The emotion of fear is shaped by reason and by learning, and thus fears can become “rational”—in response to a threat or danger that has been assessed as reasonable based on past experiences or by a lack of reassuring information about the level of threat—or can become “irrational,” either not based in reason or out of proportion to the actual threat. Persistent irrational fears are called phobias, and many healthcare professionals consider avoidant personality disorder a type of social phobia.
The ability of humans to modulate fear through learning and through cognitive reasoning makes cognitive behavioral therapy, or CBT, a very effective treatment for both avoidant personality disorder and for addiction. CBT is a type of psychotherapy that helps identify problematic behavior patterns. In CBT, participants will closely examine the thoughts, feelings, and actions that make up these behavior patterns and, with guidance, look for ways in which they can be reconsidered or reimagined. CBT involves confronting previously unexamined, reflexive thoughts (“automatic thoughts”) and gently challenging clients to consider other possibilities.
It is this process of challenge that allows people who engage in CBT to often become able to root out “vicious cycle” thinking patterns. For example, when there is an automatic belief that “things never work out for me,” a person may preemptively withdraw from potentially healthy activities, relationships, or experiences because of the belief that they will result in failure, and the withdrawal from them creates a sense of shame or embarrassment that in turn reinforces the belief that things will “never work out.”
Case reports and smaller studies of less rigorously researched techniques suggest that metacognitive interpersonal therapy and emotionally focused therapy are especially helpful when AVPD and addiction co-occur.
Twelve-step-based therapy remains a staple of addiction treatment, but it can also help address avoidance behaviors. Some 12-step-based literature asks participants to include instances of avoidance and fear in their work on Step 4 (“made a fearless and searching moral inventory of ourselves”). In these books, the goal is to have people take a more balanced approach to their self-appraisal; rather than being ashamed about the times they were paralyzed by fear or avoided responsibility, participants are also asked to recall times when fear helped protect them from danger or when they assumed responsibility.
When healing from co-occurring addiction and avoidant personality disorder, many approaches can be utilized, sometimes in combination with each other. Residential drug addiction treatment and therapies can be tailored to include individual, group, and self-directed learning experiences. They should involve management of withdrawal when necessary and always involve a long-term care plan. The conditions of AVPD and addiction, like all chronic conditions, can be managed successfully, and those with AVPD and addiction can live fulfilling, rewarding lives.
