Pathways towards the proliferation of avoidance in anxiety and implications for treatment

- Understanding avoidance, a key symptom of anxiety, can help improve treatment.
- Five pathways for proliferation of avoidance are proposed.
- Novel strategies might help reduce avoidance in the long term.
- Research should continue to address avoidance and strategies for its reduction.

Avoidance is a key symptom of anxiety disorders. Maladaptive avoidance impairs general functioning acutely and maintains chronic anxiety. A better understanding of the mechanisms that elicit and maintain excessive avoidance might provide opportunities to improve treatment. Here, we discuss pathways through which avoidance might get amplified in the context of anxiety disorders: 1) increased threat appraisal; 2) enhanced threat avoidance tendencies; 3) impaired regulation of avoidance; 4) habitual avoidance; and 5) attempts at increasing psychological distance. Novel strategies for reducing avoidance are considered. These include memory reconsolidation interference, retraining of avoidance tendencies, mindfulness training and habit disruption approaches. Throughout the paper, we highlight a number of suggestions for future research on avoidance and how to achieve lasting behavior change.