What does CBT for avoidance look like?

March 28, 2018 6:27 PM

I have developed an extremely avoidant personality in the last few years. I don't recall being this way before my late 30's. It manifests as extreme avoidance of conflict or difficult conversations. What would a CBT approach to working on this look like?

I have never done therapy for anything. I don't have major emotional issues at all. I don't get anxiety or depression outside of situational/finances-related occurrences. I do have a big problem with getting lost in the internet far far more than I want to admit and feeling out of control of myself when I do this.

Last year I thought the 'stickiness' (ie "getting lost online") problem might be related to some kind of atypical depression, because it seems worse in mid-winter even though I don't feel sad. I found a clinician to try a course of Wellbutrin. She ran a battery of diagnostic tests on me and thought I didn't fit into any one category- not ADHD, not depressed, etc.
After starting Wellbutrin, I got very motivated, busy, accomplished a lot, and got over a lot of the 'wasting my life on a screen' stuff. I don't know if that is a result of the Wellbutrin or just because of situational changes in my life that coincided with it.

I still have the extreme conflict-avoidance behavior, though, and I'd really like to deal with it. It's out of character for me in general and it feels like a somewhat new problem, too.

What would CBT for avoidance look like if I found a therapist to work with? Is there a workbook that you'd recommend I look at?

posted by twoplussix to Human Relations (10 answers total)

Just for clarity...I don’t think of depression as being sad. More like feeling flat and helpless, at the bottom of a well. If you don’t feel depressed, how do you feel? Do you feel highs and lows?
posted by A Terrible Llama at 6:51 PM on March 28, 2018 [1 favorite]

An earlier AskMe recommended these workbooks from this site. I’m currently working through the Perfectionism workbooks and find it immensely helpful. This is essentially a CBT approach and will give you an overview of how CBT works.

Additionally, The Feeling good Handbook workbook was super helpful to me earlier and would also be a good primer for you on CBT.
posted by samthemander at 6:52 PM on March 28, 2018 [8 favorites]

CBT is all about how identifying thoughts around behaviors. So, CBT therapist would have you identify thoughts in a avoidance situation you engage in. What are your thoughts about it? Your beliefs about what will happen if you engage? If you don't engage? What are your feelings?

From there you can identify any type of cognative distortions, create more rational thoughts around what may happen and experiment by not avoiding.

Usually CBT is intertwined with talk therapy but there are some very workbook like approaches out there.
posted by AlexiaSky at 8:26 PM on March 28, 2018 [1 favorite]

When Anger Scares You: How to Overcome Your Fear of Conflict and Express Your Anger in Healthy Ways by John Lynch.
posted by lazuli at 9:17 PM on March 28, 2018

Just between you and me, I found the Burns CBT Feeling Good Handbook (mentioned by samthemander) the most helpful of any therapy, in person or not. For one, committing the doing the exercises and doing them is a turning point toward health in itself. Two, the learning I gained through the exercises has benefited me greatly, over time. Three, the act of reflecting and writing, by hand, connects cognitive pathways that I found beneficial. And because it was all me and the Handbook, it felt less mediated, more direct, more tailored for my own understandings.

CBT is not an instant cure-all although it can rapidly change some thought patterns. But once you learn to see around your thoughts, they become simpler to prioritise. It's a huge relief when having an intense disturbing run of thoughts to have another mental voice pop up to ask if there's some catastrophisation, or mind-reading, or future-telling going on, all of which are misleading frameworks for thinking. Once that understanding is heard, the destabilising thoughts potentially lose their power. The Handbook (and reading Metafilter, who told me to read the Handbook) gave me the structure and language to understand how to empower myself this way.
posted by Thella at 5:09 AM on March 29, 2018 [5 favorites]

Best answer: What AlexiaSky describes above is a cognitive-heavy form of CBT. The behavioral-heavy form would involve confronting the the kind of situations you've been avoiding in a systematic manner. You would likely list out all of the situations you avoid and rate them from 0-100 in terms of how distressing you'd expect to find them. Your therapist would help you figure out different permutations of each situation (e.g., changes to topic, location, person you're interacting with) so that there are as many items on the list as possible. Then you'd start with situations you rated as 40-50 and practice confronting them (either in real life or in roleplays with your therapist, or both) without avoiding until they feel much less distressing. Usually, your therapist would have you fill out a worksheet before and after each instance where you confront a situation to examine your thoughts and emotions (this would likely involve using some of the cognitive skills AlexiaSky describes). You'd then work your way up the list, ideally practicing situations daily.
posted by quiet coyote at 10:06 AM on March 29, 2018 [3 favorites]

Response by poster: Thank you, that's the sort of info I was looking for.

In the absence of a therapist, are there workbook-type resources that may be helpful there?
posted by twoplussix at 10:13 AM on March 29, 2018

Acceptance and Commitment Therapy (ACT) is exactly about combating what they call "experiential avoidance," where you avoid things that would be otherwise fulfilling or in line with your values because you don't want to feel negative emotions like anger, fear, shame, etc. Stephen Hayes' Get Out Of Your Mind And Into Your Life is sort of the gold-standard ACT self-help book. It sort of combines some cognitive and behavioral approaches with mindfulness, to help you "de-fuse" from your thoughts and emotions so that they don't run roughshod over your life.

In my experience, though, it can be a little... elliptical and slow if you're doing it on your own. I also really liked Mark Freeman's The Mind Workout, maybe even better than Hayes' book. It's much more readable and pragmatic, and it gets to the behavioral stuff earlier.

Both books have a lot of concrete exercises, including the type of exposure hierarchy quiet coyote mentioned above.
posted by en forme de poire at 11:47 AM on March 29, 2018 [3 favorites]

I have "Cognitive-Behavioral Therapy for Adult ADHD" by Mary Solanto, which is targeted specifically at therapists rather than for use as a self-help book but it might be worth looking into specifically because it's targeted at addressing executive function.

I have particularly found useful the section on emotional distracters, which asks you :

1. How are you feeling?
2. What is the current situation, event, task, or activity that you are faced with? What are you currently doing?
3. Write down all the thoughts you are having in the situation - particularly the thoughts you are having about yourself
4. What cognitive distortions do you recognize? (All-or-nothing thinking, "should" statements, catastrophizing, etc)
5. Challenge these negative thoughts - what is the evidence the thought is true, is there an alternative explanation, what could be the effect of changing my thinking?
6. What are more rational thoughts in response to the situation?
7. Outcome - how do you feel now? How did the situation end?

The section on time management, activation, and motivation is also good.

But for it to work, I think it's most important to catch yourself in the moment that you realize that you're avoiding the thing.
posted by Jeanne at 11:56 AM on March 29, 2018 [2 favorites]

Response by poster: oh wow, thank you for those suggestions too.
posted by twoplussix at 6:40 PM on March 29, 2018 [1 favorite]