How to Reduce Avoidance in PTSD

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Learning how to reduce avoidance in post-traumatic stress disorder (PTSD) can be an important part of PTSD treatment. Avoidance can be a central symptom of PTSD. Avoidance often occurs as a result of someone trying to limit contact with triggers for anxiety, fear, or memories and thoughts about a traumatic event. This is understandable as these emotions and thoughts can be incredibly distressing.

However, not all situations, people, or places can be avoided. And triggers also can present themselves unexpectedly. They are all around. In addition, avoidance only works for a short time.

Over the long haul, avoidance generally becomes more severe and it can cause your PTSD symptoms to worsen.

As a result, avoidance is a symptom of PTSD that can greatly interfere with the quality of your life.

How to Reduce Your Avoidance Behavior

Breaking down avoidance behavior is not an easy thing to do. However, there are steps you can take to start reducing your avoidance behavior now. Follow the steps below and start taking back your life from your PTSD symptoms.

  1. Spend a week monitoring your behavior. Pay attention to what situations, people or places trigger your PTSD symptoms and lead to avoidance behavior. Write down as much information as you can about what it was in your environment that triggered avoidance and what you did to avoid the situation.
  2. At the end of the week, on a new sheet of paper, make three columns. In the first column, write down the numbers 0 through 10. These numbers are going to refer to your level of fear or distress associated with being in a certain situation. In the second column, organize the situations, people, or places that you avoid based on the level of fear or distress that they cause for you. You can have more than one situation, person, or place for each number. What you are doing here is essentially creating a fear hierarchy (as is done in exposure therapy for PTSD). In the final column, write down specific behaviors you can engage in to start approaching these situations. It is important that you don't just write down the opposite of the avoidance behavior. For example, if you wrote down in the second column that you avoid going to the grocery store due to fears of large crowds, you don't want to just write down in the third column, "Go to the grocery store." It is not that easy. Instead, write down a series of behaviors that you can engage in that will allow you to slowly start approaching feared situations. For example, if you fear going to the grocery store, you might first write down, "Drive to the grocery store and sit in the parking lot." Once you are successful with that step, you might then move to going into the store for just 5 minutes. Once successful with that step, you might then go shopping for 20 minutes during a time when the store is not busy, and so on. Break down all of your approach behaviors into concrete, well-defined steps.
  3. Once you have your list completed, start at the bottom of the list (with situations listed as causing zero fear or distress) and begin tackling those situations. Take your time. There is no rush. Once you feel as though you have accomplished a situation, move on to the next one. With each step, you will slowly build up your confidence and the easier it will become.

Some Points to Consider

It is important that you make sure you practice anxiety-reduction coping techniques when engaging in this exercise. It is very important that you do not avoid while doing these exercises. If you notice that your anxiety spikes during the exercise, stay in the situation and use healthy coping skills to allow the anxiety to naturally reduce on its own.

It may also be helpful to start doing these exercises with a friend or source of support. However, you don't always want to have someone with you when you do these exercises. Doing so may prevent you from feeling as though you can approach situations on your own.

If you aren't initially successful in approaching a situation don't give up. Breaking down avoidance behavior is a very difficult thing to do and it can take some time. If you get stuck on a certain step, try to break down the approach behavior into even smaller steps. The most important thing is that you keep trying. Even a little forward progress can have a tremendous impact on your life.

Finally, when you have fully approached a situation that you used to avoid, make sure you reward yourself. Overcoming avoidance behavior is not an easy thing to do. Therefore, it is important to recognize your accomplishment.

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  • Foa, E.B., Hembree, E.A., & Rothbaum, B.O. (2007). Prolonged exposure therapy for PTSD. New York, NY: Oxford University Press.

By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.