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How do I know I need help?

There is nothing more alarming than an ambulance. On a quiet road, its screeching sounds, blinding lights and outrageous speed all signal urgency. An ambulance signals a visible, audible and perceivable emergency that someone needs help. The sound of a person struggling with their mental health however, is often silence. The individual may be self-soothing by doing things without knowing why, like drinking an excessive amount of alcohol, hooking up with strangers or even washing their hands repetitively. In general, they are spending a lot of time thinking: “I don’t want to be thinking,” a coping mechanism known as avoidance. For many, avoidance is the first line of defense against intense emotions. I asked Dr. Mary Frances O’Connor, a clinical psychologist at the University of Arizona and the author of “The Grieving Brain”, why avoidance gets a bad rap:

“Avoidance is perfectly ok in small quantities. The problem is if you keep using avoidance as a primary tool. You eventually won’t be able to avoid because the things you are avoiding will keep growing.”

Dr. O’Connor is highlighting the difference between positive and negative avoidance tactics. If the behavior is used in the short-term to establish control over a situation that’s perceived as uncontrollable, it is positive and should be encouraged. If the behavior is used in the long-term, becomes a habit and doesn’t address the original problem, it is negative and likely requires professional help. To get a better sense of the difference between the two (and whether help is necessary), we must first answer: What am I avoiding, and why?

Let’s unpack this question, starting with the “why.” Emotions such as grief, anxiety and anger can be big. Love, traditionally thought of as positive, can also fall into this category depending on the individual's experience with it. So big in fact, that their size and unfamiliarity overwhelms us. We label them as bad and ignore them. We run to pleasure (or even nothingness) because it is familiar, comfortable and to some degree, in our control. O’Connor explains that “emotions can be painful and even counterintuitive to think about. People don’t know what will happen if they let themselves feel the emotion, and they have a hard time conceiving of their emotions in terms of an ebb and flow. They think emotions will last forever.” Avoiding strong emotions is normal then. And having strong emotions is human. The answer to why we avoid powerful emotions is simple: we’re scared.

And that’s human too.

The next part of the question delves into “what” people are avoiding. I talked to Mariam Hovhannisyan, a Clinical Psychology graduate student at University of Arizona, to best pinpoint what happens when someone begins using avoidance as a coping mechanism. Her answer was simple, “Look at your everyday life and ask yourself, are you doing things you want to be doing? Are you happy with those things? Don’t compare yourself to others, focus on your own progress. What’s changed and what caused it?

It’s true. Identifying what event made ripples on the otherwise placid surface of our emotional waters is crucial in understanding the change that leads to using avoidance. Helpful questions such as, “Am I constantly thinking or worrying about what’s going on at school/work, even when I’m not there?,” or “Am I forgetting important events or tasks, do I feel like I’ve “lost time?” followed by “When did this start happening?” can be a powerful aid in singling out the cause for the mental anguish, and importantly, the first step in seeking professional help.

Towards the end of our interview, Dr. O’Connor kindly reminds me that professional help is not the only kind of help available, “You know, it doesn’t have to be me. It could be a pastor, a friend, or any respected authority figure. The idea is, you just tell someone. That’s the first step.”

So tell someone. Whether you’re the one in crisis or are witnessing a loved one struggling, turn on the resounding sound and flashing lights. Tell someone you need help. Because at the end of the scary ambulance ride, help will find you.


Helpful resources:


If you have any questions about mental health, send them over to our questions tab or reach out to us on Twitter!



  1. Buhk, Alex H., Mary J. Schadegg, Laura J. Dixon, and Matthew T. Tull. "Investigating the Role of Negative and Positive Emotional Avoidance in the Relation between Generalized Anxiety Disorder and Depression Symptom Severity." Journal of Contextual Behavioral Science 16 (2020): 103-08. Web.

  2. Hofmann SG, Hay AC. Rethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders. J Anxiety Disord. 2018 Apr;55:14-21. doi: 10.1016/j.janxdis.2018.03.004. Epub 2018 Mar 9. PMID: 29550689; PMCID: PMC5879019.

  3. Kabigting, Edwin-Nikko R. "Conceptual Foreknowings: Integrative Review of Feeling Overwhelmed." Nursing Science Quarterly 32.1 (2019): 54-60. Web.

  4. ​​Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

  5. National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009.

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