This section moves on to consider the fifth and final area of your Five Areas Assessment – altered behaviour.

Altered behaviour may add to anxiety in two key ways – avoidance and unhelpful behaviours.

Altered behaviour 1: Avoidance.

When somebody develops anxiety, it is normal for him or her to try to avoid difficult situations, people or places. This avoidance can make matters worse by making the person lose even more confidence.

The result is often an increasingly restricted lifestyle and additional distress. A Vicious Circle of Avoidance may result. This is summarised below:

For example, someone who has panic attacks in shops may begin to avoid going there, or will only go into smaller shops when they are likely to be empty.

To help you see if this applies to you, ask yourself “What have I stopped doing because of my anxiety?”

Question:

You may find yourself avoiding certain situations, people or places because of how you feel. Try to identify ways in which you might be avoiding things as a result of anxiety.

For example, do you avoid going out or mixing with others? Consider what you are avoiding because of anxiety.

What situations at home, work or in my relationships with others am I avoiding tackling/putting off?

If I didn’t have this anxiety, what things would I like to be able to do?

What have I stopped/reduced doing that I used to enjoy because of my anxiety?

Remember, sometimes avoidance can be quite subtle.

For example, choosing a time or place when you think the anxiety-provoking situation will be easier to deal with, or choosing the easiest option when making decisions.

The following checklist will help you consider any areas of avoidance in your life.

Checklist: Identifying the vicious circle of avoidance.

As a result of feeling anxious am I:

Avoiding dealing with important practical problems (both large and small)?

Not really being honest with others. For example saying yes when I really mean no?

Trying hard to avoid situations that bring about upsetting thoughts/memories?

Brooding over things and therefore not longer living life to the full?

Avoiding opening or replying to letters or bills?

Sleeping in to avoid doing things or meeting people?

Avoiding answering the phone, or the door when people visit?

Avoiding sex?

Avoiding talking to others face to face?

Avoiding being with others in crowded or hot places?

Avoiding busy or large shops, or finding that I have to think about where and when I go shopping etc.?

Avoiding going on buses, in cars, taxis etc., or any places where it is difficult to escape?

Avoiding walking alone far from home?

Avoiding situations, objects, places or people because of fears about what harm might result?

Avoiding physical activity or exercise as a result of concerns about my physical health?

Q. Am I avoiding things in other ways?

Having completed these questions, reflect on your answers using the three questions below:

1). Am I avoiding doing things as a result of anxiety? Yes �� No ��

2). Has this reduced my confidence in things and led to an increasingly restricted life? Yes �� No ��

3). Overall, has this worsened how I feel? Yes �� No ��

If you have answered Yes to all three questions, you are experiencing the vicious circle of avoidance.

Before moving on, think back on what you have learned and think about how avoidance may be affecting your life.

Take time to think this through and take a break now if you wish to.

Altered behaviour 2: Unhelpful behaviours.

When somebody becomes anxious or depressed, it is normal to try to do things that make him or her feel better. This altered behaviour may be helpful or unhelpful. The purpose of both types of activity is to reduce anxiety – at least in the short-term.

Helpful activities may include:

• Talking with friends or relatives and receiving helpful support.
• Reading or using self-help materials to find out more about the causes and treatment of the problems.
• Doing activities that provide pleasure or support such as meeting friends, playing sport, and attending religious activities.
• Challenging anxious thoughts by stopping, thinking and reflecting rather than accepting them as true.
• Going to see your doctor or health care practitioner or attending a self-help support group.

Write down any helpful things you have done here.

You should aim to try to maximise the number of helpful activities you do as part of your recovery plan.

Sometimes however, the person may try to block how they feel with a number of unhelpful behaviours.

Unhelpful actions designed to make you feel safer.

Unhelpful behaviours include leaving situations where you feel anxious, or rushing through things as quickly as possible so as to minimise the amount of time spent there.

Sometimes the person may carry out a mental task such as counting things a set number of times, repeating positive statements such as “I won’t panic”, or saying a prayer again and again.

These are sometimes called distraction techniques – because the person is trying to distract from how they feel. They may also try to do this by clenching their muscles tightly, digging their nails hard into their hands, or gripping onto things such as a shopping trolley as tightly as they possibly can to distract from how they feel.

Other ways that we block how we feel may include over-eating, using illegal drugs or mis-using prescription medication by taking tablets at times when they are not prescribed to try to relax.

Alcohol misuse is very common in anxiety.

This may start out as just having an extra drink to help us get off to sleep. The danger is of escalating amounts being taken more and more frequently. The risk is alcohol or drug dependency.

Reassurance-seeking and asking others to accompany you whenever you do anything that causes anxiety also commonly occurs.

This is a good example of an action that in moderation can be helpful and a source of support, but which can become unhelpful when taken to excess. The result is a feeling of dependency on others and a further loss of confidence in yourself.

It can sometimes be tempting to throw yourself into excessive activity at home or at work. The intention is to “work” through the distress.

By filling every part of the day with non-stop activity the hope is to avoid noticing how bad you feel. This may involve other ways of avoiding emotional distress such as deliberately staying up late watching films, or sleeping in during the day to avoid seeing others.

It also could include spending hours on computer games or watching television. Other common activities are listening to music, chatting/surfing on the Internet or texting others all the time.

This is not to say that such activities are all unhelpful – more about why they are done.

Doing these things because they can help us to avoid life is a very different motivation than doing them because they are fun.

The purpose of all the unhelpful behaviours is to feel safer/better at least in the short-term. They are sometimes therefore called safety behaviours as a result.

Although they lead to a short-term relief in symptoms, this doesn’t last. The anxiety returns to the same or even higher level.

For example, if we rely on alcohol or sedative drugs to give us false courage, we may find they cause us additional problems of their own.

A Vicious circle of unhelpful behaviour can occur.

This can further worsen how you feel by increasing self-blame and confirming negative beliefs about you or others as a result.

A useful question to identify unhelpful behaviours is to ask yourself "What am I doing differently to cope with how I feel?"

The following checklists will help you to identify any unhelpful behaviour in your life. At times these actions can be quite subtle and often revolve around avoidance of people, places or events.

Unhelpful behaviours leading to avoidance of anxiety-provoking situations.

Am I:

Quickly leaving anxiety-provoking situations?

Rushing though a task as quickly as possible? (E.g. walking or talking faster).

Trying very hard not to think about upsetting thoughts/memories? Trying to distract myself to improve how I feel?

Only going out and doing things when others are there to help?

Taking the easiest option (for example joining the shortest queue in the shop as a result of anxiety, or turning down opportunities that seem scary)?

Deliberately looking away during conversations and avoiding eye contact? Bringing conversations to a close quickly because of not knowing what to say?

Q. Am I avoiding things in other subtle ways?

Write in what you are doing here if this applies to you.

In addition, a number of other unhelpful behaviours may occur as a means of blocking or improving how you feel.

Checklist: Identifying the vicious circle of unhelpful behaviour.

As a result of how I feel, am I:

Misusing drink/illegal drugs or prescribed medication to block how I feel in general or improve how I sleep etc.?

Eating too much to block how I feel (“comfort eating”), or over-eating so much that this becomes a “binge”?

Trying to spend my way out of how I feel by going shopping (“retail therapy”)?

Becoming very demanding or excessively seeking reassurance from others?

Looking to others to make decisions or sort out problems for me?

Throwing myself into doing things so there are no opportunities to stop, think and reflect?

Pushing others away and being verbally or physically threatening/rude to them?

Deliberately harming myself in an attempt to block how I feel?

Taking part in risk-taking actions for example crossing the road without looking, or gambling using money I don’t really have?

Compulsively checking, cleaning, or doing things a set number of times or in exactly the “correct” order so as to make things “right”?

Carrying out mental rituals such as counting or deliberately thinking “good” thoughts/saying prayers to make things feel “right”?

Being overly aware and excessive checking for symptoms of ill health?

Excessively changing the way I sit or walk to reduce symptoms of physical discomfort? The altered posture then creates or worsens the physical problem.

Sleeping with a number of people as a means of blocking how I feel or to feel needed, attractive or relaxed?

Having completed these questions, reflect on your answers using the three questions below:

1). Am I doing certain activities or behaviours that are designed to improve how I feel? Yes �� No ��

2). Are some of these activities unhelpful in the short or longer-term either for me or for others? Yes �� No ��

3). Overall has this worsened how I feel? Yes �� No ��

If you have answered Yes to all three questions, you are experiencing the vicious circle of unhelpful behaviour.

Key point. The purpose of both the avoidance and unhelpful behaviours is to feel safer/better at least in the short-term.

Although they lead to a short-term relief in symptoms, this doesn’t last. The anxiety quickly returns to the same or an even higher level.

These actions also teach an unhelpful lesson - that it is only by avoiding/leaving the situation/harming yourself/drinking too much/seeking reassurance etc. that you managed to cope.

In the longer-term this behaviour therefore backfires and adds to your problems. This can further worsen how you feel by increasing self-condemnation and confirming negative beliefs about you or others.

Summary for Area 5: Altered behaviour (avoidance or unhelpful behaviours).

Having answered these questions:

Q. Overall, do I have any problems in this area? Yes �� No ��

These difficulties are potential targets for change. You will find out more about what steps to take to tackle these in section 5 of the workbook.

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Overcoming Anxiety © Dr C J Williams (2003)

Excerpted from online workbook: Understanding panic and phobias by Dr Chris Williams

Related books by Dr. Williams:

Overcoming Depression: A Five Areas Approach

Overcoming Anxiety: A Five Areas Approach

I'm not supposed to feel like this: A Christian self-help approach to depression and anxiety.