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An example of the fear-avoidance model, anxiety sensitivity stems from the fear that the symptoms of anxiety will lead to harmful social and physical effects. As a result, the individual delays the situation by avoiding any stimuli related to pain-inducing situations and activities, becoming restricted in normal daily function.
When designing an exposure hierarchy, therapists first conduct a thorough assessment of their client's fear with particular attention to the (a) feared object or situation, (b) feared consequences of confronting the object, (c) fear-related avoidance or safety behaviors, and (d) triggers and contexts of the fear. [3]
This self-reported assessment scale consists of 17 items, which cover the main spectrum of social phobia such as fear, avoidance, and physiological symptoms. The statements of the SPIN items indicate the particular signs of social phobia. Answering the statements a person should indicate how much each statement applies to him or her.
Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction. [10] The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear.
These behaviors are also known as "emotional avoidance behaviors". [13] [14] These behaviors are aimed to reduce fear or anxiety in future situations. [12] Examples include: Completely avoiding situations in which the threat might occur [4] Relying on safety signals such as inviting companions to social events for support [4]
These factors include the expectation of therapeutic benefit, the therapist's ability to foster social reinforcement, the information-feedback of approximations towards successful fear reduction, training in attention control, and the vicarious learning of contingencies of non-avoidance behaviour in the fear situation (via instructed imagination).
Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution. Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous. Sustaining avoidance often requires effort and energy. Avoidance limits one's focus at the expense of fully experiencing what is going on in the present.
The neural circuit responsible for expressing signaled avoidance behavior is the same that controls extinction of fear responses. The presentation of the aversive stimulus activates neurons in the central amygdala which project to the periaqueductal gray region to elicit a fear-motivated motor response.