In November I wrote about how the field is shifting away from thinking about complicated pain and some of the controversy surrounding changes in pain as an exclusion criterion for depression. I still agree that the change was a step in the right direction and with this in mind, we will look at how CBT can be helpful in addressing avoidance behaviors in the context of complicated grief. Individuals struggling with complicated grief may engage in avoidance behaviors as a way to cope with distress caused by loss-related situations. Behaviors may include avoiding family gatherings, isolating at certain times of the year, avoiding certain family members, avoiding places that have a connection to the loss – the list can be long or short. Avoidance behaviors have two big costs, the first is that in the long run they worsen the discomfort linked to the situation. To understand why this happens, it may be helpful to understand the culprit behind the behavior – faulty thinking. Avoidance behaviors are generally driven by catastrophic assumptions. By engaging in avoidance behavior we get immediate relief from distress because we avoid any catastrophic event that we believe could happen if we were to confront or deal with the situation – that's the hook. By avoiding the situation we deprive ourselves of the opportunity to test the hypothesis. Because negative thinking surrounds the situation we are trying to avoid, our beliefs about the situation become more catastrophic as more time passes between the present and our last positive exposure to the situation. This increases the likelihood that we will accept the hypothesis as fact without evidence. Let's say a hypothesis someone might have seems... middle of the paper... expected at exposure but eventually the distress drops below its pre-exposure level as a result of hypothesis testing and/or testing. survival of the situation even though it didn't go the way you wanted. Although we've used family reunions as an example in this post, we can really apply this thinking and skill set to anything we avoid as a result of the loss - photo albums, restaurants, city neighborhoods, etc. While exposure is effective, it is not advisable for every situation. For example, I would never encourage a person struggling with a gambling addiction to frequent a casino. Also, it is very important to remember that exposure can make things worse if not done correctly and so if there are any safety concerns or fears that exposure could lead to worsening of symptoms, it is probably best to seek professional assistance..