In Module 6, we identified how health related behaviours exist on a continuum, where too much or too
little of a behaviour may be unhelpful for us. While Module 6 explored behaviours we might be doing too
much, this Module will explore behaviours that we may be avoiding or putting off due to feelings of anxiety.
In Module 3, we introduced the notion of avoidance and safety behaviours. In this Module, we will revisit
the common types of avoidance and safety behaviours, and introduce a way to gradually start to challenge
and overcome these behaviours.
What are Avoidance and Safety Behaviours?
When we feel anxious or expect to feel anxious, we often act in one of two ways to try to
control our anxiety. One way is to engage in avoidance, where we stay away from those
situations or activities that we associate with feared illnesses or that remind us of our
mortality. This could include avoiding:
• people (e.g., medical staff, ill friends or relatives),
• places (e.g., hospitals, public restrooms, funeral homes), or
• activities (e.g., attending medical appointments, thinking about death, writing a will)
Also, because people with health anxiety tend to worry more that usual about physical symptoms in their
bodies, we may also avoid activities that bring about changes in our physiological state (e.g., exercise, having
sex, eating spicy foods, drinking caffeinated drinks).
Alternatively, we may engage in safety behaviours, where we may not outright avoid a situation or
activity, but we will only do so if certain precautions are in place. For example, someone who is fearful of
contracting an illness may only visit a friend with a non-infectious disease if they are taking a preventative
course of antibiotics and plan minimise touching objects within the friend’s house . Safety behaviours are
often thought of as a more subtle form of avoidance because you are not fully testing out your fears or
engaging with the situation.
Avoiding situations or activities, or using safety behaviours to cope with them, may reduce the anxiety we
feel in the short term, but is likely to have some less helpful long term effects. In the long term, our health
worries and concerns will continue, because we haven’t given ourselves the opportunity to face our fears
and see how things really play out. We will also feel the need to continue to use avoidance and/or safety
behaviours, as we haven’t learnt whether we can survive without them. Over time, using avoidance and
safety behaviours can deplete our sense of self confidence. These behaviours may also stop us from doing
things we would like to do and lead to a very restricted an unsatisfying life.
Ultimately, you will need to face and confront your fears if you want to overcome health anxiety.
Overcoming the fears that drive avoidance and safety behaviours can seem daunting at first. Some people
might encourage you to tackle your biggest fear first – to “jump in the deep end” and get it over and done
with. If, however, you try to tackle your biggest fear straight away, it can end up being too overwhelming
and may even leave you more anxious than when you started. Many people therefore prefer to take it
“step-by-step, like climbing up a stepladder. We call this stepladder approach “graded exposure”.
Graded exposure consists of structured and repeated exposure to anxiety-provoking situations or
activities. These are presented in levels of difficulties, starting with the situation or activity that provokes
the least amount of anxiety, and then moving towards more challenging ones. There are a number of
benefits to engaging in exposure.
• Psychotherapy • Research • Training
Module 7: Reducing Avoidance and Safety Behaviours