Welcome to the third module of LUNA
This week you will learn more about avoidance and why avoiding things that make you anxious will not help you overcome your anxiety. You will also learn about behaviors that we call “quick fixes” which can also get in the way of you overcoming your fears.
You will spend about 20 - 30 minutes reading, watching videos, and doing activities on your own and with your parent.
The Behavior Aspect of the CBT Triangle- The Avoidance Cycle
Last week, you learned how to identify anxiety and other emotions by noticing how your body feels and by paying attention to your thoughts and behaviors. When we are anxious, we have more control over our behaviors and what we choose to do compared to our feelings or thoughts. Because of this, it may be helpful for us to focus a little more on the connection between your anxiety and your behaviors.
Usually, when we are anxious about something, it is natural for us to avoid it, but avoidance may not always help us in the long run. Sometimes, avoidance can lead us into a cycle that makes our anxiety worse over time.
Watch the video below to learn more about the avoidance cycle.
Sometimes when we encounter challenging situations, it’s easier to avoid them than to face them. Some difficult emotions – like anxiety, fear, or worry – stick around or get worse because of this. It’s natural to avoid things that challenge us.
Sophia’s new friend Bethany asks Sophia if she wants to go to anime club after school. Sophia loves anime, but this would disrupt her normal routine of going home right after school, changing her clothes, and watching anime. This makes her feel anxious and she wants to avoid changing her routine, so she decides not to go. It makes her feel a little better at first knowing she can do her normal routine, but she’s also disappointed that she didn’t hang out with Bethany. Sophia’s avoidance does not help her overcome her anxiety. In fact, Sophia ends up doubting her ability to handle any future changes in her routine. Let’s look at Sophia’s avoidance cycle to see how this happens. The cycle is triggered by Bethany’s invitation to go to anime club after school. Because of this, Sophia’s starts worrying about the possibility of changing her routine. This thought makes Sophia anxious. Because of her anxiety, Sophia avoids changing her routine to hang out with Bethany. Avoidance makes Sophia feel better at first. But Sophia never learns that she can handle changing her routine to do the things she wants to do.
George sees the new kid at school, Jerry, reading a medieval book and wants to talk to him. George always wants to connect with people who are also interested in medieval times, but he is anxious he won’t know what to say or will act awkwardly, so he avoids talking to Jerry. It makes him feel better at first knowing that he will not embarrass himself, but it also makes him sad that he didn’t get to become friends with Jerry. George didn’t get the chance to learn that talking to new people can be exciting and rewarding, and not as scary as it seems. He also didn’t get to learn that he has the ability to socialize and make friends if he reaches out to others. Let's look at this cycle to see how avoidance makes George's anxiety worse over time. The cycle starts with George’s interest in becoming friends with Jerry. George starts to think that he will embarrass himself if he talks to Jerry. This thought makes him anxious. So, George avoids talking to Jerry. This makes George less anxious at first, but he never gets to learn that he can face his fear of embarrassment in order to make new friends.
Sophia has a big math test coming up, and she’s scared she’s going to fail the test. This makes her feel so nervous that she procrastinates studying for her test by drawing comics for hours. This makes her feel a little less nervous, but because she’s not studying, she worries again that she’s going to fail the test, and the cycle continues. If Sophia had tried to study, she could have learned that even though studying is hard and makes her feel anxious, she can handle it. Plus, she would have felt prepared for the test. Let's see how Sophia's avoidance stops her from overcoming her anxiety. First, Sophia encounters a trigger- remembering that the math test is just a few days away. Sophia starts worrying that she will fail the test. This thought makes Sophia anxious. Sophia avoids studying so that she does not have to face her anxiety about the test. This makes her feel better at first, but when Sophia is forced to think about the test again, she feels even more anxious. It’s natural to avoid things that are hard for us, but we will work on overcoming this cycle!
As you can see, it is important to work on overcoming our avoidance cycles by recognizing and changing the ways we behave when we are anxious. This is exactly what we will be focusing on in the LUNA program.
When we avoid our anxieties over and over again, we are not able to learn anything new about them. This can make our fears stronger overtime. Avoiding our fears and worries means we don’t get the chance to see that what we are afraid of might not really happen. We also don’t get to see that even if something bad does happen, everything might still be okay!
To get more familiar with avoidance, take a look at the list of common avoidance behaviors below, or view the PDF version.
Common Avoidance Behaviors:
- Not talking or interacting with others
- Canceling plans with others or missing events
- Procrastinating on things you need to do like assignments or chores because of anxiety
- Refusing to do things or put yourself in certain situations because of anxiety
- Isolating yourself by staying in your room or by not leaving the house
- Distracting yourself from things that make you anxious
Then, take a look at some more Avoidance Cycle examples!
Anxiety and Avoidance
As you have learned, anxiety can be a very helpful emotion in certain situations. Anxiety is also a natural emotion which means that everyone gets anxious sometimes, and that's okay! But anxiety can be unhelpful if it is too intense or if you experience it in situations that are not really dangerous.
Just like anxiety, avoidance can also be helpful and necessary to keep us safe. However, avoidance is usually only helpful in situations that are truly and immediately dangerous. For example, if you are feeling anxious because of a tornado warning in your area, it may be necessary to avoid going outside and to stay in a safe location. Also, if you are trying to overcome your fear of dogs, but you know your neighbor’s dog often bites and attacks people, it would still be helpful to avoid that neighbor’s dog to keep you safe.
Remember, if you experience too much anxiety that stops you from doing things you want to do, then avoiding things that make you anxious will only make your anxiety worse. But it’s important to know that both avoidance and anxiety can be helpful in dangerous situations.
What Are Quick Fixes?
“Quick fixes” are another type of behavior that we engage in when we are feeling anxious. In addition to avoiding things to calm down our anxiety, we might also perform certain behaviors or actions over and over again in order to make us less anxious. We call these behaviors quick fixes because they do not get to the root of what is causing our fears and worries or solve our problems in the long run. Quick fixes are similar to avoidance behaviors because they both help us feel more relaxed in the moment, but they do not help us overcome our anxiety.
Watch the video below to learn more about quick fixes.
Sometimes we have “quick fixes” for anxiety, fears, or other emotions. Quick fixes help us feel better at first but do not help with these problems in the long-term. A really common quick fix for fears or worries is asking lots of questions about them. Another common one is spending too much time searching the internet for things you are worried about. And another common quick fix is to check things you are worried about over and over.
At first, quick fixes help you feel better, but over time they trick your brain into thinking your fears are something you need to keep worrying about. For instance, after George touches anything he thinks might have germs, he uses a quick fix such as immediately washing his hands to stop him from worrying about the germs. But now, George spends way too long washing his hands multiple times a day, because he is always thinking about all the germs that could be on his hands.
Sophia often worries that her friends might be upset with her, even when there is no clear reason. Whenever she has this worry, she repeatedly asks her friends if they are mad at her. Her friends reassure her each time that everything is fine, which helps her feel better for a little while. However, the more she asks for reassurance, the more she feels the need to keep asking if her friends are mad at her, and the harder it becomes for her to feel confident in her friendships without constantly confirming with her friends.
Sophia also feels like she must watch her favorite anime before going to bed every night. Whenever the plans change, Sophia worries that she might not get back home in time to watch it, which makes her anxious. She asks her mom repeatedly to go home so she will have enough time to watch the show before bed. Her mom reassures her that she will have enough time, which makes her feel better at first, but every minute they do not leave to go home Sophia feels a little more anxious.
George sometimes worries about getting really sick, and often uses quick fixes to deal with these worries. Whenever he gets a stomachache, he will spend hours looking on the Internet to see what this may mean. He keeps looking but never feels 100% certain, so he keeps asking his mom and dad what they think too. Each time they tell him he’s okay, he feels a little better. But when his parents aren’t with him, he won’t be able to handle these thoughts by himself. The next time he notices his stomach hurting, he starts worrying all over again.
It is natural to get into the habit of using quick fixes to deal with your anxiety, like asking questions about your fears or worries, looking up information about them on the internet, or checking to make sure everything is okay to deal with your anxiety. But, you have what it takes to break this habit and face your fears instead!
Like avoidance, quick fixes may relieve anxiety for a moment, but they will not help you face fears. When you use quick fixes to deal with your anxiety, you start to feel like the quick fix is the main reason that you got through the scary situation and made it out okay. This stops you from gaining confidence in your ability to face your fears on your own. The more you use quick fixes, the more you will feel like you need to use them to slow down your worries. As you may have guessed, quick fixes can also lead to a cycle that keeps anxiety going.
Take a look at this list of common quick fixes below to get more familiar with them, or view the PDF version.
Common Quick Fixes:
- Washing your hands too much or cleaning things too much
- Checking things over and over (like door locks, the oven/stove, or where exits are located)
- Carrying a special object everywhere
- Asking too many questions about your fears
- Checking your phone for notifications you are worried about over and over
- Spending lots of time researching your fears online
Then, take a look at the Quick Fixes Cycle. As you can see, the quick fix cycle looks almost exactly like the avoidance cycle!
Identifying Avoidance and Quick Fixes
Now that you’ve learned more about quick fixes and avoidance behaviors, take some time to think about how you behave when you are feeling anxious. Do you avoid things due to your anxiety? Can you think of any quick fixes you have used? Use the “Anxiety Behaviors” worksheets to list out any avoidance behaviors and quick fixes that you use when you are anxious. You can also view examples of those worksheets below. If you need help coming up with behaviors to list, your parent may have some good ideas.
Anxiety Behaviors: Avoidance
Think of some times when you felt anxious, worried, or afraid and list out any common avoidance behaviors you use.
- Situation: "I don’t know where to sit at lunch"
- Emotion or Fear: "I feel anxious. I’m afraid others will judge me"
- Avoidance Behavior: "I avoid the lunch room, don’t talk to others, and sit by myself in the hall"
Anxiety Behaviors: Quick Fixes
Think of some times when you felt anxious, worried, or afraid and list out any common quick fixes you use.
- Situation: "My stomach is hurting and I don't know why"
- Emotion or Fear: "I feel anxious. I'm worried I might be really sick"
- Quick Fixes: "I spend hours looking up my symptoms to make sure nothing is seriously wrong with my health"
Let's Learn About OCD
Before we move on, we have one more anxiety cycle to talk about- The OCD cycle.
Note: OCD is a bit different than other types of “anxiety”. Every kid or teen in this program will most likely have anxiety. But not all of you will have OCD. The information here will only be needed by a few of you!
Obsessive Compulsive Disorder, or OCD, is often misunderstood. It is common for people to think that OCD is just a quirky trait or a preference for staying clean and organized- but this is not what OCD is! OCD involves a cycle that repeats over and over. This cycle can impact many areas of life, and it uses up a lot of time and energy. Here are the steps in the OCD cycle: (View as PDF)
Step #1: Triggers
It all begins with a trigger that brings up an intrusive thought. Intrusive thoughts are upsetting or unwanted ideas, doubts, images, or feelings that pop into someone’s head. A trigger can be almost anything – a person, a situation, a place, or a feeling in your body.
Step #2: Obsessions
It’s normal to have intrusive thoughts! We all experience doubts or unwanted ideas at times. Intrusive thoughts only become a problem once they turn into something called obsessions. Obsessions are intrusive or unwanted thoughts that come up over and over again. For someone with OCD, intrusive thoughts carry a lot more meaning- this makes them feel very threatening, scary, urgent, or important. For most people, intrusive thoughts are just temporary ideas, but in OCD, they turn into something much bigger. When someone gets stuck in the OCD cycle, their intrusive thoughts start to recur and turn into obsessions.
Step #3: Emotions
In OCD, obsessions can bring up a lot of really uncomfortable emotions such as fear, shame, anxiety, or disgust. Another common emotion in OCD is feeling like things are not correct or not just right. This is called having a “not-just-right” experience. For example, when cleaning his room, George has a constant feeling that his bookshelf is not organized just right. This feeling upsets and bugs George a lot.
Step #4: Compulsions
Emotions such as distress, fear, or disgust caused by obsessions can lead to actions called compulsions. Compulsions can be any action someone with OCD uses to try and get rid of these feelings or to stop bad things from happening. Compulsions are usually physical actions, such as washing your hands or checking on your pet over and over, but they can sometimes be in your head too. For example, you might try to block out scary thoughts or replace your “bad” thoughts with “good” ones. You may adjust your thoughts like this over and over again, even if it does not seem to work for very long.
Compulsions are a specific type of quick fix. Compulsions happen much more often than other kinds of quick fixes, and they also tend to come along with the strongest urges. For example, George has a very strong urge to keep organizing his bookshelf, not because he enjoys organizing, but to try and get rid of the upsetting feeling that it is not organized correctly.
Step #5: Temporary Relief
Compulsions provide a short break from upsetting emotions and thoughts, but they also keep the OCD cycle going. When using compulsions, someone with OCD will feel temporary relief, so it makes sense why they would keep using compulsions to try and feel better. But the next time an upsetting thought comes up, they feel like they must repeat the compulsion over and over again to get rid of the uncomfortable thought or feeling. Compulsions end up stopping someone from learning that their unwanted thoughts or doubts do not have to be a big deal. They don’t get to find out that they can face these thoughts and emotions when they give themselves a chance!
You’ll notice that the OCD cycle looks almost exactly like the other two anxiety cycles we have shown you so far. This is because the OCD cycle is a specific version of these other cycles. One difference is that the OCD cycle tends to be faster. Someone can move through the steps in the OCD cycle pretty quickly. This means that the OCD cycle can repeat itself a whole lot of times in just one day.
If you have OCD, or if you feel like you might be dealing with some obsessions or compulsions, then take some time to fill out the Understanding Your OCD worksheet.
Then, take a look at this chart to see some common obsessions and compulsions that can show up in OCD. But keep in mind- there are many other types that are not on this list:
| OCD Type | Common Obsession | Common Compulsion |
| Harm | You are afraid that you might hurt yourself or someone / something else | You may be extra careful that you don’t accidentally hurt yourself or others (Ex. Hiding knives or sharp things) |
| Contamination | You are afraid that germs or harmful substances will hurt or kill you or others | You may wash your hands or surfaces in a specific way or for a specific amount of time |
| Bad Thoughts / Rumination | You can’t stop going over unpleasant thoughts in your head | You might ask people to reassure you that your unpleasant thoughts are wrong or try to avoid thinking about upsetting topics |
| Order & Symmetry | You need things to feel “even” or equal and if they aren’t you are fearful for some reason | You may count your movements or try to do things equally on the right and the left |
| Somatic | You have a fear around normal things your body does, like blinking, swallowing, or breathing | You may count normal bodily functions or check that you are still completing them (Ex. Making sure you are still breathing / breathing correctly) |
| Magical Thinking | You think that your actions are connected to unrelated things that happen to you and other people | You may do certain things the same way every day to make sure that unrelated bad things do not happen to yourself or other people |
| Health | You are afraid that you already have or will develop a serious health issue | You may look up health conditions on the internet and feel convinced you have a condition |
| Other | Obsessions can be about almost any topic that is important to you | Compulsions can be almost any action |
Do any of the thoughts or behaviors on this list seem familiar to you? Are any of these thoughts or behaviors similar to the ones you wrote down on your worksheet? If so, take a quick mental note of this!
OCD can be hard to understand, and it can be even harder to know if it is something you are dealing with or not. If what you have learned about OCD confuses you, or if it seems like OCD is something you could be dealing with, please talk about this with your therapist the next time you meet with them! You can also talk about these things with your parent.