Step 1: Learning about anxiety and phobias
This is a very important first step, as it helps you understand what is happening when you experience anxiety. All the worries and physical feelings you are experiencing have a name: ANXIETY. Learn the facts about anxiety.
FACT 1: Anxiety is normal and adaptive because it helps us prepare for danger. Therefore, the goal is to learn to manage anxiety, not eliminate it.
FACT 2: Anxiety can become a problem when our body tells us that there is danger even when there is no real danger.
|To learn more details about anxiety, see What Is Anxiety?|
It is also important to know that phobias are common. Having a phobia does not mean that you are weak or going crazy. Phobias CAN be successfully managed! After all, many people have learned to overcome their fears, and to „override‟ their immediate fear response. For example, firefighters enter burning buildings even though their adrenaline is pumping, and their first instinct is likely telling them to run the other way! Most window cleaners need to get accustomed to hanging off the side of a building at gradually increasing heights, before they can comfortably hang outside the 60th floor!
Special Case: Blood-Injection-Injury Phobias
If you have a phobia of blood, needles, or of being injured, your symptoms might be different from other phobias. Like other phobias, your heart rate and blood pressure increase when confronted, in this case, by blood or a needle. However, unlike other phobias, this increase can be followed by a quick drop in blood pressure, which causes dizziness and/or nausea. You can even faint. Although a fear of fainting is common in all phobias, blood-injection-injury phobia is the only phobia where fainting can actually occur. In this case, it is important to learn some strategies to prevent fainting. For more information on how to prevent yourself from fainting, see How to do Applied Tension.
Step 2: What is the real fear?
Make sure you work out what exactly about the object or situation is frightening. Is it the noise it makes? Or the way it moves? Is it the fear of being trapped? If you don't work out the real focus of your fears, you could be wasting time trying to overcome the wrong problem, or be making the work more difficult than it needs to be. For example, if someone is afraid of getting blood drawn, he or she might actually have a blood phobia, not a needle phobia. Thus, doing exposure with needles would probably not be very helpful – to improve, he or she would have to do exposure with blood.
Step 3: Realistic Thinking
Often, the anxious thoughts that people have due to their phobia are unrealistic, or very unlikely; however, when they are very anxious, it is difficult for them to recognize this fact. For example, an individual who has experienced choking on a piece of bread may believe that anything with a bread-like consistency that they put in their mouths will make them choke again. Even though this is unrealistic, he or she will avoid many different foods. Someone with an elevator phobia might avoid elevators because they believe that the cables will break and the elevator might crash. The likelihood of this happening is very small, yet someone with an elevator phobia will walk up twenty flights of stairs to avoid taking the chance.
It is helpful to examine your thoughts, and decide whether the worries are unrealistic. Remember: we learn our irrational fears, but we can also unlearn them.
Get the Facts! Sometimes, people have false beliefs about feared objects or situations, and it can be very helpful to get the facts. For example, if you have a fear of needles because you believe the needle could hit a bone or lead to an infection, it can be helpful to talk to a nurse about how deep the needle actually goes, and how each needle is sterilized. Some people believe that the chance of a plane crash is high; getting the statistics on how infrequently planes actually do crash can be reassuring to them. Find the facts out first! For more information, see Realistic Thinking.Step 4: Facing Fears
Facing fears in a gradual and consistent manner is the most effective way to overcome fears and phobias, and is called “exposure”. This process involves gradually and repeatedly exposing yourself to the feared object or situation in a safe and controlled way. You learn to “ride out” the anxiety and distress until the anxiety passes.
This process requires courage and determination. Sometimes your anxiety is so high, that you cannot imagine resisting it. Anyone who decides to try exposing themselves to their fears needs to draw up a personal “training program”. This means working out where they are now, deciding where they want to be at the end, and fitting as many gradual “exposure” steps in between as they need. For more help, see Facing Your Fears: Exposure. For example, if Karen wanted to be able to remain in a room with a dog without panicking, she may take the following steps:
|Step 1:||Draw a dog on a piece of paper.|
|Step 2:||Read about dogs.|
|Step 3:||Look at photos of dogs.|
|Step 4:||Look at videos of dogs.|
|Step 5:||Look at dogs through a closed window.|
|Step 6:||Then through a partly-opened window, then open it more and more.|
|Step 7:||Look at them from a doorway.|
|Step 8:||Move further out the doorway; then further etc.|
|Step 9:||Have a helper bring a dog into a nearby room (on a leash).|
|Step 10:||Have the helper bring the dog into the same room, still on a leash.|
If you have a fear of dentists, you might do the following steps:
|Walk in an out of the dentist's office with your partner.|
|Step 2:||Walk in and out of the dentist's office alone.|
|Step 3:||With your partner, sit in the waiting area for ten minutes.|
|Step 4:||Sit in the waiting area alone for ten minutes.|
Make an appointment with the dentist just to talk for ten minutes
|Step 6:||Sit in the dentist's chair for ten minutes, with your partner beside you.|
|Step 7:||Sit in the dentist's chair alone for ten minutes.|
|Step 8:||Make an appointment for the dentist just to look in your mouth, and not do any work.|
|Step 9:||Make an appointment to have your teeth cleaned only,
with your partner staying in the room with you.
|Step 10:||Make an appointment for the dentist to do some work on your teeth,
with your partner staying in the room with you.
|Step 11:||Repeat Steps 9 and 10 alone.|
Through repeated experiences of facing your fears, you begin to realize that the situation, while possibly unpleasant, is not harmful. With each exposure, you will feel an increasing sense of control over your phobia. This sense of control over the situation is the most important benefit of exposure. As your anxiety gradually decreases, you no longer react with uncontrollable panic when confronted with it.
Use the Facing Your Fears Form to help track changes in your anxiety when completing the exercises.
- Stick with it! Do the exposure exercises as often as you can. You are trying to build up positive experiences to replace all the bad ones of being defeated by the phobia, and too long a gap between exercises makes this more difficult.
- Recruit help! Enlist the help of family and friends. It can help to find someone to work with who can talk to you calmly and positively while you are doing the steps. Make sure the helper you recruit is not over-sympathizing or endlessly asking how bad you are feeling! This will make it harder for you to focus on the steps and to stay positive.
Step 5: Learning Relaxation
Learning relaxation techniques can help you to reduce feelings of anxiety that occur when you are about to face, or anticipate facing, a feared phobic situation.
Calm Breathing: This is a strategy that you can use to calm down quickly. When we are anxious, we tend to breathe fast and shallow. This can make us feel dizzy and lightheaded, which can make us even more anxious. Calm breathing involves taking slow, regular breaths through your nose. For more information, see How to do Calm Breathing.
Muscle Relaxation: Another helpful strategy is to learn to systematically relax all the parts of your body. This process involves tensing various muscles and then relaxing them. For more information, see How to Do Progressive Muscle Relaxation.
Reminder: If you have blood-injection phobia, relaxation can actually increase the likelihood of fainting. See How to do Applied Tension for more details.
Step 6: Building on Bravery
Learning to manage anxiety takes a lot of hard work. If you are noticing improvements, take some time to give yourself some credit: reward yourself!
How do you maintain all the progress you’ve made?
Practice! Practice! Practice!
In a way, learning to manage anxiety is a lot like exercise – you need to "keep in shape" and practice your skills regularly. Make them a habit! This is true even after you are feeling better and have reached your goals.
Don't be discouraged if you start repeating old behaviours. This can happen during stressful times or during transitions (for example, starting a new job or moving), and this is normal. It just means that you need to start practising using the tools. Remember, coping with anxiety is a lifelong process.
For more information on how to maintain your progress and how to cope with relapses in symptoms, see How to Prevent a Relapse.