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: shame or avoidance?

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Avoidance

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

BehaviourCognitionTrauma+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

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

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

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

Look for

ADowncast gaze · Concealment

BMissed appointments · Safety behaviours

Patient language

A“There is something wrong with me”

B“I just avoid it”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

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

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

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

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

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

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

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

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: shame or avoidance?

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Avoidance

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

BehaviourCognitionTrauma+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

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

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

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

Look for

ADowncast gaze · Concealment

BMissed appointments · Safety behaviours

Patient language

A“There is something wrong with me”

B“I just avoid it”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

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

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

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

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

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

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

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

Open full guide

Browse the map Use both hypotheses