In accordance with cognitive-behavioral theory, anxiety disorders manifest when individuals perceive situations as more perilous than they truly are. This distortion in perception sets off a chain reaction of responses, beginning with a heightened focus on threat-related stimuli, physiological arousal, and the adoption of safety-seeking behaviors, such as avoidance and escape tactics.
Paradoxically, these safety-seeking behaviors, including agoraphobic avoidance (i.e., avoidance of open spaces and crowds), inadvertently perpetuate the symptoms of panic disorder by impeding the disconfirmation of the erroneous threat belief. To illustrate, imagine a patient who avoids going to the store due to a fear of collapsing. If they manage to avoid the store and do not experience a collapse, they interpret this as a stroke of luck, reinforcing their belief in the effectiveness of the safety-seeking behavior. Consequently, they perceive the situation as a “near-miss” and construct a logical argument justifying the continuation of their avoidance strategies.
Moreover, as panic and avoidance behaviors persist over time, they become habitual, and the awareness of the inaccuracies in accompanying thought patterns diminishes. This phenomenon finds support in an experimental study that revealed a significant reduction in fear and a greater change in beliefs when individuals reduced their reliance on safety-seeking behaviors, as opposed to those who maintained such behaviors. These findings provide a framework for distinguishing between coping responses, which are behaviors aimed at managing anxiety alone, and avoidance responses, which are behaviors designed to evade a perceived “catastrophe.”
Furthermore, the dichotomy between coping and avoidance responses extends beyond panic disorder to other anxiety disorders, such as social anxiety, wherein avoidance and safety behaviors also play prominent roles.
Reference:
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behav Res Ther, 37(6), 559-574. doi:10.1016/s0005-7967(98)00153-3