A Contemporary Behavioral Analysis of Anxiety and Avoidance

Despite the central status of avoidance in explaining the etiology and maintenance of anxiety disorders, surprisingly little behavioral research has been conducted on human avoidance. In the present paper, we first provide a brief review of the empirical literature on avoidance. Next, we describe the implications of research on derived relational responding and the transformation of functions for a contemporary behavioral account of avoidance, before providing several illustrative research examples of laboratory-based analogs of key clinical treatment processes. Finally, we suggest some challenges and opportunities that lie ahead for behavioral research on anxiety and avoidance. Lifetime prevalence rates of anxiety disorders are estimated at between 10.6% (Sommers, Goldner, Waraich, & Hsu, 2006) and 28.8% (Kessler, Berglund, Demler, Jin, & Walters, 2005). These high prevalence rates "eclipses the capacity of specialized mental health service providers" (Sommers et al., 2006, p. 110), placing considerable demand on clinical, social, and financial resources. Unlike research on low incidence disorders, such as autism, with which behavior analysis has had a significant and lasting impact, behavioral research on high incidence disorders like anxiety is virtually nonexistent. Several authors have commented on the factors that may have hampered behavior analytic research on anxiety disorders (e.g., Eifert & Forsyth, 2007; Friman, Hayes, & Wilson, 1996). First, definitional problems with the term “anxiety” may help explain behavior analysts’ reluctance to fully pursue an experimental analysis of this topic (see Friman et al., 1996). The etymology of the term 'anxiety' shows that it has evolved from a metaphor referring to choking sensations ("anguisse") into a pseudotechnical term with fuzzy, topography-based boundaries (Friman et al., 1996). Indeed, the ongoing expansion of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) has spurned an ever increasing number of categories and constellations of symptoms such that "anxiety disorders" is now used as an umbrella term for a range of specific (i.e., social phobia) and non-specific (e.g., generalized anxiety disorder) forms of anxiety. That the term anxiety refers to a fuzzy set of topography-based behavioral dimensions does not, however, preclude a functional analysis of the contexts that evoke use of the term (Skinner, 1945). Indeed, it may be argued that much of the existing conceptual analyses from within behavior analysis have done just that. Also, despite the inclusion of private events and topographical features in the definition of anxiety disorders, this does not rule out identification of the potential operant function of the behavior of anxious individuals (for a similar point made within the context of determining the function of pathological gambling, see Dixon and Johnson, 2007).