焦虑工具箱 第8章

Avoidance 规避

Behavioral Shifts to Overcome Avoidance Coping 转变行为以克服规避应对模式

Thinking shifts are only half the answer when it comes to stopping avoidance coping. You have to marry your thinking shifts with little shifts in your behavior. The more tiny behavioral shifts you make to scale back your avoidance, the less you’ll experience urges to avoid in the first place. In other words, your behavior will influence your thoughts and feelings. The strategies in this section, combined with the thinking shifts we’ve discussed, will help you make significant changes in your avoidance habits.

思想上的转变仅仅是停止规避应对行为的一半解答。你还要将你的思想转变和一点点行为转变结合。行为上的小转变越多，你减少规避行为就越多，你在一开始想要进行规避行为的经历就越少。这个部分的策略结合了我们之前讨论的思维转变，将帮助你再你的规避习惯上带来大的明显的改变。

Work Through a Hierarchy of Avoided Situations 通过避免情景的阶梯来转变

Back in Chapter 5 on rumination, we covered imagery exposure. Let’s now talk about a different type of exposure technique. Virtually every version of CBT for anxiety disorders involves working through what’s called an exposure hierarchy. The concept is simple. You make a list of all the situations and behaviors you avoid due to anxiety. You then assign a number to each item on your list based on how anxiety provoking you expect doing the avoided behavior would be. Use numbers from 0 (=not anxiety provoking at all) to 100 (=you would fear having an instant panic attack). For example, attempting to talk to a famous person in your field at a conference might be an 80 on the 0–100 scale.

在第五章的反复斟酌内容理，我们讨论了想象型曝光。让我们现在谈谈一个不同的曝光技巧。事实上每个版本的焦虑失调的CBT包含一种通过一个叫做曝光阶梯的的方法。概念很简单。你制作一个包含所有由于焦虑而规避行动的情景和行为的清单。然后基于你预期激发你采取规避行为的的焦虑程度，你对每一项进行打分。使用从0（一点不激发你的焦虑）到100（你几乎害怕会有一个直接的恐慌袭来）。举个例子，尝试在一个会议上与一个你的领域的名人进行对话可能是在0-100范围内排80分。

Sort your list in order, from least to most anxiety provoking. Aim to construct a list that has several avoided actions in each 10-point range. For example, several that fall between 20 and 30, between 30 and 40, and so on, on your anxiety scale. That way, you won’t have any jumps that are too big. Omit things that are anxiety provoking but wouldn‘t actually benefit you (such as eating a fried insect).

将你的清单排序，从最低的到最高的焦虑激发度。目标是构建一个清单，这个清单里面每10分的范围就有几个规避行为。例如，你的焦虑清单分成了几个落在20-30区间的，30-40区间的，等等。这样，你不会有任何太大的跨度。忽略掉那些引发焦虑但是不会有任何实际好处的事物（例如吃掉一个煎昆虫）。

Make a plan for how you can work through your hierarchy, starting at the bottom of the list. Where possible, repeat an avoided behavior several times before you move up to the next level. For example, if one of your items is talking to a colleague you find intimidating, do this several times (with the same or different colleagues) before moving on.

制定你如何克服你的阶梯的计划，从清单最下层的开始。只要可能，在移动到下一层之前，多重复一个规避行为几次。举例子来说，如果你的选项有一个是同一个你觉得吓人的同事对话，在进行下一阶段前多做几次这样的事（同一个或不同的同事）。

When you start doing things you’d usually avoid that are low on your hierarchy, you’ll gain the confidence you need to do the things that are higher up on your list. It’s important you don’t use what are called safety behaviors. Safety behaviors are things people do as an anxiety crutch—for example, wearing their lucky undies when they approach that famous person or excessively rehearsing what they plan to say.

当你开始做一些你通常避免去做的在你的阶梯底部的事情的时候，你会获得你做你需要做的清单上更高层的事情的自信。重要的一点是你不要使用所谓的安全行为。安全行为是一些人们作为焦虑拐杖的东西——例如，当穿上幸运内衣去接近名人或者过度演练他们计划要说的东西。

There is a general consensus within psychology that exposure techniques like the one just described are among the most effective ways to reduce problems with anxiety. In clinical settings, people who do exposures get the most out of treatment. Some studies have even shown that just doing exposure can be as effective as therapies that also include extensive work on thoughts. If you want to turbocharge your results, try exposure. If you find it too difficult to do alone, consider working with a therapist.

心理学圈有一个共识是，就像之前描述的，曝光技巧是减少焦虑带来的问题的最有效的方法。在临床中，进行曝光的人从治疗中获益最多。一些研究甚至表明，仅仅采用曝光技巧就与包含思想扩展工作的治疗手段一样有效。如果你想要提升你的结果，尝试曝光技巧。如果你发现自己一个人做很难，考虑和一个治疗专家一起来做。

Try a 30-Day Project for Overcoming Avoidance Coping 尝试30天克服规避应对模式

Avoidance coping habits aren’t something you can snap your fingers and change. A 30-day project focused on gradually turning around avoidance coping can help. You can use this approach as an alternative to the exposure hierarchy if doing a 30-day project seems more appealing or relevant to you.

规避应对习惯不是什么你打下响指就能改变的。可以通过一个为期30天的聚焦逐渐改变规避应对行为的项目来帮忙。如果30天的项目看起来更有吸引力或更适用你，你可以使用这个方法作为一个规避阶梯方法的备选。

During the 30 days, take as many opportunities as you can to be less avoidant than you usually would be. This will help you overcome any problems you might have with not knowing where to start in reducing your avoidance. As situations come up, focus on taking some action, even if you’re not certain what the absolute right action is. For example, if you’re confused by all the options for backing up your digital photos in the cloud, you might ask your most tech-savvy friend what she does, and just go with that. You can always switch later.

在30天里，尽可能多地抓住你可能比你通常规避较少的机会。这回帮助你克服任何你可能不知道从哪里开始减少规避行为的问题。当事情发生时，聚焦在采取一些行动，即使你不确定什么是绝对正确的行动。举例子来说，如果你对所有在云服务上备份数字照片的选项所困惑，你可以问问你最懂技术的朋友她怎么做的，照着她做就好了。你将来总是能切换成别的。

Don’t be too all-or-nothing about overcoming avoidance coping. We all have only so much willpower available for dealing with things we’d prefer not to do. The goal is to start unraveling your avoidance coping habits bit by bit. If you sometimes fall back into the avoidance coping trap, that’s to be expected.

不要在克服规避应对模式的时候太过于非此即彼（要么全部，要么没有）。我们只有有限的意志力来应对我们不愿意应对的事物。目标是开始一片片拆解你的规避应对的行为。如果你有时候落回到这个陷阱，那不出意外。

Boyes Ph.D, Alice. The Anxiety Toolkit