Author: Dr. Gordon Ball

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Fear Is Your Friend

We have no direct control over fear, but we can reduce fear by ACTING in a non-fearful way.

How Fear Works

  1. There is a specific primitive part of our brain where we learn to be afraid.
  2. Whenever we have any kind of negative experience, this part of the brain goes to work, and automatically help us to escape.
  3. This escape mechanism is often called the fight or flight response.
  4. All our past escape or avoidances are recorded in this mechanism.
  5. Whenever we run into situations that remind us of our past negative experiences:
  • This fear mechanism immediately wakes up, and prepares us to escape from this event.
  • We feel lots of changes in our bodies, such as increased heart rate, chest tension, increased breathing and we interpret this primitive arousal as fear.

We have not direct control over these feelings:

  • They are automatic.
  • They help us do what we have done in past situations, which is to protect ourselves.
  • And repetition of these escape responses make us more and more afraid.

In other words; fear remembers what you did in the past and automatically prepares you to do it again.

Here’s a simple example. If someone has a strong fear of dogs:

  • I guarantee that they have a history of running away from dogs.
  • Many can recall a negative experience that started process.
  • And some have no conscious memory of the event.
  • But this primitive part of the brain seems to never forget.
  • So the sight of a dog immediately gets this primitive mechanism aroused, which simply prepares them to do their usual habit of running away.

The Main Point About Fear

  • The fear of dogs that someone has today is a result of their past escape responses.
  • As long as they avoid dogs, or run away from dogs, there is no way in which their fear can ever subside.

This leads to a remarkable observation:

  • If our present fears are controlled by past attempts to escape, the fear is a slave to past behaviors.
  • As long as we keep running away, the fear is doing its job of preparing us to run.
  • So fear is NOT the source of your problem. It is the running away that’s the problem.

Stop Running Away

Stop running away and the fear has no choice but to eventually go to sleep.

This is why Graded Exposure and Response Prevention (ERP) is a very effective strategy for treating most of the anxiety disorders such as phobias, panic attacks, obsessive-compulsive disorder and post traumatic stress disorder. It involves gradually facing our fears. Many other contributors to this question have discussed similar ways of learning how to handle fear, which is to face it in some fashion. In general, the method involves:

  • Deliberately putting yourself in a slightly threatening situation, and then surprising the fear, by acting as if you are not afraid.
  • In other words, you need to live with the mismatch of feeling the fear, but acting as if you are not afraid.

Fear Is Not Your Enemy

  • Fear is an early warning system,
  • Fear is your bodyguard.
  • Fear is your friend
  • Fear’s job is to remind you to run away from anything that you have consistently run away from in the past.

So you can indirectly control fear:

  • Fear is a product of your past defensive behaviors
  • So if you keep surprising the fear by not running away, the fear which was preparing you to flee has no choice but to change to match the new predicted relaxed behavior.
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How do I overcome OCD?

In overcoming OCD, the use of Exposure and Response Prevention (ERP) is absolutely essential. But CBT is often mentioned as the treatment of choice. So, what is the difference? Let me explain:.

  • Behavior Therapy, BT, starting using ERP in the late 1950s, and was the first treatment that showed consistent success for OCD.
  • Cognitive Therapy, CT, worked well with Depression, but initially showed poor results in treating Anxiety Disorders.
  • Cognitive Behavior Therapy, CBT was born when the CT therapists added the BT technique of ERP to their regimen.
  • Studies show that BT and CBT work equally for treating OCD,
  • So there is little evidence that the Cognitive part of CBT is needed.

Even Aaron Beck, the “father” of CT and CBT, emphasizes the importance of using ERP when treating OCD. In his book, “Cognitive Therapy for Anxiety Disorders” he states:

….exposure is perhaps the most powerful behavioral intervention for fear reduction. Whenever possible, employ this therapeutic tool in the treatment of anxiety disorders. p. 247

Cognitive interventions should be introduced in the early sessions with with frequent and intense exposure-based behavioral exercises employed throughout the course of the treatment. p. 486

Clients should engage in daily exposure between sessions. p. 246

Unfortunately, in many CBT training programs, the emphasis is on learning the cognitive techniques, and less on the behavioral techniques. So, if you seek treatment with a CBT therapist, it very important that you enquire how experienced the person is in using ERP.

To learn more about ERP, please read this article by Fred Penzel, PhD, where he gives 25 excellent tips for increasing your chances of success.

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How can I stop being aware of everything and filled with worry?

The problem: We worry for a reason. We are trying to escape from an uncomfortable thought. (Obviously, if the thought were not creating discomfort, we wouldn’t be worried!)

The answer: We have to stop trying to escape from the thought.

There is a well-established technique called Exposure and Response Prevention (ERP), that works well for these worrisome thoughts, and it involves facing the thought, rather than trying to get rid of it. Anxiety, fear and worry always decrease if we practice facing our fears.

The procedure:

To stop worrying, you can try the following strategy.

  1. Get relaxed and breathe as gently as you can for about 5 minutes.
  2. Next, choose a particular worrisome thought. Something not too scary to begin with.
  3. Now focus on that thought for the next 15 minutes. Do not try to escape from that disturbing thought. If the thought fades, keep chasing it. Don’t let the thought escape.
  4. It is very important to stay relaxed and very still during the whole 15 minutes of exposure.
  5. Repeat at least once a day until the thought gets absolutely boring.
  6. Now repeat this strategy with other worrisome thoughts.

What to expect:

  1. The fear may get worse for the first two or three trials.
  2. But within about 10-20 repetitions, you will find yourself getting bored.
  3. More importantly, when the thought appears spontaneously, it also feels boring, which is opposite to worrying.
  4. As you work with several thoughts this way, you will notice that your thoughts in general get less worrying.

The Reason Why This Works:

  1. What your brain is doing in this process is teaching your primitive fear mechanism, (fight or flight) mechanism not to be so reactive to thoughts.
  2. This method is sometimes called Imaginal Flooding, or Progressive Exposure.
  3. It is very effective, if practiced diligently, with the most troublesome of thoughts.

Bottom Line:

Anxiety, Worry, Fear. These emotions, whether triggered by external events, or by thoughts, can be conquered by steadily facing them, rather than trying to escape.

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How can I stop worrying about ridiculous things?

It seems such a waste of time to worry about ridiculous things, but it’s amazing how many people get trapped in this vicious cycle. It falls into the category of irrational fears. If you want to stop this type of worrying, you need to know how worry works in our heads.

I have worked with hundreds of worriers over the years, with a variety of techniques. I get the best results using an exposure technique where I get people to stop trying to come up with an answer , and learn to live with the doubt. You say to yourself “Maybe I didn’t go to my singing lesson, but it’s not the end of the world”. We get into trouble when we demand certainty, and the peace of mind that it temporary brings. And then comes the next thing to worry about!

The more we demand certainty, the more we fill ourselves with anxiety. Life will always be full of uncertainties. The more we practice tolerating uncertainty, the sooner we can shrug our shoulders when we get these trivial doubts.

This technique may sound counter-intuitive, but it is a well-researched and has been used in Behavior Therapy for at least 30 years. It is also used with people suffering from OCD and who are having severe ruminative thoughts. It’s officially called Graded Exposure and Response Prevention. A helpful, very practical, book about this problem is call “The Imp of the Mind,” by Lee Baer, PhD.

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What are some non-chemical cures for OCD?

The best cure for OCD is actually a non-chemical cure. The method is called graded Exposure and Response Prevention (ERP). This therapy is a very specialized technique, developed 60 years ago, as part of Behavior Therapy. A book that describes the technique well is by Edna Foa who has researched OCD for many years. The book, called “Stop Obsessing”, is very specific in how to set up daily exercises whereby you learn to stop some of your small compulsions before moving on to the more difficult ones.

Many people claim that OCD can be treated with Cognitive-Behavior Therapy, (CBT). In reality CBT has little effect on OCD, unless it incorporates the ERP technique. So it is extremely important, if you seek out treatment, to make sure that the therapist is well practiced at using ERP.

OCD is the most crippling of the anxiety disorders, but at least 75% of the sufferers can escape from the torment with the ERP method. For the most severe cases where this method has failed, there are several excellent residences in the country where people can go for intensive treatment for this disorder.

In general, the best referral source for information about this disorder is the International OCD Foundation, (http://iocd.org). It also has a list of out-patient therapists, many of whom use the ERP technique.

There are no effective medicines are presently available for treating this disorder, although some can give temporary relief from the anxiety.

OCD, and other kinds of irrational fears, are becoming more understood as neuroscience explores the internal workings of the brain. The major problem appears to be that there is a mismatch between two learning mechanisms in the brain.

1. The first is a subcortical mechanism for handling threats. which works extremely quickly, usually referred to the Fight or Flight system. It functions by the most primitive of learning mechanisms, called Classical Conditioning.

2. And then we have a very sophisticated cortical mechanism for handling threats in the future, but it takes time to think. Here we can voluntary change our behavior to increase our chances of future rewards, and decrease our chances of failure. This elaborate system is referred to as Operant Conditioning .

In OCD, and in anxiety disorders , this more primitive brain has taken over too much control, and our intellectual cortex is at the mercy of many subcortical defense patterns. ERP is a counter-conditioning method, based on Classical Conditioning, where we can slowly teach the primitive brain to cool it, and let our sophisticated cortex make more rational decisions without the irrational fears.

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How do people with OCD deal with their irrational thoughts?

The most effective treatment for OCD is the technique of graded exposure to the uncomfortable situation, and a prevention of the usual response of trying to escape from that event, (usually abbreviated to ERP). I have found in my practice that this technique works well with people, whether the fear is about an external event, such as germs, or an internal event, such as a scary irrational thought. In both cases, there are well established cognitive and behavioral procedures where one learns to walk towards the uncomfortable situation, whether it is a external from your body, or inside your head.

On a slightly deeper level of explanation, with OCD, the germs or irrational thoughts are not the villain. It is the constant attempts to ESCAPE from the discomfort that keeps making matters worse. In general, the more you try to escape from the discomfort, the more fearful you may become.

OCD is the most crippling of the anxiety and fear disorders. It is controlled by a primitive part of your brain which unfortunately can function independently from your more rational self. This is usually called the “Fight or Flight Response”. In anxiety disorders this mechanism has got the upper hand.

In ERP therapy it is possible to teach that primitive part of your brain to “cool it”. ERP teaches you how to act as if you are not in danger, despite the fact that the primitive animal is screaming that you will die if you don’t try to escape. You won’t.

The more you learn how to put the fear mechanism to sleep using ERP, the more you can go through life using this skill in any area where fear raises its ugly head.

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How to stop ruminating

If someone is chronically anxious about murderers, then it is almost certain that they are also acting in a defensive way, such as checking for possible murderers (under the bed), or avoiding situations where there may be murderers (dark alleys). It is this constant acting as if you are in danger that makes our anxiety worse.

Anxiety is a primitive defense mechanism that does not understand the world, but guesses from our actions whether or not the world is safe.

  1. If you keep acting as if there are murderer around, your anxiety gets stronger to help you do a good job of checking for murderers.
  2. Consequently, if you stop looking for murderers, the anxiety initially will get stronger, just to remind you that you are supposed to be checking.
  3. But if you continue to check less often, (and survive!), the anxiety will eventually get weaker, as you keep acting as if you are relatively safe.
  4. This means living for a while with a mismatch of feeling a little anxious, but acting as if you are safe.
  5. If you work on this approach daily, the anxiety has no choice but to eventually go to sleep, as you act as if the world is not full of murderers.
  6. As most writers suggest, you need to this very gradually, otherwise the anxiety will get too strong, and you will end up checking again.

This technique is called Graded Exposure and Response Prevention, and has been researched by neuroscientists and behavior therapists for the last 60 years. There are many self-help descriptions on the internet of how to do use this technique successfully. This technique is extremely effective in any area where one’s fear is out of line with reality.

A few further points about anxiety:

  • I am saying that there is nothing wrong your anxiety mechanism.
  • It is not disordered.
  • You, through your defense behaviors, have taught it that the world is full of murderers And it believed you!
  • Now, you have to surprise the anxiety by acting as if the world is safe.
  • Through your new behaviors, you have to show it that murderers are very few and far between.

With time and gentle persuasion, it will eventually believe your new behaviors. Remember to look at anxiety as your friend.

  • It is your bodyguard.
  • It is your early warning system.
  • Stop making it work overtime!
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What makes a person boring?

Boredom is an emotion. It is not a person. The person isn’t boring: we are bored when we are with that person. But there is someone out there who would be fascinated by that person. The boredom is in us: not in the other person.

I find opera boring. Yet other people find it absolutely fascinating. As my children were growing up, I sometimes got bored by the stories that they wanted me to read to them over and over again! They saw the stories as the most hilarious things ever created.

Some people find me boring: others enjoy my company. That’s okay. I don’t need all the world to be my friend.

When I first came to this country, I found American football extremely boring until, by chance, I watched it with a good friend who was an avid fan. He explained what was going on, and the more I learnt about it, the less I saw it as boring. I eventually became quite a fan, and I am still interested in it..

I work with quite a few depressed people in my practice. One of the most common complaints is that they are extremely bored. I encourage them to become more active, as activity is one of the best antidotes for depression. I can usually predict their answer to my suggestion:

“Oh, that’s sounds boring. I wouldn’t be interested in that”

“Have you ever tried it?”

“No”

“So how do you know?”

“I JUST KNOW!”

I continue with gentle persuasion, and if I can get them to try a few easy things, I know there is a high probability that some of the boredom will go away.

Boredom is an emotion created by inactivity. The feeling of boredom gets stronger the less we interact with the world. That is why solitary confinement, with absolutely nothing to do, is guaranteed to produce extreme boredom and excruciating depression.

The more we can force ourselves to interact, the less bored we become, even around “boring” people.

(Disclaimer: When I first thought of answering this question, it felt a little boring. As I started writing, I was quite surprised how quickly my boredom disappeared as I struggled to come up with an answer that may be useful for the questioner. As usual, some people will be bored by my comments: some will not. That’s life!)

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Most people agree we should face our fears. So why do psychiatrists prescribe medicine to get rid of our fears?

Here’s my guess of why psychiatrists do what they do. Medication is the quickest way to block fear.

When a psychiatrist first meets a new patient suffering from acute stress, fear or anxiety, he or she is quite likely to prescribe fast-acting medications, such as Xanax or Klonopin. For most psychiatrists, this is the first line of defense for helping distressed people begin to gain some control over their emotional problems . They prescribe it because it works. The distressful feelings magically melt away, at least temporarily.

(It is recommended that these types of medications should be discontinued after two months, as longer use can result in chronic addiction).

At this point, the psychiatrist, if following protocol, will slowly taper the patient off the benzodiazepines, and probably switch to alternate medications such as a long -lasting antidepressant with less addictive qualities. If the second type of medication works, all well and good. Some patients can live comfortably on this second class of drugs for years. Many fail on the second medication, and so a third is tried, and so a fourth……

The problem with this approach is that medicines do not cure the uncomfortable emotion. They simply block it. If the medication is stopped, especially too quickly, there is emotional chaos, with most people experiencing more fear than they felt before they started the medication regimen. It is extremely important that you very gradually come off these medications, as any self-respecting psychiatrist is likely to emphasize. The slower the taper, the better.

So medications work well for about one-third of the people who try them. They are the lucky ones, as long as they never need to come off the medications, and as long as the medications continue to work.

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Overcoming Fear of Public Speaking

I know how you feel. I used to have the same problem. My body would sweat, my face would feel like it was burning, and I felt extreme fear. In my late teens, I even joined organizations where I had to speak on occasion. Hated it! Made it worse!

I even took up rock climbing believing that if I did a sport that was dangerous, I would be less fearful in other areas. I became a great rock climber, but it had absolutely no effect on my speaking fear. Surprise! Surprise!

Then I actually forced myself to do some speaking in one or two organizations that I had joined, but I was always terrified no matter how much I prepared for these short talks. After about 20 attempts at these minor speaking engagements, the fear was a little better, but I still agonized too much before each event. I still was afraid that, somehow, I would make a fool of myself. I eventually quit on this approach. I got somewhat better after I left home and went to the University. Still, public speaking was avoided whenever I had a chance .

It wasn’t until I switched from research, and went into clinical work as a Behavior Therapist, that I learned the tools for getting over this fear. And the answer was “start small.”

Many years later, I became a Behavior Therapist, and once I learned how fear worked in the brain, I learned how to put the fear to sleep.

And the biggest revelation was learning that fear was not the problem. It was the avoidance and escape behavior that was the problem.

  1. Your fear, blushing, shaking, and sweating are not under your voluntary control.
  2. They are part of a very primitive learning system to help you try to escape situations that you tried to escape from in the past.
  3. So all these embarrassing responses are a product of your past attempts to escape from these embarrassing situations.
  4. And the more your try to hide these responses, the stronger they are likely to become.

So how do we solve your problem?

You need to practice trying to produce the fear, blushing and sweating rather than trying to escape. You need to practice living with the mismatch of feeling the urge to escape, while you refuse to leave the threatening situation. Obviously you have to be practical how you do this. You need to practice in easy situations before trying more difficult ones.

Here are several suggestions:

  • Spend 15 minutes, twice a day, in the privacy of your own home, looking into a mirror while reading aloud a piece of text. at the same time, you are text trying as hard as you can to make yourself feel nervous, blush, make your voice shake, and sweat. Use thoughts about past embarrassing situations to get yourself as nervous as possible. Keep trying to do it. Don’t stop. Some people find it easy; others don’t do so well. It doesn’t matter.
  • Do this for about 3 or 4 days, at which time you will probably find that it has become increasing difficult to produce any of the sensations and feelings.
  • Now add in new exercises similar to the first one, where you deliberately try to get these sensations and feelings while you are around your friends and family. Do it at odd moments, but if possible try to do it for a total of 30 minutes a day.
  • Then try producing the uncomfortable feelings when you are buying things in stores or having to interact with strangers. These later exercises often take less than a minute to do, but that’s OK. Still try to put in 30 minutes a day if you can.
  • In general, keep looking for ways where you can interact with anybody, where you are deliberately trying to put in these old defensive responses.
  • Usually, if people put in about 30 minutes a day for 3 weeks with this type of procedure, most report feeling quite comfortable
  • If people work 30 minutes a day using this procedure, most report considerable improvement after 3 weeks of practice. As time goes on, you should find yourself able to speak up in class, and feel only slight hints of the old nervous responses. I

As you progress, you will notice that the old fear gets weaker and weaker,and is gradually replaced with a feeling of confidence as you act in a calm and relaxed manner.