To cope with anxiety and overwhelming experiences, many people develop distracting strategies which can lead to dysfunctional habitual patterns. It is often when poor behavioural coping becomes symptomatic that people come into therapy.

Regular avoidance of uncomfortable situations can hardly offer a long-term strategy to deal with our problems. Yet, when faced with stressful and overwhelming events, our immediate response is often to remove ourselves from the unbearable and painful experience. The problems arise when over time the avoidant tendencies become automatic and start limiting our range of responses, affect optimal performance and social interactions, ultimately lowering the very quality of our lives.

Distress Tolerance

Recognising the protective factors underlying even the most disruptive coping can help individuals in the understanding of their relapsing behaviours. With each failure to prevent undesired behaviour, many people report feelings of regret, shame and loss of control. This, in turn, exacerbates anxiety further, causing subsequent coping failures, and eventually locking affected individuals in a perpetuating habitual cycle. Despite the common stigma surrounding substance use disorders, it is often in an effort to feel normal again that people resort to harmful choices, often against their best judgement. Similarly, habitual automaticity can be recognised in any number of avoidant behaviours, whether it is excessive smartphone and internet use, overeating, smoking, or other distracting habits.

When we speak about “anxiety” or “coping strategies”, ultimately we are referring to our ability to respond to stress. Literature on the neurobiology of stress response and the survival mechanism (fight/flight) provides valuable insights into the biochemical and physiological processes contributing to the automaticity of our behaviours. Chronic mobilisation of our systems due to prolonged or accumulated stress can pose a significant risk to our health. Addressing some of the early signs can help in reducing the development of more severe impairments:

  • Mood disorders and heightened sensitivity (hypervigilance, etc.)
  • Poor concentration, procrastination
  • Panics, feelings of overwhelm
  • Increased alcohol and substance use
  • Eating behaviour disorders
  • Sleep difficulties
  • Blood circulation issues and heart concerns
  • Stomach aches and digestive issues

While stress response is a natural (evolutionary) mechanism experienced by all of us, it is shown to vary in its intensity across individuals. Thus the level of emotional reactivity can be moderated depending on how we experience and perceive stressful events, as well as our ability to tolerate distress.

Therapeutic work to build greater emotional resilience is often aimed to reduce one’s anxiety sensitivity (AS), – a common predictor of alcohol and substance use disorders, anxiety, panic and depression. Individuals who report higher AS are prone to misinterpret the bodily sensations (somatic expressions) associated with perceived threat or danger. Consequently, failure to regulate anxiety states amplifies stress responses and results in poor cognitive, metabolic and immune function. Research shows that high activation of the sympathetic nervous system impairs our executive control and decision making processes in the brain.

Strengthening prefrontal cortex

It is for the above reasons that therapeutic treatment of addictions and behavioural change work will often emphasise the strengthening of PCF. This may include cognitive restructuring, attention focus training and stress reduction interventions. Thanks to neuroplasticity, which allows the brain to restore and create new healthy pathways, re-learning how we respond to distress can help to reduce the intensity of impulses and re-write new coping strategies.

The therapeutic work of Self-regulation and distress tolerance aims at helping an individual to learn how to create a pause in their reactive behaviours, from where executive control and a more skilful decision making can take place. Cognitive-behavioural therapies including CBT (Cognitive-Behavioural Therapy), DBT (Dialectical-Behavioural Therapy), ACT (Acceptance Commitment Therapy), and MBCT (Mindfulness-Based Cognitive Therapy) are often integrated into addictions treatment and include skills-based practices to enhance patient’s regulation of intense emotions. In the course of a committed therapeutic treatment of addictions and relapse prevention, an individual can expect to learn how to identify their triggers and down-regulate the agitation levels to interrupt the escalating stress responses. Over time, the self-regulatory practice, together with cognitive-behavioural therapies can help to level the patient’s anxiety baseline.

When do you look for support?

It is hard to argue that all of us would benefit from a stronger emotional resilience to pivot in everyday stress. Evidence from burgeoning research into the subject suggests that high reactivity to stress exacerbates the risk for many mental illnesses as well as heart problems and hypertension. On an individual level, taking the time to introspect our daily quality of attention, energy levels and performance satisfaction, can arguably help to determine when to intervene.

Addiction Behaviour Disorders (DSM-V) is a chronic medical condition requiring a systematic treatment that addresses its biological, psychological and socioeconomic effects on an individual. If you think that you or a family member are at risk or suffering from any related symptoms, making a call for early intervention is key in successful treatment.