Are We Coping Or Avoiding
What 30 Years of Research on Experiential Avoidance Tells Us About Coping with Life's Hard Transitions
In my practice as a therapist, there is a particular kind of client I have met often. She is competent, kind, articulate, running slightly late, apologising for the traffic, and telling me within the first few minutes that she is not sure she really needs to be here since others have it so much worse. She has been holding many parts of her life together for a long time and this ability to multitask like a pro has become so automatic that she no longer notices the effort it takes.
So what brings her to the therapy room? It is not an obvious sense of falling apart or the exhaustion but rather the strange and unwelcome discovery at the pit of her stomach that the strategies which have carried her so faithfully through her life are not serving her any more. She thinks, "am I going crazy or are the people around me changing?"
When I read some of the well-known peer-reviewed literature that has accumulated over the past three decades, one particular idea keeps surfacing in exactly this territory, weaving through addiction and chronic pain, through depression and anxiety, through the emotional aftershocks of a cancer diagnosis and the slow attrition of bereavement, and that idea is experiential avoidance, which has become one of the most clinically useful concepts to emerge from Acceptance and Commitment Therapy.
The case of Aby
Let me tell you about Aby, who is a composite drawn from many people I have worked with and who belongs, in her particulars, to none of them.
Aby is forty-six, she runs a team of eleven people at a firm where she has been promoted twice in four years, she has a daughter sitting through national board exams and a son who has recently stopped talking to her in complete sentences. Eight months ago her father died after a long illness during which she managed his medications, his appointments, his insurance paperwork, and his moods, largely on her own, while her brother called dutifully from abroad every Sunday. Her mother now lives with her, and the arrangement is loving and impossible in roughly equal measure, and there is a running conversation about whose life is being sacrificed for whom that nobody in the house has ever said aloud.
What Aby told me in our first session was that she was not sad, she was efficient, and that she had not cried since the funeral and that she had built her whole adult life on the conviction that a woman can decide who she is going to be and then become that person through sheer application. Her belief that strong affirmations would manifest into positive outcomes was not really working anymore.
Her symptoms were physiological: chest would tighten in meetings for no reason she could identify, and she would excuse herself to the washroom and stand there breathing until it passed and then return and continue the agenda. The symptoms were also cognitive and emotional: at two in the morning she would find herself replaying a single sentence from a conversation with a colleague nine days earlier, turning it over and over, drafting replies she would never send.
She had stopped answering messages from the two friends who knew her best, not because she was angry with them but because the prospect of being asked how she was doing felt like standing in front of an open door she did not have the strength to close again, and so it seemed simpler, in each individual moment, to leave the message unread and tell herself she would reply properly at the weekend.
Every one of these responses made complete sense to her, and every one of them was a small, reasonable, immediately effective way of not feeling something, and together they were slowly leading her towards a familiar sense of dread which she just couldn't shake off.
Naming The Unknown
Experiential avoidance describes the tendency all of us have to push away, suppress, or escape from unwanted internal experiences such as difficult thoughts, painful emotions, uncomfortable bodily sensations, or distressing memories, even when the pushing away ends up costing us far more in the long run than it saves us in the short run.
Steven Hayes and his colleagues gave the idea its formal shape in 1996, proposing that rather than sorting human suffering into ever finer diagnostic categories we might do better to look at what a person is functionally doing with their inner experience. This reframing turned out to be enormously fertile because it let clinicians see the shared machinery underneath very different presentations.
Researchers typically describe avoidance as taking two broad forms:
The first being suppression, where we try to control or eliminate an unwanted internal experience directly, as Aby does when she breathes her panic down in the washroom and walks back into the room as though nothing has happened.
The second being situational escape, where we instead rearrange our external circumstances so as to sidestep whatever might trigger that unwanted experience, which is precisely what Aby is doing every time she leaves a friend's message unopened.
Why It Is So Difficult to Simply Stop
The concept grew out of Relational Frame Theory, which offers an account of why avoidance becomes so remarkably entrenched in human beings and so much less so in other animals. This rationale rests on the peculiar power of language. Since we relate things symbolically and bidirectionally, a word or a name or a place can come to carry the full emotional charge of the event it points to.
For example, merely hearing words like hot soupy dumplings can make the mouth water and, similarly, merely thinking about one's source of stress can reliably increase the heart rate and simulate actual anxiety. This means that, unlike a creature which can simply walk away from a threatening predator, we carry the memory of our stress with us wherever we go, encoded in the language we cannot switch off.
This is why Aby cannot solve her problem by leaving the room, and it is also why the more strenuously she tries not to think about the last weeks of her father's life, the more insistently those weeks arrive at two in the morning, uninvited and in high definition.
One Thread Through Many Rooms
The reason experiential avoidance has drawn such sustained research attention is that it behaves as what psychologists call a transdiagnostic factor, meaning that it appears as a common thread underneath many different conditions rather than belonging to any single one, and this gives practitioners something concrete to work with instead of chasing down each individual symptom as though it were a separate problem.
A 2024 theoretical review by Wang and colleagues traced how avoidance, once it becomes habitual through negative reinforcement, begins to erode attention, memory, and emotional processing over time, producing what those authors describe as a downward spiral that deepens vulnerability to depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder.
What I find clinically valuable in this model is that it explains something my clients often describe with real bewilderment, which is the sense that the more skilfully they manage their feelings the worse their capacity to feel seems to become. It's almost as if they have somehow become both harder and more fragile at the same time.
What the Evidence Actually Says
Most of the research comes from meta-analyses, which are studies of studies. Researchers gather every piece of published work on a question, pool the numbers together, and calculate one overall result. A single study can be a fluke, but a pattern that holds across hundreds of them is much harder to dismiss.
In psychology, anything above 0.5 is considered a strong link, and it is uncommon.
The largest picture we have
In 2022, Akbari and colleagues pooled 441 studies covering more than 135,000 people. They found that the more a person avoids their inner experience, the more depression, anxiety, obsessive-compulsive symptoms, and post-traumatic stress they tend to report. The links ranged from 0.41 to 0.59 depending on the condition, which is moderate to strong across the board. What matters here is the breadth, because avoidance is not attached to one diagnosis but shows up underneath many of them.
When the pain is real and unavoidable
You might argue whether this holds when someone is facing something genuinely terrible rather than something they could talk themselves out of. Fawson and colleagues looked at 108 studies covering 17,195 people living with cancer. Avoidance and distress moved together at 0.58, which is strong.
More strikingly, that link was tighter than the links for acceptance and present-moment awareness, meaning avoidance predicted suffering more powerfully than acceptance predicted relief.
This suggests that how hard someone is pushing their fear away tells you more about how much they are suffering than almost anything else you could measure. The cancer is not the variable we can change, and neither is the diagnosis or the prognosis. What we can work with is the pushing.
The same pattern in addiction
A 2026 review by Sequeda and co. showed that higher avoidance consistently predicted heavier use of alcohol, tobacco, cannabis, and other substances.
More importantly, avoidance was often the bridge between a person's past and their present, sitting in the middle of the path that runs from trauma to addiction. Substances were not the beginning of the story but the tool that made not-feeling possible.
One impulse, many disguises
The same review offers two small portraits worth holding side by side. Combat veterans with PTSD who avoided more and reappraised their emotions less went on to drink more heavily. Smokers who worried more avoided the discomfort of quitting more, and then found quitting harder.
This is what researchers mean when they call avoidance transdiagnostic. It is not a symptom belonging to one condition but a habit that borrows whatever is nearest. For a veteran it might be a bottle, for a smoker a cigarette, and for Aby it is an unread message and a closed car door. The behaviours look nothing alike, and the function is exactly the same.
Where Aby's Story Turns
I did not begin our work together by telling Aby that she was avoiding anything, partly because she would have heard it as an accusation of weakness and partly because it would not have been the most useful thing to say first. What we did instead was slower and gentler, and it began with a question about cost rather than a question about feeling, because I asked her what she had given up in the past eight months, and she listed the friendships almost without noticing she was listing them, and then she stopped talking for a while.
The work of Acceptance and Commitment Therapy is not the work of making difficult feelings go away. I want to be careful here because the coping strategy Aby had built for herself held the belief that with enough discipline a person can engineer her way out of grief.
This promise is both seductive and, in my experience, sneakily cruel. What the therapy offers instead is the possibility of making room, of learning to carry anxiety and looping thought and the ache of a father's absence in the same hands that are also holding a daughter's exam schedule, a difficult colleague and a mother's loneliness.
For Aby this looked like continuing to stay in a meeting with a tight chest rather than leaving to manage it, and finding that the chest loosened with a specific learned awareness.
It looked like replying to a friend with the entirely honest sentence that she was not doing well and did not want to talk about it yet, which turned out to be something a friend could receive without alarm. It looked, eventually and much later, like letting herself cry somewhere other than the car.
What This Means, In the End
The clearest thread running through the whole body of this research is that experiential avoidance is not merely a symptom of psychological distress but is one of its central engines, linked across hundreds of independent studies and multiple meta-analyses to poorer outcomes in mental health, in addiction, and in physical illness alike.
What this means practically is that therapies which work directly on our willingness to make room for difficult thoughts and feelings, rather than on our capacity to defeat them, are addressing something with real mechanistic weight.
It's not about focussing on a peripheral matter of changing a coping style but about accepting the discomfort with awareness. This is very probably why acceptance-based approaches continue to show meaningful, if sometimes modest, benefits across such an unusually wide range of conditions.
It is worth holding the modesty of those benefits honestly, and it is worth noting too that much of this evidence is cross-sectional and cannot establish causation, that the great majority of it comes from high-income Western settings, and that the most widely used measures of avoidance overlap uncomfortably with measures of general distress, all of which are limitations the researchers themselves name clearly. The construct is useful rather than complete.
But for the woman sitting across from me at six in the evening with her phone face down on the table, apologising for the traffic, what the research finally culminates in is something simpler.
She has not failed at what she set out to do. She has been working with enormous determination at an endeavour no amount of determination can accomplish. It then becomes our shared goal to work together to channel all that energy and attention on constructively working through actually feeling the discomfort before watching it fade on its own accord.
References
Akbari, M., Seydavi, M., Hosseini, Z. S., Krafft, J., & Levin, M. E. (2022). Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. Journal of Contextual Behavioral Science, 24, 65–78. https://doi.org/10.1016/j.jcbs.2022.03.007
Fawson, S., Moon, Z., Novogrudsky, K., Moxham, F., Forster, K., Tribe, I., Moss-Morris, R., Johnson, C., & Hughes, L. D. (2024). Acceptance and commitment therapy processes and their association with distress in cancer: A systematic review and meta-analysis. Health Psychology Review, 18(3), 456–477. https://doi.org/10.1080/17437199.2023.2261518
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., Zvolensky, M. J., Eifert, G. H., Bond, F. W., Forsyth, J. P., Karekla, M., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553–578. https://doi.org/10.1007/BF03395492
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152
Sequeda, G., Durán-Rondón, S., Acosta-López, J. E., Torres-Santos, E.-A., & Rivera-Porras, D. (2026). Experiential avoidance and psychoactive substance use: Systematic review. European Journal of Investigation in Health, Psychology and Education, 16(2), Article 22. https://doi.org/10.3390/ejihpe16020022
Wang, Y., Tian, J., & Yang, Q. (2024). Experiential avoidance process model: A review of the mechanism for the generation and maintenance of avoidance behavior. Psychiatry and Clinical Psychopharmacology, 34(2), 179–190. https://doi.org/10.5152/pcp.2024.23777
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