TIFT #70: Affect Avoidance–Universal and Central

Avoiding uncomfortable feelings is familiar to all of us. How often do we have trouble engaging in those difficult conversations that are often the most productive? Furthermore, the concept has an important place in a number of therapies. Cognitive-Behavioral Therapy has recognized the phenomenon from the beginning. Acceptance and Commitment Therapy (ACT) places “Experiential Avoidance” at its center, as does Affect Phobia Therapy. Much earlier, Janet described how trauma patients were intent on avoiding uncomfortable emotions. For the most part, existing descriptions identify avoidance of emotions as a feature of certain problems such as trauma or anxiety, but not a universal feature of the problems we treat and not something central to all of psychotherapy.

More important than generally thought

The theme of this post is that a modern view, taking into account our evolutionary past, as well as what we know about how change happens, will show affect avoidance in a bigger, brighter light. In this essay, I propose that affect avoidance has roots far back in the evolution of the central nervous system and is a universal aspect of the problems therapy is designed to address. In addition I will show how it is central to our clinical work, not just with certain kinds of problems, but with all the problems we are likely to encounter.

Evolution

First, let’s consider avoidance in the light of evolution. If we go far back, let’s say to one-celled organisms, self protection is a matter of stimulus and response. A noxious stimulus produces an avoidant response. However, with the evolution of a central nervous system, a much more effective approach is prediction. Responding to events that have already happened continues, but anticipating threats is even more useful for survival. So central nervous systems devote a lot of energy and resources to prediction of threats.

What happens when danger is encountered or anticipated? By the time mammals evolved, the central nervous system had developed an highly flexible way of signaling danger and mounting a response. In the midbrain, limbic system structures such as the amygdala act as beacons to signal danger. This system is genius because competing dangers and needs can be weighed, one against another, based on the intensity of neural activity. Thus, activation of limbic nerve cells acts as a universal currency to determine which circumstance is more important for survival. Those signals then set off a response such as fight/flight/freeze, designed to cope with the threat. Thus, limbic activation lies at the center, between the mind’s appraisal of circumstances, and the responses it generates. In it’s signaling role, limbic activity acts as an equivalent or proxy for danger. We’ll come back to that later, but first, let’s look a bit deeper into how limbic activation relates to emotion and affect.

Limbic emotion, conscious emotion, and affect

In human babies and other mammals, when limbic centers are activated and send signals of danger, what we see outwardly are spontaneous bodily responses. Because they are similar to our own bodily reactions, we identify them as emotion. We say the dog is “feeling threatened” or that the baby is “happy.”

That is actually a bit problematic. Neurophysiologists tell us the limbic system does not have a direct line to consciousness. We can’t actually know what a dog “feels,” nor can we know the subjective experience of a smiling baby. On the other hand, the late Jaak Panksepp says it’s ok to trust our instinct and assume from the indirect evidence of bodily responses that a dog or baby is feeling something not far from our own conscious experience. We’ll never know, but for us therapists, noticing those bodily responses is the best window we have into the otherwise unknowable limbic system.

That’s where affect comes in. Affect can be defined as conscious feeling when it is accompanied by spontaneous, involuntary bodily changes, such as smiling tears, changes in heart rate, breathing, fidgeting, etc. While conscious feeling may be different and more complex than what is going on in the limbic system, affect is still our the most useful indicator that we have that the limbic system has been activated.

Affect is central to change processes in psychotherapy

What’s important for psychotherapy is that affect turns out to be central to our profession in that it is our main confirmation of readiness for change. Specifically, affect tells us that each of the two requirements for the important change mechanism of Memory Reconsolidation (MR) has been met. The first requirement is that limbic emotion is in an active state. The second is that a channel from consciousness to the limbic system is open and ready to receive new, corrective information communicated downward from the conscious mind.

How affect avoidance is universal

So far, we can see that affect is central to the fundamental change mechanism of Memory Reconsolidation. That’s important because MR is the only process allowing permanent modification of existing Entrenched Maladaptive Patterns (EMPs), the problems targeted by psychotherapy. Now it’s time to consider that affect avoidance is a universal characteristic of the problems therapy aims to treat. Yes, that means that all the problem responses that are targets of psychotherapy can be thought of as examples of affect avoidance.

The principle of affect avoidance for survival

Let’s return to evolution. From far back, limbic activation, which I’ll also refer to as “limbic emotion” functions as a proxy for danger. It follows that the central nervous system bases the success of responses on their ability to suppress the very limbic emotions that launched the response. This works well as long as limbic emotion remains an accurate representation of imminent danger. Thus, a general principle of the central nervous system with regard to dangers is that it functions as a negative feedback loop, where outward responses are calculated to eliminate or suppress limbic emotion. In pre-human mammals this works well because activation of limbic emotion and the presence of danger are closely parallel. Successful defense against a danger lowers limbic emotion, and less limbic emotion signals that the danger has been brought under control. When growling makes the intruder go away, the dog stops barking.

What’s different about humans

The availability of consciousness in humans complicates what has been a simple and effective system. What’s different about us is that we are clever enough to take steps to suppress painful and uncomfortable affects without concerning ourselves with the danger they might represent. For us, the close link between danger and negative affects is no longer so simple. Painful affects are experienced as problems in themselves, even when the danger they originally signaled is no longer relevant. For example trauma survivors who dread having to re-experience past pain can resort to strategies such as substance use to suppress painful affects. And they do.

While affect avoidance is one of the most natural of all survival tactics, in humans it becomes a broad-based tool for feeling better, whether or not there is danger or long term benefit. Consider the added complexity that comes from being able to invoke symbolic equivalents. Hunger can become the equivalent of emotional pain and eating, a way to sooth pain from some other source. Notice that much of the pain and distress of being human comes not from physical threats, but from social ones. Those are far more complex and invite playing with meaning and symbols to control affect.

But it’s not the Wild West. The universal principle for therapists is that the problems we aim to treat (Entrenched Maladaptive Patterns) can now be seen as strategies for avoiding negative affects. Why? Because that’s how our survival systems have evolved. Their design is based on suppressing negative affects. Does this reflect clinical reality? Yes. A clinical review of the full range of problems treatable in psychotherapy confirms that they can be seen universally as based on affect avoidance.

Clinical application

From this perspective, we can see how natural and instinctive it is for humans to avoid painful and uncomfortable affects. This begins to explain the age old puzzle of why humans so often act against their own best interests. In a large number, if not all cases, the instinctive solution to a life-and-death problem for which there is no effective solution, is avoidance. This may work, but takes energy to maintain and leaves the constant threat that the affect might re-emerge into consciousness. 

Meanwhile, we know that “healing” or “processing” the emotion using Memory Reconsolidation is usually a far better and more lasting answer. It produces permanent resolution of the original threat and allows us to leave the past behind. This is the basis of essentially all psychotherapeutic approaches to trauma. It is also the final common pathway for healing of other pathologies, where maladaptive avoidance strategies have remained “frozen in time” awaiting therapy for a definitive solution such as mindful acceptance.

Cases of neglect or unmet need are similar. Painful longing for fulfillment is avoided by strategies for the suppression of affect. When efforts at avoidance begin to fail, yearning becomes a threat, sometimes overcoming avoidance and expressing itself in the therapeutic relationship. There, if the affect is identified and met with authentic understanding and compassion, the two requirements for healing by Memory Reconsolidation will have been met: Activation of limbic emotion as indicated by affect, and illumination by the new and unexpected awareness that life can go on, based on fulfillment of adult needs combined with acceptance of the pain of childhood needs that will never be met.

Anxiety is a bit different. Here, problems originate in systems far older than human existence. They become problematic when the danger signal becomes disconnected from a real danger. The mind goes into an unending loop trying to quiet itself by mis-identifying dangers and attempting to manage them. The role of psychotherapy is to provide an alternative to the natural instinct to eliminate the affect. In place of avoidance, we therapists teach mindfulness and acceptance of anxiety as long-term answers, knowing that treatments that focus on eliminating the affect have the same drawbacks as the client’s other efforts at avoidance.

Is “facing your feelings” the only answer?

No, there are times when the answer to affect avoidance goes beyond processing emotion. One is when the mind’s appraisal of the situation needs to change. An example is the deep belief that “one must be perfect to be loved.” Change requires that the appraisal of danger must change, which probably takes place in the cortex. This change process is likely to be mediated by MR, but changes in memory may take place beyond the midbrain.

Another therapeutic pathway might involve learning and practicing a new, healthier pattern of response. The limbic trigger might remain the same but now initiates a new, healthy response instead of the old, maladaptive one.

What is universal is that helping our client trade their old, maladaptive avoidance strategy for a new way to respond to circumstances is the final common pathway of every psychotherapy.

Benefits of an affect avoidance model

Thinking that the problems our clients bring to us represent the mind’s attempts to avoid painful, uncomfortable, or overwhelming affects points us towards two highly productive questions:

What is the dreaded affect? Asking this naturally leads towards activation of the limbic emotion that needs to be soothed and healed. Expressed in a different way, engaging our client in “following the dread” leads towards “accurate empathy.” The act of exploration encourages activation of old patterns with their limbic emotions. And that activation fulfills the first requirement for healing by Memory Reconsolidation.

The second question is this: How can the old, insoluble problem, the one responsible for the affects being avoided, be resolved once and for all? This leads to old schemas being illuminated and corrected in the light of new, enduring solutions, fulfilling the second requirement for Memory Reconsolidation. 

An Affect Avoidance Model, by recognizing the universal role of affect avoidance in problems addressed by psychotherapy, as well as the centrality of affect in their healing, provides us with a relatively simple and cohesive conceptual framework, one that guides therapy, facilitates training, and binds together the often overwhelming profusion of “branded” therapies.

Jeffery Smith MD

 Reference:  Smith, J  Johnson, B, The Affect Avoidance Model: An Integrative Paradigm for Psychotherapy, Preprint, ResearchGate.net, find under "Jeffery Steven Smith"

 Photo credit,  Guillaume de Germain, Unsplash