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Smart search·Try “avoidance after panic” in Formulation.

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Select candidate mechanisms, structure them with a clinical framework, challenge the hypothesis, then edit a de-identified draft.

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Mechanism hypotheses

Search and add mechanisms that may explain the pattern. Selection is provisional: evidence and alternatives come next.

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12 mechanisms

AvoidanceAvoidance may explain why distress persists despite the patient working hard to stay safe.

BehaviourCognition+2

SplittingSplitting can organise otherwise overwhelming mixed feelings, but it may make alliance ruptures more likely.

DefenceInterpersonal+2

ShameShame may explain avoidance, anger, withdrawal, or self-attack when the patient feels exposed or dependent.

AffectTrauma+2

Emotional dysregulationEmotional dysregulation can explain why stress rapidly becomes behavioural, interpersonal, or risk-relevant.

AffectBehaviour+2

Reassurance seekingReassurance seeking may show how anxiety is regulated interpersonally while uncertainty tolerance remains low.

InterpersonalAttachment+2

Attachment avoidanceAttachment avoidance may explain disengagement just when support, closeness, or dependency becomes clinically relevant.

AttachmentInterpersonal+2

Negative core beliefsNegative core beliefs provide a bridge between developmental learning and current interpretations.

CognitionDevelopmental+2

ProjectionProjection may explain why intolerable self-states are experienced as threats located in other people.

DefenceInterpersonal+2

RuminationRumination may maintain distress by keeping attention fixed on negative meanings without corrective action.

CognitionAffect+1

WorryWorry may function as an attempted safety strategy that keeps threat active and uncertainty intolerable.

CognitionAffect+2

DissociationDissociation may explain sudden disengagement, memory gaps, or emotional numbing when arousal exceeds coping capacity.

TraumaAffect+2

PerfectionismPerfectionism may organise coping around preventing shame, criticism, or loss of worth.

CognitionBehaviour+2

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

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Mechanism hypotheses

AvoidanceAvoidance may explain why distress persists despite the patient working hard to stay safe.

Framework: 5Ps
Review: 0/4

Treatment leverage

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Treat each mechanism as a hypothesis, not a diagnosis. Check the person’s context, culture, development, mental state, risk, and alternative explanations, then revise the formulation when new evidence does not fit.