Overcoming the Fear of Fear

I encounter a lot of people who live with heightened anxiety in my professional and personal life.  A friend suggested that I read this book so that I could better understand what it is like to live with anxiety, which can often be disabling, and be able to offer more constructive support.  I am grateful for their recommendation because I think it has helped a lot.

The authors develop the concept of "Anxiety Sensitivity."  They define it as "the tendency to respond fearfully to the bodily sensations associated with fear and anxiety. .....  In other words, anxiety sensitivity is the fear of fear."

We all experience fear or anxiety from time to time.  Something shocking or stressful occurs (the trigger), we have an adrenaline surge and we have associated physical sensations such as an awareness that our heart rate has increased.  For most of us we do not focus on these sensations as we know that they are harmless.  We deal with the situation at hand, then the sensations and any fearful thoughts abate, usually pretty quickly, and we get on with our day. 

Unfortunately for some people it does not work like that.  The sensations such as quickened heart rate, or faster breathing, seem catastrophic in themselves and lead to a cascade of various mental and physical events that can culminate in panic.

The book gives a very in-depth analysis of how and why the trigger leads on to this over reaction in some people and not others.  It also explores why some people are prone to this (including a good summary of childhood and family of origin influences) and why very minor events can be enough to trigger the cascade in them.

As with any good self help book it doesn't stop there.  It goes on to give a program to overcome this, based on Cognitive Behavioral Therapy (CBT).  The book is well researched and referrenced.

From the cognitive angle they look at unhelpful thought patterns and how to challenge them, particularly:

• Catastrophizing
• Overestimating the probability
• All of nothing thinking 

From the behavioral angle they look at the counter-productive "coping" strategies that people often employ, particularly many forms of avoidance.  They suggest the use of interoceptive* exercises to help people "to be in anxiety".  The theory goes that exposing yourself to the feared sensations will help reduce your fear of them.  I have to say, that even as someone who does not suffer anxiety, I think that some of the interoceptive exercises they suggested sound awful.  I will be incorporating a lot of the information I learned from the book into my clinical practice but I don't see me recommending any of these exercises to anxious patients anytime soon, unless they are first performed in a therapy session with a good therapist:

• Shake head from side to side for thirty seconds.
• Breathe through a narrow drinking straw for two minutes.  Combine with running on the spot or stair climbing to evoke more intense sensations.
• Place a tongue depressor at the back of the tongue for thirty seconds.

The book includes some good sections on the importance of a healthy lifestyle (stress reduction, sleep regulation, good nutrition, exercise and the benefits of humor), and the Stages of Change (pre-contemplation, contemplation, preparation, action, maintenance and relapse).

Overall, I think the book would be a great read for anyone suffering with anxiety, or wanting to understand/support someone they are close to who has an anxiety disorder.  I think the chapters on addressing the "cognitive" side of CBT, particularly challenging the unhelpful thought processes that are often the trigger for anxiety, are really good.

However, I think that more of a Graduated Exposure Therapy approach may be more acceptable and manageable for a lot of people, than the interoceptive challenge approach that the authors advocate.  I think that perhaps these exercises need a "Don't try this at home - alone - without therapist supervision" caveat, otherwise, if not followed through correctly the exercises carry the risk that people's anxiety sensitivity may be increased rather than abated.

For a good description of Graduated Exposure Therapy (also called Systematic Desensitisation) see: Overcoming Anxiety for Dummies

*Interoceptive - of, relating to, or being stimuli arising within the body and especially in the viscera.  From Merriam Webster Dictionary