** Why gas only, their crisis is multiplying everywhere ** A number of children admitted to Thakurgaon Adhunik Hospital for cold-related diseases compelled to stay along with their parents outside of the hospital due to lack of beds. This photo was taken on Wednesday. ** 1 in 3 BD kids fed properly ** ADB trims GDP growth forecast ** HC orders freeze on Evaly asset sale ** Truck, covered van workers call off strike ** Another case filed against Evaly couple ** SAARC FMs' UN assembly sideline meet over Afghanistan cancelled ** Biden pledges 500m jabs for developing nations ** e-commerce scams Writ seeking judicial probe ** Supply shortfall hits gas sector ** AI demands 2b Covid jabs for poor nations ** US should ask forgiveness for betraying its core values and mass killing ** Hundreds of people crowd in front of a Covid-19 vaccine centre at Mugda in the capital on Tuesday. ** Can e-commerce be rescued? High-level meet today ** High fever common among city children IEDCR for early diagnosis ** Evaly CEO remanded again, wife sent to jail ** Truck, covered van owners, workers go on 72-hour strike ** HC rule for stopping fraudulent ad ** ACC frames charges against ex-DGHS driver, his wife ** Suu Kyi goes on trial for incitement ** Aggrieved customers and sellers of controversial e-commerce platform Evaly engage in a scuffle in front of CMM court in the capital on Tuesday. ** Covid infection rate drops below 5pc ** Garment worker gang-raped in Chattogram ** Biden urges unity at UN amid tensions with allies **

Problem of Avoidance

10 March 2021

Marc Lener, MD :
No one enjoys a stressful situation. From time to time, we all avoid dealing with our problems; however, when avoidance becomes a repeated behavior, it can encroach upon the productivity of our daily lives and hint towards something more serious.
What is Avoidance?
Avoidance is a maladaptive coping strategy, or in other words, an active escape from some stressful situation. The different forms of avoidance fall into two main categories and can often present concurrently. The first type involves cognitive avoidance, achieved through diverting thoughts away from the stressor. The second involves behavioral avoidance, where one employs physical behaviors to escape from the reality of a stressor.
What are the Evolutionary Origins of Avoidance?
Avoidance may have evolved as a strategy in anticipation of danger. When animals detect imminent threat, the best protection is often to remain still. Likewise, rather than give in to impulsive behavior, we have evolved inhibitory mechanisms to first evaluate situations for danger, weigh it against future rewards, and potentially give up on futile undertakings to avoid wasting resources and energy. Impulsivity and inhibition are constantly playing a tug-of-war to generate pre-meditated, beneficial actions. However, when fear and inhibition go into overdrive, our brains may prevent us from taking any action at all or prompt us to escape the situation entirely.
What are different types of Avoidance?
1. Cognitive Avoidance:
Denial: Denial is when a person outright ignores the existence of the stressor. This process typically occurs outside of the person's conscious awareness; a person in denial will be convinced that "everything is OK" when evidence proves otherwise to an outside observer. Remaining in denial can lead to the person "acting out," where he or she exhibits anxiety or anger associated with the stressor rather than confronting the issue and seeking a solution.
Minimization: Minimization is when the person decreases the significance of a stressor in order to make it more manageable. A person who minimizes may use language to signify that things are "not that bad", but the negative outcomes are not congruent with such a judgment. A person may minimize the stressor so much that the issues are no longer clear and solutions are less attainable.
Rationalization: Rationalization occurs when someone justifies uncomfortable thoughts, emotions, or behaviors in a seemingly logical manner to avoid more difficult truths. A person may attach to extremes of a situation as reason for the behavior, such as, "I lied to my boss because he is always picking on me". This thought process often mismatches cause and effect, carries over untrue or incomplete assumptions from the situation, and shifts blame outward rather than inward. Rationalizations reinforce maladaptive thoughts or behaviors through a pseudo-logical justification and a subsequent lack of a solution.
2. Behavioral Avoidance
Procrastination: Procrastination is when one delays a task with irrational disregard for future deadlines, choosing instead to do something counterproductive or trivial. The procrastinator may subsequently go into a period of distress and crisis from having too little time to complete the task or missing a deadline
Addictive Behaviors: Excessive gambling, video-gaming, sex, abnormal eating (binging or restricting), and substance use are all prevalent forms of an addictive behavior. All addictive behaviors achieve a high degree of emotional reward, thus offering a soothing and pleasant escape from the reality of a stressor. Similar to procrastination, if an addictive behavior becomes overwhelming and results in missed deadlines, it will also lead to distress.
Ghosting: Ghosting manifests in an apparent disappearance from any forms of contact with another person. A person typically exhibits this behavior due to some social discomfort and fear of rejection; thus, he or she disconnects and possibly severs ties with another thus preemptively rejecting the other person.
How can we Avoid Avoidance?
Stressors are typically due to problems that are not easily solvable and can cause a high degree of anxiety and distress. Here are a few ways to help break the patterns of avoidance.
1. Address the problem
Problems don't go away even if we wish them to do so; addressing it is the only way to find a solution. Avoidance is a result of a perceived threat that is too high/painful and/or we don't have a trusty process to clearly evaluate the problem. Fortunately, we can build an effective and reliable process that we can optimize in most problematic situations.
2. Process your emotions towards the problem before making a final judgment
Negative emotions exist primarily to protect ourselves from perceived threat to our safety. However, if a situation is not an actual threat, our emotions, though valid, may not always lead us to a viable solution. They may even cloud our judgement and ability to make decisions, thus exacerbating the problem at hand. For example, if we perceive verbal feedback as judgement or criticism, we may feel attacked and misunderstood. In order to benefit from feedback, we need to learn to perceive it as an opportunity to solve the problem rather than perceive it as a personal threat to our safety.
3. Understand the problem
This is the most challenging but also most important step when faced with a problem. Problems must be clearly articulated-laid out in a sequence of events that have logical causes and effects, with assumptions that are based on fact, rather than opinion or speculation. However, this may take time as we can be tempted to draw hasty conclusions from poor understanding
4. Break up the problem into "bite-sized" chunks
If the problem remains broad (e.g. I failed the test), then it will seem insurmountable. However, if we can divide and subdivide the problem down into smaller chunks, we can see that the problem has components that can be solvable (e.g. time management of daily study habits).
5. Position any rewards after the achievement of tasks
If pleasurable rewards (defined as emotionally soothing) come before any task, it will be difficult or impossible to start the task, especially if it's arduous or tedious. Positioning rewards at the end of one or more tasks motivates the completion of tasks. This also builds greater self-esteem as it will elicit positive emotions upon the completion of a goal and prove to themselves of competency.
6. Re-evaluate what worked or didn't work
Problem solving is a continual process that strengthens our ability to find more efficient and nuanced solutions
7. Work with a psychotherapist or coach
Confronting stressors can be incredibly difficult, draining, and sometimes overwhelming. It is important to acknowledge your level of experience and expertise. If any of these strategies are too challenging to do on your own, please consider asking for help from someone with the training and experience to help you through the process.

(Marc Lener, MD, is a psychiatrist in private practice in New York City and Founder and Chief Executive Officer of Singula Institute, a 501©(3) organization, whose vision is to transform mental health diagnostics and treatment for individuals at risk for anxiety and depression).

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