Fear and avoidance: The invisible duo that hinders the return to work

The "inappropriate avoidance cycle" (Becker-Haimes et al., 2022) works as follows: 

• Perception of a threat: a negative stimulus is evaluated as a potential danger. 

• Anxiety response: the amygdala quickly activates, within just 150 to 300 milliseconds, triggering fear. 

• Avoidance: to stop or prevent the anxiety, the situation perceived as threatening is avoided. 

• Reinforcement of the threat: by avoiding, we do not test our beliefs about this threat, and it continues to grow in our mind. 

As our psychologist emphasizes: "Let’s take an example: let’s imagine that I am afraid of speaking in public because I fear judgment from others regarding my skills. The more I avoid, the less I will have the opportunity to check whether the audience really judges me so harshly. In the end, the more I fear, the more I avoid… and the more I reinforce my fear." The problem is that avoidance, even though it provides temporary relief, prevents learning that maybe the situation is not as threatening as we thought. Without confrontation, there is no challenge to the anxious beliefs, and fear becomes persistent. 

When this fear mechanism applies to returning to work (e.g. after a burnout), it can cause a significant block. The reasoning follows the same logic as with other phobias or anxiety disorders: 

• I am afraid to return to work → I avoid → I continue to perceive this return as a threat. Consequence: the longer the avoidance lasts, the stronger the fear of returning to work becomes, leading to feelings of doubt, guilt, and a low sense of self-efficacy. 

In her practice, our psychologist shares: "I’ve met many patients who, though ‘cured’ of their mental illness, were still terrified to return to work. The symptoms were no longer really present, but the anticipation of potential failure or judgment was so strong that they preferred to avoid returning." 

Several types of threats can be felt when returning to work: 

• The fear of not managing residual symptoms or the side effects of treatments. 

• The fear of not being up to the task, of no longer being able to deliver quality work. 

• The fear of judgment from others: colleagues, managers, clients/patients, family members, etc. 

• The feeling of not being understood or heard, the sense of not being recognized. 

• The fear of being stigmatized or discriminated against, or even mistreated or sidelined. 

• The fear of falling back into a stressful or hostile environment. 

• The fear of relapse and becoming ill again. 

These threats, whether perceived or real, fuel the spiral of fear and avoidance, where every new anxious thought justifies the refusal to face the return to work. 

To break this cycle, it is essential to understand that it is difficult, if not impossible, to reason with oneself in the first milliseconds when the amygdala triggers fear. As our psychologist points out, the pathway through the cortex (conscious reasoning) takes more time to activate. 

The first step is to clearly identify the thoughts, emotions, and physical sensations linked to the fear. Then, gradually, it is important to expose oneself to the feared situation. Exposure is the key to allowing our brain to integrate new reassuring information: 

• Assessing the reality of the threat: Am I really being judged as harshly as I imagine? 

• Discovering one’s own capabilities: Am I really incapable of delivering proper work after a prolonged absence? 

• Realizing that the situation is not as serious as fear led us to believe. 

Exposure therapy is a psychological approach where the patient gradually confronts their fears in a safe environment. The idea is to reduce avoidance behaviors and reprogram the brain to perceive the situation differently. 

• Gradualness: we start with easier exposures, then gradually increase the difficulty. 

• Support and guidance: a professional (psychologist, therapist) guides the person step by step and helps analyze their reactions. 

• Cognitive restructuring: over the course of sessions, the perception of the threat weakens because the concrete experience does not validate the worst-case scenarios anticipated. Applied to the return to work, exposure therapy can include real or simulated role-playing scenarios, visualization exercises, and especially guidance to remove limiting beliefs, overcome fear, and regain confidence in one’s abilities. 

Fear and avoidance form a formidable duo when it comes to returning to work after a long period of absence. Avoidance behavior seems legitimate at first (who doesn’t want to flee a situation they perceive as threatening?), but it strengthens the sense of danger and makes it more persistent. 

Thanks to the Melimpus approach based on cognitive behavioral therapy, it is possible to break the vicious cycle. Gradual exposure in virtual reality, under guidance of a professional, allows for the reprogramming of the fear response and helps to realize that, often, perceived threats are much more intimidating than they are in reality. 

 
The advantage of the Melimpus solution and virtual reality lies in the fact that the exposure takes place in a safe and controlled environment: with your coach or therapist. This approach makes returning to work not only feasible but also transforms it into an opportunity to regain self-confidence and trust in one’s abilities.