Using Opposite Action to Reduce Avoidance

Given that post-­traumatic stress symptoms are very distressing, resulting in high levels of anxiety and fear, and sometimes shame, guilt, and anger, it is not surprising that people experiencing these symptoms or emotions try to avoid them or avoid situations that bring up those symptoms. For example, a person may avoid large crowds, certain television shows, new people (such as going on dates), or new, unfamiliar places. This avoidance generally works in the short term, helping a person to avoid triggers of unpleasant memories, thoughts, and emotions associated with a traumatic event. However, in the long term, this avoidance often results in greater distress or increased separation from people or situations the person cares about. That is, a person may start to feel trapped or controlled by the post-­traumatic stress symptoms and the avoidance behaviors that they bring on.

One antidote to avoidance is the DBT emotion regulation skill of opposite action (Linehan 1993b). As mentioned in chapter 4, opposite action basically involves doing the opposite of what you feel like doing when you feel a particular emotion. In the case of post-­traumatic stress, often the emotion is fear. So, we will discuss next how to use opposite action to gain freedom from fear and avoidance.

Here’s how opposite action works. Let’s say that your traumatic event involved assault by a male acquaintance whom you met in a park in the middle of the day a few years ago. Over time, you have begun to fear parks and other places with concealing trees and bushes, and thus you avoid walking in such places. You might also have begun to avoid walking or traveling any distance outside alone, even during the day (after all, you were assaulted in the middle of the day), and perhaps you even generally avoid men. You eventually find that your life has become narrower, because there are so many people and places that you avoid.

Well, opposite action works by helping your brain to figure out which of these places or people are not actually dangerous and don’t need to be avoided. Once your brain makes that connection, your fear tends to diminish, you stop wanting to avoid things or people, and your life opens up so that you have more freedom to go where you want to go and do what you want to do. In this way, opposite action is a lot like exposure therapy (Linehan 1993b), which we described in chapter 2 and with which you might have had some experience yourself.

Opposite action, in this case, would involve actively doing the opposite of what your fear tells you to do. Let’s say your fear tells you to avoid riding the bus in the middle of the day because someone might assault you on the bus. Well, opposite action would involve actively riding the bus in the middle of the day as much as possible so that your brain learns that it’s safe to ride the bus. Let’s say you’re afraid of walking in a public park at noon. Opposite action would involve repeatedly walking on purpose in a public park at noon, until your fear diminishes.

Now, you might be thinking Hey, that’s not safe! What if I actually get harmed or assaulted? Well, here’s an important point to remember about opposite action: You should only take opposite action for fear in situations where your fear probably won’t come true. So, you wouldn’t, for example, choose to walk in the dark through a dangerous neighborhood. If you’re afraid of walking through that neighborhood, you probably have good reason to be afraid, and avoidance is a good idea. On the other hand, you can never be 100 percent sure that a situation will be safe. So, when you get started with your bus riding or walking through a park, you might want to make sure that you are much more likely to be safe than unsafe.

For instance, one of us worked with a woman who was in this exact situation: She had been assaulted by a male acquaintance whom she met in a park at midday. But she loved nature and running, and she didn’t want to avoid parks in the daytime for the rest of her life. So her version of opposite action was to repeatedly visit the park but ensure that she did so safely, such as by avoiding listening to music while running and sticking to well-­used trails.

Please see exercises 7.2 to 7.5 for the steps involved in using opposite action.

Exercise 7.2 Opposite Action Step 1: Figure Out What You Are Avoiding

In this first set of steps, you identify people, places, and situations that make you afraid and that you avoid. These steps will help you figure out what you’re avoiding and many of the places in your life where you can use opposite action. Under “Situation, ” describe briefly a few key situations that you tend to be afraid of and avoid. Under “Fear, ” rate your fear of these situations on a scale from 0 (not at all afraid) to 10 (maximum fear possible). Then, under “Avoidance Behaviors, ” briefly describe what you do to avoid these situations or escape from them. The following example will get you started. Let’s say that you generally avoid places or situations where you perceive danger, such as public parks, buses, or places where you might end up alone with men.

Exercise 7.3 Opposite Action Step 2: Figure Out Your Emotions and Action Urges

This next set of steps helps you determine how and when to use opposite action in the moment when you are afraid or want to avoid situations and people.

Determine your emotion and your action urge. Your emotion is the emotional state that you are in, and in this case we’re talking about fear-­related emotions, such as anxiety, fear, nervousness, and trepidation. Your action urge is what you feel like doing when you have this emotion. Remember the example from exercise 7.2, in which you tend to generally avoid situations where you are around men or alone with men? Well, if you are in a coffee shop and suddenly realize that you and one man are the only customers there, your emotion might be fear (let’s say 7 on the 0-­to-­10 scale). Your action urge, or what you feel like doing, might be to pack up and leave, and perhaps you feel that urge at a level of 8 out of 10.

Exercise 7.4 Opposite Action Step 3: Determine Whether Your Fear Is Justified

If your fear is justified, that means that what you’re afraid of (in this example, let’s say you’re afraid you’ll be attacked) might very likely occur. If your fear is unjustified, that means that what you are afraid of is very unlikely to occur. So, if you think of it in terms of a fire alarm, a true alarm (when there really is smoke and a fire) is like a justified fear. A false alarm (when the alarm goes off, but there’s no fire or smoke) is like an unjustified fear.

Use opposite action for fear only if your fear is unjustified. For example, if the man in the coffee shop really was going to attack you, then it would be best to do exactly what you feel like doing and leave, rather than to do the opposite of what you feel like doing, which would be to stick around. Generally, fear is justified when there is an imminent threat to your life, safety, or well-­being. Use the columns below to figure out whether your fear is justified. Really think it through, and ask yourself Is there really reason to believe that my life, safety, or well-­being is threatened in this situation? If you answer no to all three, then your fear is unjustified, and it’s a good idea to use opposite action. Let’s say that your feared event is that the man will corner you and attack you. Think about, instead, the most likely event. Think of whether this poses any threat to your life, safety, or well-being.

Exercise 7.5 Opposite Action Step 4: Figure Out and Do the Opposite Action

The final steps are to figure out and then actually do the opposite actions. The opposite actions are the actions that are completely opposite to your action urges, or what you feel like doing. So, here, you revisit your action urges and then write down in the other column what the opposite action would be. This can be a little tricky, so we have included some examples for you. It is important to remember that you are to take the action that is opposite to what you feel like doing, or your action urge. It is also important to keep taking this action over and over again until your brain learns that the situation is safe rather than dangerous. Under the “Helpful” column, rate from 0 (not at all helpful, no reduction in fear) to 10 (extremely helpful, fear went way down) how helpful the opposite action was in reducing your fear. Remember, however, that opposite action often works over the long term rather than immediately in the short term.

We might suggest that you choose some of the situations you identified in exercise 7.2 and then gradually work through each of them, using these worksheets and taking opposite action where indicated.

Exercise 7.5