Addressing Avoidance and Safety Behaviors in Trauma-Related Anxiety
Amber Benziger, MS, LPC
I’m a Licensed professional counselor in New Jersey, a private practice owner, speaker, an experienced clinician for 13+ years,
I’ve worked in all levels of care holding many positions from case manager to Clinical director/chief clinical officer, creating programs, running departments, and managing teams.
I specialize In working with women who are working though anxiety and/or trauma.
IT’S NICE TO MEET YOU!
Delving into the intricate landscape of trauma-related anxiety
Focus on understanding avoidance and safety behaviors
Drawing from cognitivebehavioral principles, cognitive processing therapy, exposure therapy, and trauma-informed care
UNDERSTAND RECOGNIZE
Understanding the role of avoidance and safety behaviors in perpetuating trauma-related anxiety
Recognize common avoidance and safety behaviors exhibited by individuals with trauma-related anxiety.
APPLY
IMPLEMENT
Apply cognitivebehavioral interventions to challenge and modify avoidance behaviors in therapy.
Implement trauma-informed approaches to create a safe therapeutic environment and support clients in confronting avoidance behaviors with courage and resilience.
UNDERSTANDING TRAUMA RELATED ANXIETY
Definition: a person experiences intense fear, stress, or worry due to a traumatic event
Key Factors: Fear, triggers, hyper-vigilance
Impact: Disruption of daily life, emotional distress
Definition: Coping mechanisms to avoid triggers or perceived threats
Examples: Avoiding places, people, or situations; rituals for safety
Consequences: Reinforcing anxiety, limiting growth
Purpose: Challenging and modifying avoidance behaviors
Goal: Encourage facing fears, building resilience
- Creating Safety: Establishing trust and boundaries
- Empowerment: Collaborative decision-making
- Resilience: Supporting clients through challenges
Background:
Sarah's Struggles with Avoidance
• Sarah is a 32-year-old Black woman who experienced a traumatic event in her early twenties, involving a physical assault in a public place.
• Since then, Sarah has developed severe anxiety, particularly in crowded or public spaces.
• She frequently avoids social gatherings, public transportation, and even essential activities like grocery shopping, fearing a recurrence of the traumatic event.
Avoidance Behaviors: Sarah consistently avoids situations that remind her of the traumatic event, limiting her social interactions and impacting her daily life.
Emotional Distress: She experiences heightened anxiety, panic attacks, and intrusive thoughts when faced with triggers or reminders of the trauma.
Isolation: Sarah's avoidance behaviors have led to social isolation, making it challenging for her to maintain relationships or engage in activities she once enjoyed. case study example
• Exposure Therapy: Gradual exposure to feared situations, starting with less threatening environments and progressively increasing the level of exposure.
• Cognitive Restructuring: Identifying and challenging irrational beliefs related to safety and danger, helping Sarah develop more adaptive coping mechanisms.
• Empowerment: Collaborative goal-setting and fostering a sense of agency in Sarah's recovery journey.
case study example
RESISTANCE TO EXPOSURE: SARAH MAY INITIALLY RESIST FACING HER FEARS DUE TO THE INTENSE ANXIETY IT PROVOKES.
SAFETY BEHAVIORS: SARAH MAY RELY ON SAFETY BEHAVIORS SUCH AS ALWAYS HAVING AN EXIT PLAN OR CARRYING PEPPER SPRAY, WHICH CAN HINDER HER PROGRESS IN THERAPY.
case study example
Sarah'scasehighlightstheimportanceofaddressingavoidancebehaviors intrauma-relatedanxiety.
Byimplementingevidence-basedinterventionslikeexposuretherapyand cognitiverestructuring,clinicianscansupportclientslikeSarahin reclaimingtheirlivesandfosteringresilienceintheirhealingjourney.
EXPOSURE HIERARCHY FOR SARAH: OVERCOMING AVOIDANCE OF PUBLIC SPACES
LEVEL
4: MODERATE PUBLIC SPACE
Sarahtakesawalkinanearbyparkduringaweekday afternoonwhentherearefewpeoplearound.
Duration:30minutes.
LEVEL 5: MEDIUM-INTENSITY SOCIAL SETTING
Sarahattendsadinnerpartywithasmallgroupof friendsatarestaurantshefeelscomfortablein.
Duration:45minutes.
LEVEL 6: HIGH-INTENSITY SOCIAL SETTING
Sarahjoinsagroupoutingtoalocaleventorfestival withalargercrowd.
Duration:60minutes.
LEVEL 7: BUSY PUBLIC SPACE
Sarahvisitsabustlingshoppingmallduringnon-peakhours.
Duration:60minutes.
LEVEL 8: PUBLIC TRANSPORTATION
Sarahtakesashortbusrideorsubwaytrip duringalessbusytimeofday.
Duration:30minutes.
LEVEL 9: CROWDED PUBLIC SPACE
Sarahattendsacommunityeventorconcert withasignificantcrowd.
Duration:1-2hours.
LEVEL 10: FULL EXPOSURE
Sarahengagesineverydayactivitiessuchasgrocery shoppingordiningoutatapopularrestaurantduringpeak hours.
Duration:Variable,basedonSarah'scomfortleveland readiness.
Alex's Struggle with Safety Behaviors
Background:
• Alex is a 38-year-old software engineer who recently survived a car accident that left him with significant physical injuries and emotional trauma.
• Despite his physical recovery, Alex experiences intense anxiety and fear of driving or being in vehicles, stemming from the trauma of the accident.
• He also exhibits safety behaviors as a means of coping with his anxiety and preventing a similar occurrence.
CASE STUDY EXAMPLE
Safety Behaviors: Alex engages in safety behaviors such as avoiding driving altogether, excessively checking his car's safety features, and insisting on driving slowly or taking alternate routes.
Avoidance: He avoids situations that require driving, such as commuting to work, running errands, or traveling with friends and family, leading to feelings of isolation and dependency.
Emotional Distress: Alex experiences intrusive thoughts, nightmares, and panic attacks when confronted with triggers related to driving or vehicles, severely impacting his daily functioning.
• Exposure Therapy: Gradually exposing Alex to driving-related stimuli, starting with low-anxiety situations such as sitting in a parked car and progressing to short drives in familiar areas.
• Cognitive Restructuring: Identifying and challenging negative beliefs and catastrophic thinking patterns related to driving and safety, helping Alex develop more realistic and adaptive coping strategies.
• Skill Building: Teaching Alex relaxation techniques, mindfulness exercises, and stress management skills to cope with anxiety and arousal in triggering situations.
case study example
FEAR OF RELIVING THE TRAUMA: ALEX MAY FEAR THAT CONFRONTING DRIVING-RELATED TRIGGERS WILL RETRAUMATIZE HIM OR LEAD TO ANOTHER ACCIDENT.
DEPENDENCY ON SAFETY BEHAVIORS: ALEX MAY STRUGGLE TO RELINQUISH HIS SAFETY BEHAVIORS, FEARING THAT DOING SO WILL INCREASE HIS VULNERABILITY TO HARM OR DANGER.
With the support and guidance of his therapist, Alex begins to gradually confront his fear of driving through exposure exercises.
He learns to challenge his catastrophic thoughts and develop more balanced and rational beliefs about safety and risk.
Over time, Alex experiences a reduction in his driving-related anxiety and an increase in his confidence and sense of control behind the wheel.
Alex's case illustrates the impact of trauma on driving-related anxiety and the use of safety behaviors as coping mechanisms.
Through evidence-based interventions such as exposure therapy and cognitive restructuring, clinicians can help clients like Alex overcome their fear of driving and reclaim their independence and autonomy in their daily lives case study example
Alex practices relaxation techniques and imagines himself sitting in the driver's seat of his car, feeling calm and in control.
Duration: 5 minutes.
Alex sits in the driver's seat of his parked car in a safe location, such as his driveway or a quiet parking lot, with a trusted friend or therapist for support.
Duration: 10 minutes.
Alex starts the engine of his parked car and listens to the sound while remaining stationary.
Duration: 5 minutes.
Alex drives around his neighborhood or a familiar area with low traffic and clear roads, starting with short distances and gradually increasing the duration.
Duration: 15 minutes.
Alex drives on local streets with slightly more traffic, practicing various maneuvers such as turning, changing lanes, and stopping at intersections.
Duration: 20 minutes.
Alex drives during daylight hours when visibility is optimal, gradually increasing the complexity of routes and encountering different traffic conditions.
Duration: 30 minutes.
Alex drives on highways or freeways with moderate traffic, practicing merging, exiting, and maintaining speed.
Duration: 30 minutes.
Alex drives during adverse weather conditions such as rain or light snow, gradually exposing himself to various driving challenges.
Duration: 20 minutes.
Alex drives at night, practicing with reduced visibility and adjusting to different lighting conditions.
Duration: 30 minutes.
Alex undertakes longer drives to destinations outside his immediate area, gradually increasing the distance and duration of trips.
Duration: Variable, based on Alex's comfort level and readiness.
Mindfulness, grounding exercises
Anxiety journals, exposure hierarchies
Today, we've explored the complexities of trauma-related anxiety and the pivotal role of avoidance and safety behaviors.
Armed with cognitive-behavioral interventions and trauma-informed approaches, we can guide clients towards reclaiming agency and fostering resilience.
Don't be afraid to ask questions!
