Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: avoidance or rumination?

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Rumination

Rumination may feel like problem-solving but often maintains low mood, shame, threat, and cognitive inflexibility.

CognitionAffectBehaviour

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BRepetitive, passive, negatively toned thinking about distress, causes, meanings, or consequences.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BAttention becomes repeatedly captured by unresolved negative meanings without moving into effective action or new learning.

Look for

AMissed appointments · Safety behaviours

BLong repetitive analysis · Difficulty shifting attention

Patient language

A“I just avoid it”

B“I keep going over it”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BNegative event -> repetitive analysis -> mood worsens -> more negative material becomes salient

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BMove from repetitive analysis to values-based action or specific problem-solving.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BThe person is doing concrete planning that leads to action.

Formulation language

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

Open full guide

Formulation language

Rumination appears to keep the patient caught in repeated negative meaning-making, worsening mood and reducing behavioural movement.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: avoidance or rumination?

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Rumination

Rumination may feel like problem-solving but often maintains low mood, shame, threat, and cognitive inflexibility.

CognitionAffectBehaviour

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BRepetitive, passive, negatively toned thinking about distress, causes, meanings, or consequences.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BAttention becomes repeatedly captured by unresolved negative meanings without moving into effective action or new learning.

Look for

AMissed appointments · Safety behaviours

BLong repetitive analysis · Difficulty shifting attention

Patient language

A“I just avoid it”

B“I keep going over it”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BNegative event -> repetitive analysis -> mood worsens -> more negative material becomes salient

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BMove from repetitive analysis to values-based action or specific problem-solving.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BThe person is doing concrete planning that leads to action.

Formulation language

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

Open full guide

Formulation language

Rumination appears to keep the patient caught in repeated negative meaning-making, worsening mood and reducing behavioural movement.

Open full guide

Browse the map Use both hypotheses