PDA-Friendly Cognitive Behavioral Therapy

Jackie Coursey, Neurodivergent Life Coach

When living with Pathological Demand Avoidance (PDA), even the smallest tasks or decisions can feel overwhelming. For those who struggle with the constant pressure of meeting demands, traditional therapy approaches may not provide the relief they need. Cognitive Behavioral Therapy (CBT) has been widely recognized for its ability to help individuals manage anxiety and stress, but it’s not a one-size-fits-all solution, especially for people with PDA. Traditional CBT, with its structured and directive nature, can often feel like just another demand, triggering resistance and anxiety. However, adaptations to CBT, aka PDA-friendly CBT, take into account the unique needs of PDAers can offer significant relief and better coping strategies.

Why Traditional CBT Probably Won’tWork

In conventional CBT, individuals are encouraged to confront and challenge their negative thought patterns in a structured, often confrontational manner. While this can be helpful for many, the rigid nature of traditional CBT can be counterproductive for people with PDA, as it can feel like a demand or a task to complete. For PDAers, even the idea of “doing something” for therapy can create a sense of overwhelming pressure.

However, adapted CBT—which emphasizes a more flexible, collaborative approach—can provide a more effective way to cope with anxiety. Unlike traditional CBT, PDA-friendly CBT avoids creating additional demands by allowing space for autonomy, self-paced progress, and coping strategies that don’t trigger resistance.

What Makes CBT Adapted for PDAers Different?

Rather than relying on structured, demand-based exercises, PDA-friendly CBT integrates strategies that work with the individual’s natural coping mechanisms and interests. For example, creative activities such as art, journaling, and gaming can provide an outlet for expression while reducing anxiety. These activities align with a person’s intrinsic motivations, rather than feeling like a task they need to complete.
Some individuals with PDA find that engaging in art or journaling allows them to process their emotions in a way that feels comfortable and safe. For instance, one individual shared that “drawing or painting helps me express feelings I can’t put into words” (PDA by PDAers). Another said, “I can lose myself in gaming, and that helps me shut off my stress for a while” (PDA by PDAers).
Two young adults, one in a black shirt and another in black / white plaid, enjoy their playstation
Losing yourself in gaming

These outlets provide much-needed relief from the constant pressure of “doing” something. Instead of seeing them as demands, PDAers often view activities like gaming or creating art as ways to gain control and reduce stress in a world that can often feel overwhelming.

How Art, Gaming, and Journaling Can Help

Gaming has become a popular form of self-soothing for many PDAers. By framing tasks as a challenge or a game, people with PDA can engage with what may feel like demanding tasks in a way that feels less overwhelming. One person shared, “I sometimes find that by distracting myself with music, made-up songs, or role-playing, I can do things on autopilot” (PDA by PDAers).
Young adult writing in her diary while relaxing with music, on their soft, tan couch
Writing without judgment
Likewise, journaling can offer a safe space for PDAers to explore their feelings and thoughts. By writing without judgment, individuals can begin to understand their emotions in a way that feels non-threatening and self-directed. Journaling provides a chance to reflect, process, and work through emotions at their own pace, without the pressure of deadlines or expectations.
For others, art provides a way to express thoughts and emotions without words. One individual noted, “Art helps me express feelings that I can’t always vocalize. It’s like a safe space where I can just be” (PDA by PDAers).
Young adult painting on an easel. They have large glasses, short blonde hair, and a black tee-shirt.
Expressing feelings with art

Embracing Flexibility and Personal Interests

A key element of PDA-friendly CBT is its flexibility. Rather than focusing on rigid methods or approaches, this style of therapy works within the individual’s comfort zone. It recognizes that everyone has different ways of managing stress and that effective coping strategies often come from the person’s own preferences and strengths. Incorporating personal interests—whether it be through art, gaming, or journaling—allows individuals to process difficult emotions in a way that feels empowering and self-paced.

Additionally, creating space for autonomy is a crucial aspect of this approach. People with PDA thrive when they feel they have control over their choices, including how they cope with stress. For example, giving a person the opportunity to choose how and when they engage with therapeutic strategies can lead to a more positive and effective experience.

Conclusion

PDA-friendly CBT offers an adaptive approach to managing anxiety and stress, helping individuals with PDA work through their challenges without the added pressure of rigid demands. By integrating creative outlets like art, gaming, or journaling, individuals can process emotions, reduce anxiety, and regain a sense of control over their lives. These non-traditional therapeutic strategies not only provide relief but also empower individuals to work through their struggles at their own pace.
If you or a loved one is living with PDA, exploring these alternative coping strategies, tailored to individual needs, could offer valuable support in managing stress and anxiety. As we continue to understand more about PDA, finding ways to work with, rather than against, these unique needs will help pave the way for greater autonomy and emotional well-being.

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