The Overcoming Avoidance Workbook by psychologist Daniel F. Gros aims to help you stop avoiding and start living. It takes a transdiagnostic approach, meaning it focuses on specific behaviours rather than the diagnoses in which they occur. The cover says that it’s for anxiety, depression, or PTSD, but the focus is on anxiety and depression.
The approach used is transdiagnostic behaviour therapy (TBT), which is a variation of cognitive behavioural therapy (CBT). The book is laid out much as TBT would be done in person with a therapist, with eight chapters that are each intended to be covered in a week, including worksheets and practice.
The author’s style is fairly blunt, although not excessively so. This is apparent when he tells readers at the beginning of the book that panic attacks won’t physically hurt you, no matter how much you might think they will. I think that for some readers, that bluntness will be really effective, but for others, it could be off-putting.
The model underlying the book’s approach is that a difficult event causes anxiety/depression, which leads to isolation, withdrawal, and avoidance, which worsens the anxiety/depression, and around and around it goes.
The author explains that the key intervention to end this cycle is using exposures. This approach varies from your standard prolonged exposure, where you would typically construct a hierarchy of feared situations to do exposure work. Instead, the author encourages you to dive right in and do a lot of exposure in a lot of different situations.
Avoidance is broken down into four different types: situation, physical sensations, thoughts, and positive emotion-promoting situations. The author explains when these are likely to occur and how to come up with exposures to fit them. The book also covers barriers that might get in the way of exposures being effective.
One thing that struck me as a bit odd was that the author equated not learning from an exposure to leaving too early. In prolonged exposure, the idea is that after about 45 minutes in a situation, the intense negative stuff will naturally decrease, and if you leave the situation before that, it just reinforces that being in that situation will make you anxious. The learning that the author was referring to was learning about the outcome that you were anticipating, because presumably you thought the outcome would be worse than it was. I would think that not learning could just mean that needing exposure to whatever it was wasn’t the issue.
There was also the standard CBT stance that pushing yourself to do things will eventually result in increased positive emotions. I think it certainly can, no question, but the reality is, it’s not always that neat and tidy.
Of course, a book about avoidance is going to be all about dealing with avoidance. Still, it felt like the author was being simplistic in making avoidance the defining feature in anxiety in depression. Perhaps that’s where the transdiagnostic bit runs into problems. I suspect avoidance is more universally a key feature in anxiety, but perhaps less so in depression. Granted, if you’re picking up a book about avoidance, it’s probably a moot point anyway.
For potential readers who are wanting to tackle avoidance, I think the main deciding factor in whether this book will be good for you is whether you want a direct approach or a softer approach. If you want direct, this is your book, but if you want softer, this may not be your best option.
The Overcoming Avoidance Workbook is available on Amazon.
I received a reviewer copy from the publisher through Netgalley.
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