It’s natural to seek experiences that make you feel good while avoiding those that cause harm or discomfort. In fact, it’s an essential evolutionary response that could even be considered a normal, protective adaptation. (1) Sadly, avoiding persistent pain is an instinctive reaction that can end up causing even more discomfort.
When a patient’s attempts to avoid unpleasant sensations are repeatedly unsuccessful, they can end up feeling overwhelmed with a “Mission Impossible” scenario.
Experiential avoidance (EA) in the ACT model has been broadly defined as any attempt to avoid uncomfortable thoughts, feelings, memories, images and physical sensations—even when doing so creates harm.
In some ways, the inverse of short-term pain for long-term gain takes place in EA. Patients might continuously strive to avoid or control experiences that they believe will worsen their condition, even at the cost of enduring more significant consequences in the long run. (2) The effort to control discomfort can not only magnify the pain experience, but also negatively impact a patient’s well-being and quality of life.
5 Risks of Experiential Avoidance
While pain avoidance has its place in the human experience, temporary relief coupled with prolonged refusal to meet discomfort head on can present risk factors that exacerbate long-term adverse outcomes. (3) The list of complications with prolonged suboptimal coping strategies is long and has been well-established in medical literature. (4)
Here are 5 commonly cited consequences of experiential avoidance:
#1 Prescription drug dependence
Ongoing attempts to minimize or avoid unpleasant sensation may lead to coping patterns that include drug abuse, dependence and addiction. The current opioid crisis in the United States is a testament to that claim.
#2 Psychological distress
Patients who continuously seek to avoid pain that cannot be resolved are at risk for heightened distress through hypervigilance, catastrophizing, and fear.
#3 Long-term disability and lower recovery rates
While EA might offer brief short-term relief, the long-term functional outcome is poor, as patients who most frequently engage in experiential avoidance show poor adaptation to their condition.
#4 Increased levels of depression and anxiety
When patients are consumed by an effort to avoid pain or discomfort, and when these efforts consistently fail, the resulting fear avoidance is associated with worse daily functioning, poor quality of life, and negative mood states, including depression, anxiety, post-traumatic stress disorder, and other behavioral problems.
#5 Heightened Pain Sensitivity
Frequently engaging in experiential avoidance can have a detrimental effect on patients’ coping mechanisms, with studies showing that those who employ EA have decreased pain endurance and tolerance levels.
Chronic pain patients are seeking relief from pain, but at what cost, and how can we help?
Acceptance is the Key: Changing the Game with Chronic Pain
Research has demonstrated that when people with chronic pain resist the urge to control or avoid their discomfort and instead accept their condition in tandem with the possibility of leading a full life, they experience less depression, anxiety, stress and improved function. (5)
A willingness (acceptance) stance often leads to:
- Reduced physical pain
- Increased resilience
- Healthier state of mind and body
- Improved mental states
- Decreased fear and catastrophizing
- Improved physical function
The realization that pain cannot always be resolved can open the door to freedom from unsuccessful pain avoidance, in turn leading to more functional responses to their condition. Helping the client to open the door to willingness moves them forward in their recovery despite the presence of pain in their life.
A modern exploration of human suffering suggests that chronic pain isn’t the enemy and therefore doesn’t need to be “stopped,” “fought,” or “controlled.” Acceptance and Commitment Therapy is rooted in this perspective. It encourages patients to drop the struggle, to learn to accept unpleasant experiences when it serves their values, and to act in alignment with their goals (and values) as they move forward towards a life beyond pain.
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How Pain Practitioners Can Make a Difference
There are many ways that physiotherapists can help their patients develop healthier and more positive nonpharmacological coping strategies. Integrating psychological and behavioral approaches into pain response repertoire is one way to do so.
A patient’s coping strategies can generally be divided into one of two categories:
1) Adaptive/functional
2) Maladaptive/dysfunctional
When signs of dysfunctional or maladaptive response arise, physical therapists are presented with the opportunity to help reduce the burden of chronic disease, by counseling their patients or clients about risk factors and the adverse behaviors that promote or aggravate them.
If you’d like to learn more about acceptance and commitment therapy, including simple tools and tips for integrating ACT techniques into your clinical practice, download the free ACT Starter Kit by visiting www.DrJoeTatta.com/75Download.
REFERENCES:
- Lund JP, Donga R, Widmer CG. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 1991;69:683-94.
- Karademas EC, Karekla M, Flouri M, et al. The impact of experiential avoidance on the relations between illness representations, pain catastrophizing, and pain interference in chronic pain. Psychology and Health 2017;32:1469-84.
- Esteve R, Ramírez-Maestre C, López-Martínez AE. Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain. European Journal of Pain 2012;16:718-26.
- Mehta S, Rice D, Janzen S, et al. The long-term role of anxiety sensitivity and experiential avoidance on pain intensity, mood, and disability among individuals in a specialist pain clinic. Pain Research and Management 2016. Available: http://dx.doi.org/10.1155/2016/6954896. Accessed November 25, 2018.
- Costa J. Experiential avoidance and self‐compassion in chronic pain. Journal of Applied Psychology 2013;43:1578-91.
