Fear, ironically enough, is a feeling many of us are afraid of. Understandably so, as it is designed to be so unpleasant that we do something about it. It’s inherently adaptive: if we weren’t motivated by its discomfort, we wouldn’t necessarily take action to save our lives. And that’s the key: our fear response is prehistoric. It’s designed with life and death scenarios in mind. It hasn’t evolved to mind the nuances of the workplace, dating, public speaking or rolling global news.
(courtesy of ChatGPT)
In addition, our fear response lacks context, a timeline and becomes generalised very quickly. Present day scenarios that have a whiff of anything that significantly frightened us in the past often become imbued with the same level of fear as the original incident. This completely neglects changes in our circumstances, ability to cope and actual levels of danger and threat. Moreover, the fear spread to many variables beyond the things that were originally scary or dangerous. Again, this is adaptive – our limbic system wants to keep us alive at all costs. So not only do we become sensitive to a particular event or act but also sounds, smells, locations, habits and people that were associated with it. For example, someone who had to attend A&E after a scary accident might become frightened of hospitals, doctors, and the smell of antiseptic when in fact the site of the trauma was only the accident itself.
Understandably, one of the main ways we cope with fear is to avoid it and to avoid the things that cause us the discomfort of fear. This works in the short term. In the long term, it serves to reinforce our fears and our doubts about whether we can cope with certain situations. Avoidance reinforces beliefs about helplessness and prevents the acquisition of coping skills and self-efficacy. It also causes us to withdraw from things that may be integral to our lives or facilitate our enjoyment and development.
So how do we go about changing this?
Well, quite simply facing our fears and realising we can cope. If we do this repeatedly we reduce the level of fear and helplessness we feel in the feared situations and build skills to help us cope and feel some level of mastery. Good stuff. However, how we go about this is the most important bit. There is no room for a gung ho, all out, face your worst fear approach. This only serves to put us in panic which reinforces fear and increases avoidance.
Instead, we use a gentle, graded approach of exposing ourselves to small, manageable increments of fear over and over again. This is called graded exposure and it works, if managed well, almost 100% of the time. The first step is building a hierarchy of fears, starting with the lowest intensity and building up to more challenging situations. For example, if one was avoiding fear associated with heights, one wouldn’t head to the windswept top of the Eiffel Tower in winter. Rather, one might start with ascending to a higher floor of a building or a few rungs on a ladder. The idea is that one repeatedly exposes oneself to each level of the hierarchy until that level feels rather ordinary or at least manageable. At that point, one levels up one rung to the next level. To use our heights example, one might shift from climbing a few floors in a building’s stairwell to moving towards a window at an average height. Be creative – there can be as many levels to the hierarchy as one needs. There are many templates available to help one design such a hierarchy.
Comfort, stretch and panic
Absolutely vital in informing this hierarchy is the concept of comfort, stretch and panic zones of the nervous system. In the comfort zone, one is safe, at ease and minimally challenged. It is the experiential equivalent of PJs on the sofa. For graded exposure to be effective, one needs to build in some challenge but only enough to be in the first tier of the stretch zone. In this space, there is some discomfort but it is manageable: one can think and feel at the same time and the key physical indicators of stress are within a tolerable range. These key indicators are pretty easy to check and can be summarised by the acronym BEST. This stands for:
Moving from comfort to stretch, there should be some BEST indicators of the stress response. The key is that they are tolerable and that one still feels mostly embodied and present with the experience. As one moves into panic, the level of presence and embodiment will decline and the BEST indicators will become very uncomfortable. Ideally, one should never get to the panic zone as this reinforces a fear response so monitoring these indicators throughout the exposure is important, and using them as guides to increase or decrease the challenge level is important.
Grounding skills and self compassion are absolutely vital in accompanying one on ascending the hierarchy. Grounding skills help the nervous system to shift towards calm when it is activated and help one to stay present and embodied. Self compassion is vital, as neurologically states of self compassion are mutually exclusive from states of fear: they cannot be turned on at the same time.
Finally, it is a better and more humane journey if one can accept that this is hard, that it is courageous to even try and confront fears and the inevitability of the fact that we are all human. We might need to give ourselves permission for the exposure work to take as long as it takes, to soften demands for progress and go at a pace we can manage. If we can only move up the hierarchy a few levels for now, sobeit. The pressure of perfectionism and self criticism only increases the fear and anxiety response.
A graded exposure intervention works for most fears. However, in the case of complex trauma, sometimes a more nuanced intervention is required and is best discussed with a mental health practitioner.