The Grief FAQ- Avoidance

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Back in November I wrote about how the field is shifting it’s thinking on complicated grief and some of the controversy surrounding the changes to grief as an exclusionary criteria for depression. I still agree that the change was a step in the right direction and with that in mind, we’re going to look at how CBT can be useful in addressing avoidance behaviors within the context of complicated grief.

Individuals who struggle with complicated grief may engage in avoidance behaviors as a way dealing with the distress caused by situations connected to the loss. Behaviors may include avoiding family gatherings, isolating during certain times of the year, avoiding certain family members, avoiding places that have a connection to the loss - the list can be long or short. Avoidance behaviors carry two big price tags, the first being that they make the distress related to the situation worse in the long run. To understand why this happens it might be useful to understand the culprit behind the behavior namely, faulty thinking.

Avoidance behaviors are generally driven by catastrophic hypotheses . By engaging in the avoidance behavior we get immediate relief from the distress because we avoid whatever catastrophic event we believe may happen if we were to confront or face the situation- this is the hook. In avoiding the situation we rob ourselves of the opportunity to test the hypothesis. Because negative thinking surrounds the situation we are seeking to avoid, our beliefs about the situation become more catastrophic as more time passes between the present and our last successful exposure to the situation. This increases the likelihood that we accept the hypothesis as fact without evidence.

Let’s say a hypothesis someone may have looks ...

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...icipation to exposure but eventually the distress drops below the level prior to the exposure as a result of testing the hypothesis and/or surviving the situation despite it not going as well as you would have wanted.

Although we used family gatherings as an example throughout this post we can really apply this thinking and skill set to anything we avoid as a result of the loss - photo albums, restaurants, sections of town, etc. Although exposure is effective, it is not advisable for every situation. For example, I would never encourage an individual who struggles with a gambling addiction to hang out in a casino. Also, it is very important to remember that exposure can make matters worse if not done correctly and so if there are concerns about safety or fears that exposure may lead to a worsening of symptoms, it is probably best to seek professional assistance.
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