Avoidance behaviour is the tendency to steer clear of situations, activities, thoughts, feelings, or physical sensations that are associated with anxiety, distress, or perceived threat. While avoidance provides short-term relief, it typically maintains and worsens anxiety in the longer term by preventing the person from discovering that the feared situation is manageable. It is a central feature of anxiety disorders and PTSD, and is very commonly seen in cardiac arrest survivors.
How avoidance presents after cardiac arrest
Avoidance can take many forms in survivors:
- Physical avoidance: stopping exercise, avoiding activities that raise the heart rate, refusing to return to the location where the arrest occurred
- Cognitive avoidance: trying not to think about the cardiac arrest, suppressing memories, avoiding conversations about it or about death
- Medical avoidance: avoiding check-ups, ECGs, or cardiac clinic appointments for fear of what might be found
- Social avoidance: withdrawing from social situations for fear of having another arrest in public, or because cognitive difficulties make socialising exhausting
- Situational avoidance: not travelling alone, not being away from home, not doing anything that feels physically demanding
The cost of avoidance
In the short term, avoidance reduces anxiety. Over time, it reinforces the belief that the avoided situation is genuinely dangerous, shrinks the person’s world, and prevents recovery. What starts as a cautious response can become a severely restricting pattern that affects independence, relationships, and quality of life.
Treatment
The most effective treatment for avoidance is graduated exposure: gradually and systematically approaching avoided situations (under therapeutic guidance) rather than avoiding them. This is a central component of cognitive behavioural therapy (CBT) and is most effective when undertaken with professional support rather than attempted alone.
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