans Affairs. (n.d.). Avoidance. 
• Sam, N. (April 7). Avoidance behavior. PsychologyDictionary.org. 

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