By Ronald D. Siegel, PsyD, Center for Mindfulness & Compassion, Harvard Medical School
What traps people in anxiety or depression, drives us to overindulge, perpetuates chronic pain, or gets us stuck in jobs or relationships?
A big factor is avoidance.
Avoidance is evolutionarily hard-wired in our brains. Our brains developed for survival, and avoiding pain is naturally an important part of survival. Unfortunately, this vital survival mechanism also sets us up for a lot of misery.
It makes perfect sense that we’re hard-wired to seek pleasure and avoid pain. The things we evolved to enjoy—having sex, eating, getting out of the cold, or avoiding injury—have contributed tremendously to survival.
In fact, natural selection shaped our brains so that we would behave in ways to help pass on our DNA by making certain activities pleasurable.
Take sex, for instance. If it didn’t feel good, who would ever think of doing it .So what could be wrong with seeking pleasure and avoiding pain? Unfortunately, a lot. Our hard-wired tendency to try to avoid pain actually causes much of our suffering.
Avoidance can drive our clients to get stuck in anxiety or phobias, sink into depression, and even plays a big role in chronic pain. While genetics, attachment history, trauma, and many other factors can predispose us to different disorders, the way they unfold in the present almost always includes avoidance.
Let’s look at anxiety. If I get nervous before public speaking or flying in airplanes, but I do those things anyway, I probably don’t have an anxiety disorder—I’m just a nervous guy (I know, because I am one).
But if I avoid doing those things in order not to feel anxious, I probably do have a problem. And the longer my avoidance continues, the more entrenched my disorder becomes.
You’ve probably had clients who skipped a party, canceled a flight, or skirted confrontation with a loved one because they wished to avoid the fear and anxiety it might cause.
We might even say that avoidance is the opposite of courage.
I once heard an astronaut explaining what it was like to be in the early space program. He said, “Courage isn’t about not feeling fear—courage is about feeling fully afraid and doing what it makes sense to do anyway.”
Next, let’s take depression. Have you ever thought about the difference between sadness and depression?
One difference is that sadness feels alive and fluid and is an essential part of living a full life. On the other hand, depression feels dead and stuck and gets in the way of living.
In fact, depression is often a result of trying to avoid sadness and other sorts of emotional pain.
Something curious happens whenever we try to cut out one side of our emotional experience—we dampen the other side as well.
We discover that trying to eliminate painful feelings flattens out our emotional life, leading to a general deadness.
In our attempt to avoid feeling sadness, anger, or other negative emotions, we cut themselves off from joy and interest, and wind up depressed.
Finally, let’s look at chronic pain. Many chronic pain disorders involve fearfully tightening muscles—“bracing and guarding”—in an attempt to avoid re-injury or an exacerbation of pain.
Patients restrict their lives more and more, becoming frightened of ordinary movements, not to mention the physical exercise that could otherwise increase their strength, endurance, and flexibility.
Their lives go downhill as they focus more and more on what seems to make their pain better or worse; and they give up the activities that might keep their muscles and joints healthy while making their lives richer and more meaningful.
So here we also see that avoidance—in this case trying desperately to avoid feeling more physical pain—traps people in fear-pain-fear cycles that can maintain their condition.
An Antidote to Avoidance
But there’s hope. Mindfulness is a simple practice that effectively counteracts avoidance. Mindfulness helps us lean into difficult experiences.
See also: Obstacles to Committed Action: Experiential Avoidance
Mindfulness for Anxiety
First, let’s look at anxiety. Instead of trying to avoid a frightening situation to stave off that dreaded “anxious” feeling, mindfulness gives us another option.
Mindfulness trains us to approach, and then be with experiences—to feel the heart race and the breath quicken, and enter into the frightening activity anyway.
Mindfulness practice helps us recognize that in the body, anxiety feels the same as excitement, just with a different set of thoughts.
We discover that nothing lasts forever; eventually panic subsides, and we see that we don’t actually die—even though we went to the party, flew on the jet, or faced a conflict with someone we cared about.
Mindfulness for Depression
Next, let’s look at how this might apply to depression. When we get depressed, we shut down emotions—go dead—and get stuck in repeated thoughts about inadequacy or badness.
Mindfulness practice can prepare us to confront the next wave of depression with a very different attitude—with interest and curiosity about exactly what we’re feeling at the moment, and with some perspective on negative thinking.
This can help us discover the underlying sadness, anger, or fear that is sometimes masked by depression, so that we can connect with these feelings by mindfully tuning into the body.
Learning to be with difficult emotions in this way also helps us to become more whole or integrated, and better able to face future challenges.
Mindfulness for Chronic Pain
Finally, let’s consider chronic pain. Mindfulness practices help us separate moment-to-moment sensations of discomfort from our aversion responses to them—the negative thoughts, tensing of muscles, and avoidance of activities we fear will exacerbate pain.
We get to observe directly the equation pain x resistance = suffering, and learn that when we relax our resistance, suffering diminishes.
This allows us to return to normal activities—thereby interrupting pain-fear-pain cycles—which can not only reduce pain but in some cases actually resolves the disorder.
While there are many other ways that mindfulness practices can help us become more psychologically flexible and alive, using them to avoid avoidance can go a long way toward resolving a wide variety of disorders.
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