From self-labeling to self-sabotage: identifying with anxiety fuels avoidance behaviors

A new study highlights that closely identifying with mental health labels like “anxiety” may inadvertently reinforce counterproductive coping behaviors.

The research, currently available as a preprint, reveals that people who see their anxiety as central to their self-concept are more likely to avoid both the situation and the experience.

Isaac L. Ahuvia led a team of researchers at Stony Brook University. The authors suggest that anxiety may be exacerbated by justifying avoidance through the lens of illness identity. They explain:

The use of avoidant coping may be enhanced by illness identity—the degree to which one identifies with the label of one’s illness (eg, anxiety). It is useful to distinguish between two aspects of illness identity: self-labeling (identifying with an illness label, for example, I have anxiety) and identity centrality (viewing illness identity as relatively important to to self-concept). Some have hypothesized that when individuals have a stronger anxiety identity, they may subsequently believe that they cannot participate in certain anxiety-provoking situations (eg, public speaking) or that they are justified in avoiding them. By justifying their avoidant behavior, these individuals may inadvertently maintain their anxiety over time.

The study’s new approach, which uses a visual representation to measure the centrality of illness identity, underscores the profound impact that self-perception and diagnostic language can have on mental health outcomes. This finding challenges current perspectives on anxiety management and opens a critical dialogue about the role of identity in mental health treatment and self-care strategies.

Understanding how people, especially young people, adopt and adapt mental health labels is important, as research has shown that it significantly affects their self-concept and can contribute to the development or reinforcement of mental health problems.

Ian Hacking’s concept of the ‘loop effect’ where people modify their behaviors and self-concept in response to being labeled with psychiatric diagnoses is very relevant here, as it illuminates how mental health labels can become become self-fulfilling prophecies, shaping and often reinforcing the many themes they describe. The transformation of diagnostic labels into markers of personal identity can lead to a deeper consolidation of these issues as people begin to see and experience their life challenges through the lens of these diagnoses.

Recognizing this dynamic is essential for mental health professionals to prevent the reinforcement of mental health problems through diagnostic language and to ensure a more personalized and less pathologizing approach to mental health care.

The researchers in this study hypothesized that if anxiety becomes a central part of someone’s identity, the use of avoidant coping mechanisms may increase. Ahuvia and colleagues sought to test whether anxiety-induced avoidance can be made worse when avoidance is justified through the lens of illness identity.

All 1,234 participants in this study had at least moderate anxiety symptoms. They completed an indication adapted from a 1992 study by Aron, Aron, and Smollan. In this study, two circles are placed like a Venn diagram; one circle is labeled me and the other is my anxiety. Participants were asked to select an image that best represented their self-concept.

Inclusion of others in the autoscale adapted by Simon Gchter, Chris Starmer, Fabio Tufano 2015

If a participant selected the option that completely overlapped the circles, they were considered someone who considered their illness identity to be important to self-concept. If the circles were completely separate, they would be considered someone who saw their anxiety as distinct from their self-concept.

Participants then completed surveys about the amount of time they have had their anxiety, their frequency of engaging in avoidant coping, and the severity of their anxiety. Avoidant coping was differentiated into two forms of avoidance, namely situational and experiential.

Experiential avoidance involves avoiding negative internal experiences such as thoughts and emotions, while situational avoidance means avoiding specific external scenarios or activities that trigger anxiety. Over time, both can intensify anxiety symptoms: experiential avoidance can reinforce fear of internal experiences, making them seem more threatening, and situational avoidance can limit opportunities to learn that feared situations are manageable, which can lead to a more restricted life and sustained anxiety.

Situational avoidance was assessed using questions such as: In the past week, how often did you avoid situations, places, objects, or activities because of anxiety or fear?

Experiential avoidance was assessed using rating questions such as: I am willing to fully experience all thoughts, feelings and sensations that come to me, without trying to change them.

Participants responded on a 7-point scale ranging from strongly agree to strongly disagree.

The authors noted that avoidance is a symptom of anxiety itself. They excluded avoidance as a symptom when asking people about their anxiety levels and severity to avoid redundant results. This means that the study finds no novelty in people with anxiety avoiding their problems or feelings. Instead, it finds new insights into how internalizing anxiety as part of the self can lead to an increase in the symptom of anxiety: avoidance.

The results of the study support the above concept. There is a positive correlation between anxiety identity centrality and both types of avoidant coping. The most profound correlation was found between situational avoidance and anxiety identity centralitya one-level increase in anxiety identity centrality was associated with a 0.18 standard deviation increase in experiential avoidance.

No correlation was moderated by anxiety symptom severity. These data suggest that anxiety identity centrality may affect and worsen anxiety symptoms, regardless of anxiety severity.

A potential feedback loop is involved (although this study is cross-sectional): Having anxiety may facilitate avoidant coping (thus leading to worse clinical outcomes over time).

This study suggests that receiving a diagnosis may cause individuals to internalize their illness, resulting in more avoidant coping. The authors highlight the unique visual method used in this study to measure illness identity centrality and its potential for application to other mental health conditions.

The conclusions that can be drawn from the study are limited by its cross-sectional nature, which means that the study only examined outcomes at a single point in time, without tracking them over time. The authors emphasize the importance of future research investigating the causal and longitudinal relationships between identity anxiety and avoidant coping.

The present study also had limited demographic representation, with 81.2% female and 71.2% identifying as white.

This research is crucial because it highlights the potentially self-reinforcing nature of mental health diagnoses. By internalizing these labels, people may inadvertently intensify their anxiety symptoms, creating a feedback loop where avoidance behaviors, justified by an illness identity, perpetuate the very anxiety from which they seek to escape. The findings underscore the importance of careful consideration in the use of diagnostic language, suggesting the need for a more nuanced approach to mental health care that takes into account the profound impact of identity on coping and general well-being.

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Ahuvia, I., Eberle, JW, Schleider, JL, & Teachman, B. (March 21, 2024). Anxiety identity centrality is associated with avoidant coping in anxious adults. https://doi.org/10.31234/osf.io/5wgnc (Link)

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