Do you struggle with making yourself go to the gym or do self-care or take care of simple things? Does it seem like your alarm bells go off as soon as you even approach the thought “I should do this?” The response intensifies if someone else tells you what to do. Does this cause you to avoid even thinking about the topic and instead sit on the couch and distract yourself? Do you then spiral into shame and self-loathing? If so, you are not alone.

A topic that has come up frequently with my patients is the concept of “demand avoidance.” You may wonder the difference between procrastination and demand avoidance because they could look the same to an outside observer. The key distinction is that demand avoidance involves a physiological stress response—your nervous system treats routine tasks as threats, activating the same fight-or-flight mechanism you’d experience in actual danger. The stress response is activated by the perception of a demand such as an “I should” thought.

Demand avoidance can be both internal and external. It’s not just demands from others but demands individuals place on themselves that trigger this fight or flight response. The reaction to the feeling can manifest in multiple ways, the most common being avoidance. However, I have seen people exert control, manipulation of the situation with others, and anger as a response to the fight or flight feeling (that’s why it’s called fight or flight).

A 2020 study by Egan and colleagues found that approximately 70% of adults with ADHD in their sample showed markers of demand avoidance. It also can be found in individuals with anxiety and autism. This certainly seems to be the case in my practice. When I introduce the concept to my patients, the ones who experience it will often nod knowingly just from hearing the term demand avoidance. If you don’t understand what I’m talking about then you likely don’t have it.

After having a revelation that this was an invisible barrier many of my patients experienced I began to collect any solutions I came across in the hopes that they could help others. The solutions to demand avoidance seem to be highly individualized, but my patients have all felt seen and even inspired hearing other patients find creative solutions. It probably helps that I’m not telling them what to do but just sharing what has helped others. Here are the stories and strategies I have collected so far.

Mindfulness Strategies

Using Mindfulness to Observe Demand Avoidance Response

Many of my patients find relief in just naming this response and knowing it is a described phenomenon, if not a widely understood one. This mindfulness type approach can look like saying to yourself, “oh there it goes again, my demand avoidance is making my car alarm go off.” (I refer to the fight or flight response as the body’s car alarm). The goal is to not react to the feeling as much as possible. Some patients feel the alarm go off even just talking about this topic in therapy. I may encourage them to sit with the feeling and check in periodically during the session to see if the feeling subsides. If it does then they gain the confidence that they can sit with the feeling in the future without reacting in any way to it.

Slow Thoughts Through Mindfulness Practice

One patient struggled to get various tasks done including going for a walk when she took time off of work to recover from burnout. She was getting more and more frustrated by her lack of productivity due to her demand avoidance until she suffered a debilitating bout of vertigo. She was forced to stay in bed for long periods of time and was unable to overthink due to her slowed thoughts. This was quite unusual for her rapid adhd brain. She felt like she lucked into a temporary cure for her demand avoidance because she wasn’t able to tell herself the usual things that triggered her. In addition, she felt grateful and lucky every time she had the energy to go for a walk. The internal dialogue had shifted so dramatically that she no longer felt the dread about getting things done. This patient’s experience highlights how slowing racing thoughts can reduce demand avoidance triggers. Intentional mindfulness practices can achieve similar results without relying on illness. When we cultivate present-moment awareness through meditation or breathing exercises, we can step away from the ‘should’ thoughts that activate our stress response.

Cognitive Reframing Techniques

It’s important to note that these strategies work differently for different people. What helps one person may not help another, and that’s completely normal. The goal is to find your own toolkit of approaches.

“Then don’t”

One of my patients has found a way to divorce his triggering “should thoughts” from his actions. He enjoys cycling and always feels good after, but he struggles with demand avoidance when he is approaching the time to start. He has found that if he can appease his demand avoidance by saying to himself, “then don’t” he can bypass the fight or flight response. The only catch is that he still continues the ritual behaviors of getting his gear ready. In effect, it sounds like, time for my ride, I don’t want to, then don’t, just keep putting the gear on. Next thing he knows he’s out the door and on his ride.

“I get to”

The opposite of “I should” or “I have to” is “I get to.” One patient of mine struggles to open his laptop in the morning to start work anticipating the slack messages he’ll have to deal with. His fight or flight kicks in and he ends up procrastinating all day and feeling terrible. The irony is that he enjoys his work and feels deeply aligned with his company’s mission. When he reminds himself that he actually moved heaven and earth in order to change industries to one he believes in he feels more positive and on board with getting his work day started. Another common example is demand avoidance related to going to the gym. Many strategies could work, but I always like to try the reframe that having time to focus on oneself is a luxury and to feel grateful when the opportunity arises. And moving the body actually feels good!

Get Curious

In addition to taking a grateful “get to” approach, another more positive approach is to get curious and try a science experiment. “I wonder what will happen if I get to the gym today?” Chances are you won’t remain inactive. Maybe you’ll end up trying a new machine or walking on the treadmill. Better than nothing! If you take the pressure off of having a specific outcome, you might just learn something about the way you want to move your body. Record your instincts each time you go to the gym and see if you could detect a pattern to what attracts you and why.

Soften the Demand

My alcoholic patient would get demand avoidance from the daily pep talk he gave himself to not drink that night. He realized over time that he could not put pressure on the request to himself to not drink or else it would turn into a demand and he would end up drinking to avoid the feeling. He came up with the strategy to imagine a committee in his mind that just needed a majority vote about his drinking status that night. In this way, he got around the “should” feeling that often feels like a demand. Instead, he felt like it was a gentle suggestion that he could more easily comply with. An example of how to use this strategy is to visualize your mind as having a committee that makes decisions on what to do. When the activity in question comes up for review imagine three hands going up and two dissenting and then a gavel coming down with the words “we have a majority vote.” See if that can feel less like a demand. Other ways to soften the demand could be to say “wouldn’t it be nice to move my body today” or “I think it could be good to do xyz.”

Behavioral Strategies

Staying Busy

Another patient says she has to stay busy and stay out rather than going home in order to avoid the possibility of demand avoidance. She will often try to get as many things done as she can once she is out. In addition to not having time to even think (and overthink into demand avoidance), she also does not have to use more executive functioning to get out of the house again, which is in short supply.

Addressing the Underlying Resistance

In addition to these strategies to address the demand avoidance there is often another issue underneath possibly related to neurodivergence. For example, if someone is in autistic burnout it is much harder to access their executive functioning (the part of the brain that gets things done), so they may have to address that as well. Some people cover up (mask) their demand avoidance at work which drains their energy and leads to burnout quickly. Or someone with adhd who generally struggles with executive functioning may need to find ways to motivate getting tasks done such as finding rewards or learning to imagine the reward they will feel from accomplishing a task. Sometimes the issue can be intertwined with other issues such as not feeling a sense of agency in their lives. Maybe there is even a sensory issue from looking at screens or overhead lights at work being too bright.

It has become clear to me that over the years I have been battling an invisible and shame-inducing symptom in a subset of my patients that lacked a name and approach. Addressing the issue head on got us nowhere and even caused setbacks. We needed to be thoughtful and creative in a collaborative way. Whether it’s through mindfulness, creative reframes, or behavioral strategies, there are meaningful solutions to be found. It may take time to find the right strategy for you or to create your own if none of the above work, but it can be a true gift to find it. Hopefully, hearing the stories and strategies above will help inspire those with demand avoidance to feel more in control of their lives. If you have found any other strategies that worked for you please share in the comments!