Fear is an inevitable part of life. But for some, their fear is so overwhelming that it prevents them from doing things that they want or need to do. Kristen Lindgren, Ph.D., a clinical psychologist who practices at the UW Outpatient Psychiatry Clinic, works with people whose fear interferes with how they want to live their lives.
Finding a Way Through Fear
Lindgren practices cognitive-behavioral therapy, or CBT, a therapy that focuses on identifying, understanding and changing thinking and behavior patterns. Lindgren says there is a way to work through fear—and discover a more pleasant life on the other side.
The treatment she recommends (called exposure therapy) is for people to put themselves into the very situations that they most dread. Though it may sound harsh, there’s a good reason for Lindgren’s recommendation. Most of the time, the things people fear are not really that dangerous.
People may overestimate just how dangerous something is, underestimate their ability to cope with it or do a little bit of both. “We call these cognitive errors,” says Lindgren. “It’s not usually a Bengal tiger that someone is afraid of. Instead it’s crowds or public places or conversation that they fear—situations that are not inherently dangerous.”
Stopping a Self-Reinforcing Cycle
As a result of such cognitive errors, people avoid the very situations that would challenge their assumptions. They miss the opportunity to test whether the experience would be as bad as they anticipate it would be.
And they miss the possibility of learning that they can deal with the situation and come out the other side intact.
“It’s a self-reinforcing cycle but we can help people find a way out,” says Lindgren.
Understanding the Underpinnings
Lindgren begins her therapy work by helping people take an in-depth look at their specific fears. To know how to overcome a fear, someone must first understand the fear itself and the result they anticipate upon exposure to it.
For example, if someone is frightened of small group interactions, Lindgren will ask them to verbally pinpoint their fear and the anticipated result of finding themselves in that situation. As in, “I expect that if I join in a small group conversation, people will think I’m stupid. Everyone will make fun of me. I will be so embarrassed that I will have a nervous breakdown.”
To the person, their fear is very real. “It might sound a little silly to verbalize it, but their experience of fear is intensely real and includes emotional and physiological responses,” says Lindgren. Common symptoms include shortness of breath, tightness in the chest, upset stomach, pounding heart and feelings of anxiety.
The initial steps of exposure therapy are about understanding one’s fear.
- Provide education about fear/anxiety and help people distinguish between adaptive and maladaptive fear.
- Ask people to monitor what they’re afraid of in specific situations and how they respond to the fear. What do they think, feel, and notice happening in their body?
- Ask people their goals. What do they want to be able to do that they’re not doing due to their fear?
- Teach people to look at their thoughts/beliefs and think about what they need to learn to challenge them.