Face your Fears: A Valid Treatment Method for Anxiety

The Problem of Avoidance

Face your fears, because if you don’t you may always have them. It has been known for decades that the avoidance of confronting feared situations will only prolong or even exacerbate fear symptoms over the given situation. A feared situation, unconfronted, will leave an individual afraid of that situation both when thinking about it, and when exposed to it in real-life.

For example, consider a person who is afraid to give a public speech or fly in an airplane. If that person avoids trying either activity, the thought of doing either will almost inevitably provoke anxiety, or fear, for that individual even when not exposed to it in real-life. When exposed to the any real-life requirement, in our example of giving a speech or flying in an airplane, the person will either approach and endure it with great anxiety, or avoid doing it altogether. Either outcome is not good.

The Maintenance of Fear

When we avoid confronting feared situations, we remain afraid. Why does it happen this way? First, we have to look at where the fear is coming from. Primarily, as discussed in other articles on this blog, fear comes from our thoughts. We believe that the situation will cause harm in some way. In the examples above, we may be afraid we’ll give a poor speech, stumble over our words, not know what to say, etc, and look foolish. Thus, we fear we’ll be negatively evaluated by the audience. In the flying example, we may fear the plane will crash and we’ll die. In both situations, no harm has actually happened, but we fear that it will. These thoughts keep us from doing either activity.

Learning

When we avoid these feared situations, we never have the opportunity to experience a positive event from them. That is, no learning occurs that would teach us that our beliefs may be untrue. Alternatively, we since we have never experienced the situation, we also don’t know that we will be negatively evaluated by the audience, or that the plane will crash. But still we hold to these beliefs with all of our might, without evidence.

Reinforcement

Additionally, we receive a type of reinforcement when we avoid feared situations. When faced with the possibility of having to do something anxiety provoking, like giving a speech or flying, we immediately feel the unpleasant feeling of anxiety. We want this feeling to go away. Instead of pushing through and confronting the situation (e.g., actually giving the speech or actually flying in an airplane), which would over time reduce the anxiety associated with it, as we’ll see below, we avoid it, which also takes the anxiety down. Thus, you experience a cessation of the anxiety feeling when you decline to face it head on. So, your avoidance of the situation was reinforced. This never adequately reduces the anxiety of the situation long-term or of the situation itself, though it may provide some short-term relief (e.g., you don’t have to give the speech; you don’t have to fly), and as a matter of fact it actually serves to strengthen the fear even more because now you’ve learned that the way out of your anxiety is by avoidance. So what do we do?

The Treatment of Fear

In addition to cognitive methods, as discussed in other articles on this blog, direct behavioral interventions are a very useful method for conquering fear, or anxiety. Exposure Response Prevention (ERP) is a proven psychological method for overcoming fear. What does it mean exactly? A trained clinician will utilize the methods of ERP to help an individual gradually expose themselves to a situation that evokes fear, anxiety, or distress, while helping the person prevent the response they were typically using (e.g., avoidance) when confronted with the feared situation.

Exposure Response Prevention

In the examples above, the individuals were avoiding public speaking and flying. First, ERP would help the person to first stop avoiding these activities. Second, it would help the person learn to face their fear by actually doing it. This “doing it” may come by baby-steps (e.g., gradually taking on a little more of the task over time), but the point is that the person stops avoiding. A therapist may work with someone on first practicing their speech in a mirror, then on a recording, then in front of the therapist, then in front of family, then in a speaker’s forum, like Toast Masters. The person who is afraid to fly may first watch video clips of planes flying, then practice going to the airport to watch planes taking off or landing, then sit in an airplane without actually taking off, then taking a short plane trip, maybe with a trusted friend or family member.

Treatment of fear in this way allows the person to unlearn old beliefs about themselves and the situation, and replace them with new, more accurate ones. It also allows for a different type of reinforcement to take place. That is, the reduction of anxiety when fear is confronted, instead of avoided. This will provide a long-term reduction of the fear and is truly empowering to the individual.

ERP is not only useful for public speaking and flying in airplanes. It is scientifically validated for a variety of problems, such as social anxiety of various kinds (e.g., 1:1 and group interactions, dating or requesting a date, interviewing for a job, etc), trauma (e.g., posttraumatic stress disorder – PTSD), Obsessive-Compulsive Disorder (OCD), panic attacks, illness anxiety, and other phobias.

ERP can be done live and imaginal (e.g., in your imagination), and works best when guided by a trained clinician.  Contact me today to learn more about ERP can help with your fears and anxiety.

Author
Dr. Michael Messina

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