The Role of Avoidance Learning in the Development of Anxiety-Based Disorders, OCD, and PTSD

The Role of Avoidance Learning in the Development of Anxiety-Based Disorders, OCD, and PTSD

Written by Hillary Gorin, PhD, LCP

​The development of anxiety-based disorders, OCD, and PTSD, as understood at this time, involves complex interactions between genetic and environmental, behavioral, and psychological factors. In this blog, I will discuss a leading theory on one major behavioral/ psychological contribution to the development of and maintenance of these disorders: Avoidance. Unfortunately, avoidance generally prevents overcoming a fear response. Why? Because you can’t see that a feared situation, thought, or memory is actually not harmful until you repeatedly encounter that thing and see that it is not harmful. 

Specifically, the avoidance learning theory on the development of fear suggests that fear responses develop through two processes. First, fear development is based on forming an association between two stimuli: A neutral thing and a scary or unpleasant thing (as cited in Krypotos et al., 2015). This is often referred to as classical conditioning. For instance, at an early age, we learn to associate a stove (neutral thing) with being hot (an aversive and scary stimuli), after we accidentally touch the stove or are warned by our parents that it will burn us. Therefore, we learn to avoid touching hot stoves and we develop a healthy fear of putting our hands on the burners when the stove is on. Similarly, unrealistic or anxiety-disordered fear associations develop when a previously neutral stimulus gets paired with an aversive or anxiety-provoking stimulus. For instance, if a dog is startled by the loud sound of a garbage truck every time the garbage gets picked up, the dog might start to fear garbage trucks, trucks/ cars in general, or even the garbage can. Although we know the garbage truck is not actually a dangerous stimuli, the repeated pairing of a previously neutral/ safe stimulus (garbage truck/ can) and aversive stimulus (loud noise) will generate a conditioned stimulus (truck/ can) and a conditioned response (fear). In the event that the garbage truck was actually dangerous, it would be adaptive for the dog to avoid seeing or being near the garbage truck or garbage can. However, because the garbage truck is not actually dangerous, the dog has now developed a maladaptive anxiety response and false narrative about garbage trucks being dangerous. 

After this maladaptive anxiety response is formed, disordered anxiety will be further maintained by avoidance, often termed operant conditioning. For instance, if the dog starts to run and hide every time the garbage truck arrives, he will not only maintain the fear but also strengthen the fear. Every time he hides, he is confirming that something about the garbage truck is dangerous and he feels a sense of relief while hiding under the bed. This process is often termed operant conditioning, or the encouraging or discouraging of behavior by using reinforcement or reward. In this way, operant conditioning plays a role in the maintenance of anxiety disorders. When something is pleasant, it is reinforcing/ feels good, and therefore the behavior continues. Conversely, when something is unpleasant/ feels bad, that thing will be avoided so the behavior discontinues. When the dog runs and hides, he feels a reduction in negative emotion (which is pleasant) and therefore the behavior is reinforced and the fear is maintained. 

Thus, the avoidance learning theory suggests that anxiety disorders are developed through classical conditioning and are maintained through operant conditioning. After one fear-provoking situation, our brains can trick us into believing something is dangerous, when it actually is not, and then avoidance fuels and strengthens unhelpful and unrealistic anxiety responses and beliefs over time. 

Understanding this theory is important for your treatment. Why? Because the most effective interventions we have to date for the treatment of anxiety-based disorders, OCD, and PTSD involve breaking these associations using exposure-based interventions and thought challenging strategies. Thus, there is good news! If avoidance maintains these disorders, then challenging it and reducing avoidance will serve as effective treatment for overcoming your fears. 

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.
Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   
Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.