194 ASSESSMENT AND INTERVENTION STRATEGIES
in anxiety. The therapist and client can discuss a number of life- threatening examples
where escape or avoidance actually ensures one’s survival. Examples can also be given
of animals (i.e., the client’s pets) that automatically escape or avoid perceived danger.
It should be emphasized that escape and avoidance are natural responses to perceived
threat and danger.
A discussion of the natural, automatic character of escape and avoidance should
lead into a consideration of their negative consequences and how escape and avoid-
ance contribute to the persistence of anxiety. In their self-help book on panic entitled
10 Simple Solutions to Panic, Antony and McCabe (2004) cite four disadvantages of
escape/avoidance:
••It prevents learning that situations are safe, not dangerous or threatening (i.e.,
failure to disconfirm faulty appraisals and beliefs of threat).
••The subjective relief associated with escape/avoidance reinforces this behavior in
future episodes of anxiety.
••Giving into escape/avoidance will increase a sense of guilt and disappointment in
one’s self and a loss of self- confidence.
••The immediate relief associated with escape/avoidance increases one’s sensitivity
to threat cues so that in the long term it will maintain or even increase fear and
a n x iet y.Throughout this discussion of the negative effects of escape/avoidance, the therapist
should be soliciting personal examples and questioning the client on any perceived
adverse consequences of continued escape/avoidance. By educating the client on the role
of escape/avoidance in anxiety the therapist seeks to increase awareness that elimina-
tion of this control strategy is critical to the success of treatment. It will also lay the
groundwork for introducing prolonged exposure to threat as the obvious remedy for
this maladaptive defensive strategy (a fact that most individuals with anxiety are most
reluctant to accept).
The therapist should also explore with clients any dysfunctional safety- seeking
behaviors that may be used to alleviate anxious feelings. Do clients carry anxiolytic
medications at all times just in case they are needed? Do they only venture into certain
places when accompanied by a close friend or family member? Are there other more
subtle forms of safety seeking such as holding onto railings when feeling dizzy or auto-
matically sitting down when feeling weak? After examples of safety seeking are elicited,
the therapist should discuss how this form of coping with anxiety might contribute to
its persistence because:
••It prevents one from learning that his fears (i.e., perceived threats) are groundless
(Salkovskis, 1996a).
••It creates a false sense of security (e.g., person with panic disorder develops mal-
adaptive belief that having a friend close by somehow reduces the risk of heart
palpitations and a heart attack).Once again the purpose for educating clients about the role of safety- seeking responses
is to increase their acceptance that reduction in this behavior is an important goal of
treatment.