Unrelenting Crisis and Inhibited Grieving: Avoidance Reinforced in a Dialectical Dilemma
Key Points
- The dilemma of unrelenting crisis vs. inhibited grieving occurs due to the patient using avoidance as a primary coping skill.
- Avoidance of unpleasant emotion is reinforced by the environment and short-term relief.
- This creates a vicious cycle in which avoidance sensitizes the patient to future life stressors and leads to more actual crises.
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Transcript
This dilemma refers to the tendency of some patients to have multiple ongoing crisis situations coupled with an unfortunate deficit in the ability to process them. Think of it this way. If you eat a ton of food, you better have a great digestive system. The patient may seem to present in an inconsistent way as highly dysregulated about an event in one session and then seeming to dismiss it as no big deal in the next.
This fluctuation is thought to arise from the problematic way that they avoid processing emotionally charged material and instead use avoidance as their primary coping strategy. This cognitive avoidance is not sustainable and leaves them more vulnerable to future dysregulation and behavioral issues due to their failure to process the information properly. This then leads to a vicious cycle of emotional crisis and avoidance. Because it is relieving in the short term, avoidance perpetuates further avoidance and not only gets in the way of habituation to strong emotions but also creates a setup for future crises due to a lack of problem solving and anticipating problem outcomes.