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What have you found useful for avoidant behavior?


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I found DBT skills really helpful for slowing down impulsive behavior (and I like DBT in lots of other ways too), however it hasn't really done the trick for my avoidant tendencies.   In retrospect I seem to be much more avoidant than borderliney (I did have the BPD dx for a while but eventually everyone agreed I didn't really meet criteria).  I'm interested to know what has helped other people here.

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I have found opposite action to be a helpful, albeit, difficult, coping skill.  Basically, you do the thing that you are avoiding.  When I do this, I think about the steps I need to take to do the thing I'm avoiding (ie: take a shower, get dressed, get in car...) then I try to just focus on each step and not think ahead to what I'm doing.  

 

I think this is one of the more difficult skills, but also one of the most effective.  I find that by the time I'm in the car, my anxiety has lessened substantially and I can carry through with the task I was avoiding.

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Honestly, some of the best "work" that I have done around avoidant behaviors has come from outdoor adventure-type activities like working on a climbing wall/ropes course.

 

I find that I get a lot out of "lateral transfer"... which is the idea that if you learn something in one environment, you can bring it to a new environment... you don't have to start over learning from scratch... but instead you just learn the new context.

 

For example, at the beginning of the first summer, I was terrified of being 40 feet up in the air so much so that my legs would uncontrollably shake. By the end of the summer I was volunteering to go retrieve pulleys that escaped out into the middle of the cable. Going back into my day-to-day life, I could carry that experience of learning how to get used to things that had previously been hard.

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I have to make appointments with myself, so I have a deadline to calm the fuck down. So, I'll schedule a shower, which I hate. But If I say earlier in the day, 11AM is shower time, it is like I can psyche myself up for it.

 

I do the same things with phone calls, or grocery shopping. Lots of things that neuro-typical people do without a second thought, I "schedule." It works for me, I think it is because my GAD makes me an incessant planner.

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Oh yes... That's funny, crtclms... I do that so much that I don't even think about it as a "thing" that I do anymore.

 

You mean most people don't do that?  :D

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Thanks people!  This is helpful.  Opposite action is a skill that is easy to forget to do, because it is never the thing you want to do, or it wouldn't be opposite action...!!  One of my therapists told me that Marsha Linehan thinks opposite action is the most important skill in DBT.  

 

I wish I could put things on a schedule and do them, but I have never been able to follow a schedule, this does not come easily to me at all.  I wish I had an approach to this problem that is more skillful than "try harder" or "make myself" follow a schedule or do things.

 

Is there a particular other therapy other than DBT that anyone has found especially helpful for avoidant behavior?

Edited by tamagotchi
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There's ACT (acceptance and commitment therapy).  I've done some of a workbook.  I prefer DBT but that's just my preference.  It's similar in some ways but it's a different approach.

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Oh jeez, I know I asked for this, but it makes me feel so terrible to look at lists of therapists... I looked at the ACT web site and there are a lot of therapists listed in my area, but the thought of ever talking to another therapist makes me feel so horrible.  I was so dutiful about being in the DBT program for >2 years and going through all modules 3 times, and eventually had a very good therapist, but eventually we agreed I had gotten everything I could from working with her.

 

I will try all of your suggestions and I also emailed my sister and asked her to nag me about stuff.   My biggest avoidance problem right now is that I haven't opened any of the mail in ages, and then I stopped even taking it out of the mail box.  I have a pile of unopened mail in my bed and I literally covered it with a blanket.  This is really irresponsible of me, but I am just terrified to look at any of the mail.  Of course the longer it sits there, the worse it gets!

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Hm.  I don't know if you've tried this, but this is something my therapist suggests for avoidance/procrastination.

 

You rate your anxiety before you do the task (looking at the mail), then you rate your anxiety after you procrastinate/don't do it.  Then you do it for a while and rate your anxiety again.

 

Often we procrastinate because we believe that it makes us less anxious.

 

By doing this activity, I discovered that actually avoiding things makes me MORE anxious AND I still eventually have to do the thing I was avoiding.  That was enough evidence to help me get started.

 

It also helps to set a timer - like, you don't have to tackle ALL the mail.  Maybe just open mail for 5 or 10 minutes and then you can stop. 

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Yeah, I know that avoidance only makes me more anxious, and in fact the main thing that goes through my head is "I know I will feel so much better if I open the mail," and I actually do believe that, but I still feel the anxiety and just can't make myself do whatever the thing is.  I did manage to take the mail out of the mail box.  This was only after I had helped my friend pay her overdue bills that she was freaking out about, so I tried pretending it was really her mail in the box and I was just helping her some more, and then I opened the box really fast before I lost the nerve.  I could only open a couple of the more non-threatening items, but at least I left the other mail on top of the blanket.  It is all I can do right now.  The pretending was helpful and I intend to try it again later.  Thanks for all of your suggestions.

Edited by tamagotchi
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  • 2 weeks later...

Well this is just so frustrating.  Every single day I wish I could open mail, pay bills, return library books.  These are actually some of the things I enjoy the most!  I love filling out forms, putting letters in the mail box, I even love paying library fines because I feel so good that I am donating money to the library.

 

Many of the days that I don't do these things, I think "it would feel so good to do that!" but for some reason I just don't have what it takes to do it.  Sort of like if it's hot and you think it would feel good to get in a nice pool, but you don't have the pool available, so you just stay hot and miserable.  I have plenty of days when I don't actually feel anxious, I feel happy and optimistic and I still can't open the mail or even look at it.

 

So I finally opened a whole pile of mail today, paid 3 months worth of bills and returned so many library books it took two trips to physically carry them from my car to the returns slot.  Who knows why I could suddenly do it today?  I did not feel any different than yesterday when I couldn't.  Not any less anxious, or more motivated or energetic, I just did the things as though a normal person would do them, "here are the bills and they need to be paid and I'll pay them" without a lot of fanfare.

 

Is this problem what "procrastination" feels like?  Or "anxiety"?  Sometimes I feel a lot of anxiety but in general it doesn't seem like that is the problem, it feels more like I can't open the mail because I don't have hands or there is an invisible force field around the mail.  It is more like the feeling of being paralyzed in bed, and unable to get up and go to the kitchen and make something to eat.  Even though you are hungry and you would really like to eat, all you can do is lie there seemingly helplessly.

Edited by tamagotchi
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  • 4 months later...

I have found opposite action to be a helpful, albeit, difficult, coping skill.  Basically, you do the thing that you are avoiding.  

 

Jumping in here because I never realized "avoidance issues" was a specific thing; I feel dumb because it's like a light bulb, that neatly sums up 95% of my issues. But regarding the above statement... uhhh... how do you do that??? I don't mean to sound challenging at all, it's a legitimate question... if your problem is doing that thing, how can you just do it? If you could, why would you have an issue avoiding it? I guess there's more to it than that.

 

It seems up there with the "baby steps" approach, where doing one small thing is supposed to make you feel at least a little better or help you gain momentum or something... it just makes me feel worse because it took so much effort to do just that that it makes me realize even more how much there really is to do... or that it doesn't really check anything off the list because there's always something else.

 

Is this problem what "procrastination" feels like?  Or "anxiety"?  Sometimes I feel a lot of anxiety but in general it doesn't seem like that is the problem, it feels more like I can't open the mail because I don't have hands or there is an invisible force field around the mail.  It is more like the feeling of being paralyzed in bed, and unable to get up and go to the kitchen and make something to eat.  Even though you are hungry and you would really like to eat, all you can do is lie there seemingly helplessly.

 

 

Man, I could have written that!! If you figure something out, let us know! That's how everything is in my life. I'm surrounded by my disgusting house... I sit around and look at all the mess, feel a ton of anxiety, then I'm too tired/overwhelmed to do any of it, even the simplest thing, so I stare at it and stress about not doing it. It's so ridiculous. And food, too... amazing that someone else does that. If something takes longer to prepare than LITERALLY taking it out of the fridge and biting into it, I almost never bother eating. Even making a sandwich seems exhausting to me. I think I live on string cheese and trail mix :(

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  • 4 weeks later...

crtclms, you are the first person I've seen other than myself who doesn't like showers.  anyone I tell that acts like it's the strangest thing they have ever heard.  My hypomania that started last year some time made it so bad I would skip until I absolutely had to shower.  I would bathe using the old cat bath method but never the shower if I could help it.  

 

I don't make appointments tho.  That's a pretty good idea.  There's so much to talk about with my therapist I haven't even touched on the shower thing.  I'm pretty proud of myself this week tho, I've taken a shower every day including Sunday!  I had no idea that this behaviour was under some label.  

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One of my DBT instructors had us demonstrate using distress tolerance skills to overcome avoidant behavior and force ourselves to act opposite. It was an upsetting, if effective lesson.

 

First, we wrote down a number 0-10 for anxiety. Then she brought out a box of freeze dried crickets and put one on a napkin in front of each of us. Rate our anxiety again. Pick up the cricket. Rate anxiety. Eat cricket. Rate anxiety.

 

There were people crying. We sat for a long time going around one at a time: each step we would go around the group and only once we had all done it would we move on (without knowing the next step, of course). We ended up coaching each other on what skills to use to be able to complete each step. We used skills like being non-judgemental, mindful breathing, self soothing by focussing on imagery or remembering calming music, pros/cons (pro: teacher will finally leave me alone and I won't be the focus of the group attention anymore con: ew, bug). After trying a skill, re-rate anxiety level.

 

In general, we learned that, like tryp, our anxiety was highest when we were anticipating it. Once we did it, we felt so much relief at just having done it that anxiety dropped way off. It turns out eating a cricket is really not as gross and upsetting as you'd think.

 

Next step was to choose and eat one of those Harry Potter jellybeans that are all kinds of flavours including gross ones. It was much easier this time around to just jump in and eat the thing. I, of course, got the vomit-flavoured one.

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So I finally opened a whole pile of mail today, paid 3 months worth of bills and returned so many library books it took two trips to physically carry them from my car to the returns slot.  Who knows why I could suddenly do it today?  I did not feel any different than yesterday when I couldn't.  Not any less anxious, or more motivated or energetic, I just did the things as though a normal person would do them, "here are the bills and they need to be paid and I'll pay them" without a lot of fanfare.

 

Is this problem what "procrastination" feels like?  Or "anxiety"?  Sometimes I feel a lot of anxiety but in general it doesn't seem like that is the problem, it feels more like I can't open the mail because I don't have hands or there is an invisible force field around the mail.  It is more like the feeling of being paralyzed in bed, and unable to get up and go to the kitchen and make something to eat.  Even though you are hungry and you would really like to eat, all you can do is lie there seemingly helplessly.

I can really relate to this. I can spend days trying to accomplish important tasks and being completely unable to do them for no apparent reason. I know some of it's anxiety,which builds up momentum the longer I don't do something, but it's something else too. Procrastination, yes, but not completely willing procrastination, and it makes me miserable not accomplishing things. And then one day it might feel like the stars align and my meds all hit me the right way, or as you say, the force field lifts, and it's still not easy but I can do some of those things. But it feels out of my power to know when it will all come together in my head to make things happen. Very frustrating.

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Wow, Geek.

 

That's a nutty, unconventional approach to opposite action. It sounds like it was very powerful.

 

Not sure I could work my way through that.

 

I guess I'll go clean my bathroom now, if the other option is eat a cricket!

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Wow, Geek.

 

That's a nutty, unconventional approach to opposite action. It sounds like it was very powerful.

 

Not sure I could work my way through that.

 

I guess I'll go clean my bathroom now, if the other option is eat a cricket!

 

Hmm. Powerful is one word to use. I think I like nutty better. I will say I think that they were freeze-dried made it more survivable than if they were just dead. Freeze-dried means they just kind of crumble away into dust.

 

It was definitely a memorable experience!

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I hate showers, too! And I'm a girl. My husband showers twice a day for like 20 minutes at a time... I'm in and out in 5 minutes, and tend to avoid it on days off. It's not that I don't like being clean... I think it's more my ADD, it just seems like such a nuisance and so much work!

 

As for schedules... again with the ADHD thing, I could never, ever stick to a self-imposed "schedule." I'd either forget or blow it off. However I think the greatest thing EVER about a smart phone is REMINDERS!! I have many things I set up as daily reminders at certain times to do that I'd often forget to do otherwise (like charge my phone before work, take my meds, etc.) Sure, there's still the potential to blow it off, but somehow having the reminder pop up takes a lot of pressure off me to try to remember to do everything, because then I constantly have a big to-do list in my head causing me too much anxiety!

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  • 2 weeks later...

Well I had a med change and got a lot of stuff done but unfortunately I got too bouncy and that led to getting mixed, and now all that is over, but anyway-- it definitely makes a difference how depressed I am.  Unfortunately a depressed or semi depressed state can last so goddamn long, like forever, and I only got a couple of good weeks out of this deal, and life sucks?

 

It was nice to read all of your replies.  As for opposite action, it's super hard and that is just the way it is, because if you felt like doing whatever it is, it wouldn't be opposite action.  I am not very good at opposite action to be sure.

 

My best tactic continues to be pretending I am someone else.  Maybe I'll try that now.  I failed at going to the fabric store earlier today, I turned around and drove home, but I could try pretending to be a fairy princess or something.  Hey, it works for my six year old.

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