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.
Retraining the Brain to Think About Fear Differently
Once through these initial steps that help an individual to understand their fear, it’s time for the “exposure” part of exposure therapy. Exposures are, in essence, experiments that expose the individual to their fear in measured doses. Exposures give someone a chance to test their assumptions both about what will happen and how they will handle it.
Exposure therapy, first developed in the 1950s, is the mainstay technique used by cognitive-behavioral therapists to treat fear and anxiety. Exposures are a way to challenge an individual’s unique filter—to retrain the brain to think about things differently.
“We’re looking to give them a different experience than what they expect. In the lingo of cognitive therapy, we’re looking to ‘violate their expectancy,’” says Lindgren.
Finding the Sweet Spot
Just how the exposure is designed depends upon the individual. Lindgren helps people find a sweet spot that allows them to challenge their expectation without overwhelming or traumatizing them.
“Most people who fear small group interactions wouldn’t start out with an exposure like speed dating,” says Lindgren, but instead with a situation that feels more manageable.
In planning for an exposure, an individual writes down their fears, their goals and the new learnings they seek. Like it sounds, a “new learning” is a new—and different—way of looking at a situation that will enable someone to alter their expectations and their experience.
For the fear of small group interactions described above, new learnings might be:
- It’s possible that I might get made fun of but it’s also possible that I might not.
- If I am made fun of, I can handle it.
- I may actually enjoy some parts of the conversation.
Another important key to the success of the exposure strategy is to review what the person wrote down in planning for the exposure—after the exposure has occurred.
Sometimes people might find the exposure was awkward—the situation didn’t go that well. “And then the question is, what did you learn? Did you tolerate it? Because your early belief might have been that you would not be able to tolerate the situation not going well,” says Lindgren.
Learning from Expectation and Actual Outcome
Referring back to notes from planning the exposure can help people recognize that while they may have had some experiences that were in line with their expectations, they probably also had a lot that differed from them.
“Maybe someone said something kind to them or gave them a smile. And even if there was one bad interaction, how representative was that one bad interaction of their entire experience?” says Lindgren.
It is the discrepancy between someone’s expectation and what actually happens where the learning occurs. That’s especially true when the outcome is surprisingly less terrifying than was originally anticipated.
Challenging the Fear Filter Leads to Change
Even when socially awkward moments do occur, the individual starts to recognize that they survive those moments. “They begin to understand, ‘Even though I’m uncomfortable, I can do this,’” says Lindgren.
Once someone’s filter is challenged, their perspective can begin to change. The degree of exposure to the fear is slowly increased over multiple episodes, and often evokes less and less fear each time. Eventually the idea of passing up opportunities to do things that they want or need to do—in an effort to avoid the possibility of exposure—becomes too high of a price to pay.
People can learn to tolerate their fear response. And when that happens, all the activities that they have restricted out of fear re-open to them.
Facing our fears is healthy, says Lindgren. “It’s how we learn and how we grow.”