Emotional Avoidance Maintains Mental Illness

Young girl struggling with Emotional Avoidance

Contributor: Rebecca Brumm, MA, LPC, CEDS – Director of Operations at Laureate Eating Disorders Program

Imagine requesting your patient place their hand on a hot burner and allow themselves to fully engage their awareness and presence with the sensation of their burning flesh. This seems counter-intuitive, unethical and downright cruel. It certainly would not add therapeutic value. Surprisingly though, learning to move toward the physical discomfort and even pain that emotions cause appears to be an important part of recovery from mental illness and substance abuse.

Emotions produce physical sensations and sometimes actual physical pain. Several studies show that psychological pain is processed in the brain the same way that physical pain is.

(SITE) Emotions have a dichotomous relationship with pain. Instinctively we want to avoid pain, yet avoiding emotional pain can often extend suffering. Pain tells us something is wrong and that this stimulus must be avoided.

We quickly learn to avoid things that produce pain. This program in our human nature is largely functional, protective and adaptive.

Despite it being largely adaptive to avoid pain, a core feature that maintains mental illness is emotional avoidance. What is more, avoidance of emotions is a common thread running through addictions, eating disorders and mood disorders such as Major Depressive Disorder and Generalized Anxiety Disorder.

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Several therapeutic interventions promote moving into emotional pain. For example, mindfulness components in Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT) advocate for awareness of the bodily sensations produced by emotions. They further promote emotional acceptance of an approach toward mentality.

So, if pain avoidance is innate and functionally appropriate most of the time, how can we teach clients to override this instinct when it comes to feelings? Therapeutic goals aimed at increasing awareness of bodily emotional reactivity, acceptance of it, and the ability to move toward it are important areas to include in the treatment.

Interventions that teach a patient to disengage from pain avoidance by developing skills that improve a patient’s ability to move toward, express and experience emotions demonstrate how important this piece is to promote recovery and wellness.

Woman thinking and struggling with anxietyDr. Daniel Siegel, the author of Mind Sight, offers a metaphor to explain how, instead of emotional avoidance, emotional pain must be taught to be handled differently than physical pain. He explains if a dog bites someone’s hand, the natural reaction is for them to pull away as quickly as possible.

While this is intuitive, this action will cause increased damage. The action of pulling against the dog’s bite allows the teeth to sink further into the skin.

What Siegel offers as the alternative is to push into the dog’s bite. This engages the dog’s gag reflex, which in turn causes him to release the hand. Like emotional pain, by moving toward the painful stimulus, allows it to let go.

Consider how drinking, drug use, restriction or binging, and withdrawing are all attempts to avoid emotional pain. When using logic to think through our instinctive actions, life circumstances lead to emotions, emotions can lead to pain, pain tells us to avoid its source.

Unfortunately, engaging in emotional avoidance behaviors to avoid pain “allows the teeth to sink in further” and causes more damage. Teaching skills to push into emotions in order to loosen their grip must be a part of treatment so that dependency on behaviors to avoid them subsides.

Teaching patients to lean into emotions starts with explaining that emotions have a physical signature in the body. I have often been surprised to see what a difficult task it is for a patient to explain how they know they are having an emotion.

It is not unusual for someone to report that they “just do.” Upon closer examination, though, patients find that a burning in their stomach or a tightening in their chest or throat, or a clenching in their jaw signals to them the emotion they are feeling.

When a clinician can encourage a patient to be curious about these sensations without judgment, what is often found is that the sensation is largely tolerable. It can be helpful to have the patient rate on a scale from one to ten how intense the sensation is.

Woman working through Anxiety, Depression, and Emotional AvoidanceExplaining the scale as ten being the most painful experience, and one being a minor irritation, helps patients gain perspective on their ability to cope with the pain.

Asking them to breathe from the spot in their body where the sensation is located, as though moving toward it, while observing how the sensation changes, helps to demonstrate to them how awareness and allowing assist in making emotions something that is manageable.

While attempting to avoid painful emotions is understandable, given human nature’s desire to avoid pain in general, several mental health disorders thrive with emotional avoidance. Through education and intervention, patients can begin effectively coping with feelings.

Patients who can identify emotions, experience the sensations they present in their body, and learn to accept and move into them can gain freedom from behaviors that only serve to cause further suffering.


Siegel, D. J., & Goleman, D. (2011). Mindsight: the new science of personal transformation. New York: Bantam Books Trade Paperbacks.

About the Author:

Rebecca Brumm ImageRebecca Brumm, MA, LPC, CEDS is the Director of Operations at the Laureate Eating Disorders Program. She has a master’s degree in professional counseling from Central Michigan University.

Though she has helped clients through a variety of challenges in her practice as a therapist, Rebecca specializes in helping people work on improving their body image and overcoming eating disorders. She is a certified Intuitive Eating Counselor, a Health at Every Size (HAES) practitioner and has served as a national health presenter for Cigna Health.

For over a decade, Rebecca has experienced how a strained relationship with the body can negatively affect the quality of life. She is passionate about helping people develop self- compassion, connection, and acceptance. Rebecca believes learning to nurture a healthy relationship with one’s body can be transformative in someone’s overall quality of life.

Laureate Eating Disorders Program BannerThe internationally recognized Laureate Eating Disorders Program in Tulsa, Oklahoma, is designed to meet the needs of individuals with anorexia nervosa, bulimia, and other eating-related difficulties. Our program offers a full continuum of care for eating disorder recovery, including acute hospitalization, partial hospitalization, residential care, transitional living, and outpatient services. A multidisciplinary team of psychiatrists, therapists, dietitians, and nurses collaborate daily to meet the individual needs of each patient in a safe, supportive environment. The combination of our care, our facility, and our highly experienced staff creates a program that provides results. By limiting care to 18 adult women and 12 adolescent girls the Laureate Eating Disorders Program maintains a more intimate environment to ensure individualized, patient-centered care.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Reviewed & Approved on December 13, 2019, by Jacquelyn Ekern MS, LPC
Published December 13, 2019, on EatingDisorderHope.com