Coping with Fear and Anxiety
The Center for Trauma Program Innovation
A program of the Jewish Board of Family and Children’s Services

These are extraordinary times filled with threats that evoke fear, uncertainty and anxiety.  How does one go about daily life while simultaneously balancing being on alert with the need to keep from over-reacting? As mental health professionals, the message we should convey is that people can learn “how to function effectively in spite of being afraid.” We are not telling people “don’t be afraid."

In these uncertain times, each of us needs to work to promote resiliency and adaptive coping strategies. Part of this effort involves integrating the useful knowledge we now have about how the brain processes threats,¹how going into survival mode affects thinking and behavior,² and how the use of expanded concepts of safety can promote adaptive coping.

This guide was developed primarily to assist mental health professionals help clients and the general public by converting conceptual frameworks into useful psycho-educational and coping skills training.  Many other professionals may also find it useful.

TABLE OF CONTENTS  

I.                   What is the fear response?
Fear is a natural, universal and automatic response that can be managed.  

II.                How fear works.
The fear response, which occurs automatically and quickly to a perceived threat, can be overridden by more conscious mechanisms such as reason, learning and planning.  

III.             How can these observations be helpful to anxious/fearful persons?
Understanding the universal and automatic nature of fear can help individuals stop blaming themselves, counteract hopelessness and learn adaptive ways to cope.  

IV.              How can a person function in spite of being afraid?
Just as the brain has mechanisms to instantaneously activate the fear response, other mechanisms such as thinking, learning and planning can be mobilized to overcome the fear response. With practice, individuals can also learn techniques to release tension and promote calmness even when emotions cloud thinking.  

V.                 How to promote preparation and resilience.
Teach relaxation techniques to regulate intense feelings, help clients acknowledge fearful feelings rather than suppress them, and build confidence in their ability to properly assess threats.  

VI.              How to promote feelings of safety.
Help clients create psychological and social safety in their lives, not just physical security.

I.  WHAT IS THE FEAR RESPONSE?  

Acts of terrorism are designed to cause such intense fear in order to interfere with effective action even in the absence of an actual attack. They also disrupt normal trusting bonds, which further erodes ones sense of security and safety. Anxiety is defined as an unpleasant state of tension associated with a more generalized, long-term anticipation that something unpleasant may happen.⁴ Freud defined signal anxiety as the fear that arises from the anticipation of a perceived threat of danger.  Fear can also have an adaptive function in that foreseeing the possibility of danger allows one to prepare to avoid or prevent the dangerous situation.  

II.  HOW FEAR WORKS  

1)      The fear reaction occurs automatically as a consequence of the brain’s threat response system.

2)      This system operates with extreme rapidity, making split second “yes/no” decisions as to whether something is or is not a threat to our survival. Failure to defend oneself has greater consequences than responding too often. We cannot afford to debate whether something is dangerous when we need to act immediately, either by fighting or fleeing.

3)      Our fear response “turns on” faster than our higher mental functions, such as reason. It operates largely outside of conscious awareness, as our vision, hearing and other senses continually scan the environment for potential threats. However, more conscious mechanisms like reason, planned behaviors, and remembered distinctions between what is safe and unsafe, can be used to override the initial response.

4)      The fear response is both emotional and physical. The primary physical reactions are a pounding heart and rapid, shallow breathing. Often these physical reactions become automatically associated with being frightened, even if they result from other stimuli. Various relaxation techniques, which help to calm these physical reactions, can be learned. When practiced regularly during times of relative safety, they can also help promote a sense of self-control.

5)      If fear is turned on repeatedly, a bias towards overreacting to possible threats can develop even though we may eventually realize they are non-threatening. Mobilizing the capacity to accurately distinguish real threats from overreactions can actually reverse learned fear responses.

6)      Exposure to trauma interferes with the ability to properly evaluate threats causing seemingly inconsequential events to trigger fear.

III.  HOW CAN THESE OBSERVATIONS BE HELPFUL TO ANXIOUS/FEARFUL PERSONS?

Knowing that these reactions are automatic and occur in everyone can help individuals to:  

·     Stop blaming themselves. Frightened individuals may personalize their reactions, often wrongly concluding that they are the only person “getting so upset.”  Furthermore, if the individual’s fear reaction is interpreted as a sign of something being inherently wrong with them, intense shame can occur.

·     See that their reactions are explainable, which can help contain feelings of being “out of control.”

·     Reduce overestimation of potential risks, which only magnifies the feeling of danger.

·     Counteract helplessness by preparing and learning adaptive ways to cope.  

Explaining that fear is a natural, universal reaction and not a personal fault can:  

1)      Promote learning to contain the often intense, confusing emotions that interfere with effective action.

2)      Foster the realization that even though one can’t stop the fear from “turning on” there are things that can be done to turn it “off.”

3)      Reduce secondary reactions such as shame, guilt and a feeling of being “weak.”

4)      Reduce helplessness and feeling out of control by recognizing that a seemingly inconsequential trigger can turn the fear response on.

IV.  HOW CAN A PERSON FUNCTION IN SPITE OF BEING AFRAID?

Just as the brain has mechanisms to instantaneously activate the fear response, other mechanisms involving thinking, learning and planning can be mobilized to overcome learned fear responses. These techniques can promote new understandings about threatening experiences, teach ways to restore calmness and enhance active coping, even when intense emotions originally clouded thinking. These techniques allow one to:  

·    Acknowledge frightening feelings, rather than trying to suppress them.

·    Learn techniques to calm oneself down.

·    Challenge self-defeating assumptions.

·    Clarify unrealistic or catastrophic expectations.

·    Learn about the universal and natural basis of the fear response.

·    Develop effective ways to release tension.

·    Increase social connections.

·    Recognize what makes one feel safe and take steps to increase such activities.

·    Learn to distinguish physical security from psychological and social safety.

·    Learn to approach problems by breaking them into smaller more manageable proportions.

·    Learn to use healthy compartmentalization.

·    Access sources of moral and spiritual support.

V.  HOW TO PROMOTE PREPARATION AND RESILIENCE

First, the capacity to elicit a counterbalancing relaxation response needs to be learned. The use of the following calming techniques can regulate and contain intense feelings.  

·     Breathing exercises

·     Meditation

·     Progressive muscle relaxation

·     Active visualization of positive imagery

·     Relaxation tapes

·     Emotional and physical grounding techniques  

Once people feel they can contain and regulate intense emotional reactions, rather than being overwhelmed by them, they can be helped to acknowledge fearful feelings rather than suppress them. This counteracts the perception of more threat than actually exists, which can keep a person hyper-alert, jumpy and prone to interpreting innocuous stimuli as dangerous.   

·     Stress that they can learn to cope with fear and keep it within tolerable limits.

·     Discuss their fear while using learned calming techniques to insure that the level of fear arousal doesn’t exceed the person’s capacity to tolerate it. (See techniques above.) Stop the discussion if too much discomfort occurs but work toward increasing tolerance levels. (Desensitization)

·     Respect their fears—there are no right or wrong ones. Remember we aren’t trying to tell people “Don’t Be Afraid.”

·     Help them recognize that constant worry and tension is emotionally and physically exhausting and can cause fatigue, body aches and pain.

·     Help them recognize physical signs of suppressed feelings and ways to tell others how to help calm them down, especially if physical contact, such as, a hand on the shoulder, a hug or holding hands can produce soothing.  

Help to calm distressing emotions is necessary, but not sufficient unless one also pays attention to thoughts and assumptions. Confident functioning in the face of distress is undercut by self-defeating assumptions, such as:  

·     “Only weak people get frightened.”

·     “If I were brave, I wouldn’t be afraid.”

·     “There’s no way to feel safe.”

·     “I can’t cope. I feel totally overwhelmed.”  

Rather than challenging the content of such statements, help to increase the person’s ability to monitor thoughts and recognize how absolute and negative such statements are and how such beliefs increase distress. Their confidence can increase by becoming aware of their negative self-talk, challenging their assumptions and substituting more positive self-talk.  

Fear and trauma exposure changes people’s expectations and affects their ability to properly assess threats.  

·     We see more threat than actually exists because of the tendency to misperceive non-threatening events as possible dangers.

·     Our estimates of the probability of certain risks shift. This causes less likely, but very frightening events (nuclear attack, plane crash) to be ranked as more probable while more likely risks (smoking, car accidents), which actually cause more death and harm, are ranked lower.

·     Constantly having our “guard up” and expecting a past trauma to recur can evoke re-living of events even though we are actually safe (responding “as if” then is now).  

The tendency to expect the worst can be confronted by actually encouraging people to discuss their “worst case scenarios.” This helps develop perspective and promote the realization that certain fear-provoking thoughts are unreasonable or irrational.  

Educating clients about the universal, automatic, intense nature of our fear response system can help to enhance control over what otherwise seems like a personal weakness. Understanding that the response is rapid and occurs automatically outside of awareness makes it more objective rather than a personal failure of will power or intentions. This, combined with the understanding that fear is a product of evolution and shared by many species, helps to relieve guilt and anxiety that “there is something wrong with me.”⁵  

Helping people to develop successful ways of releasing tension can promote a greater sense of control and counteract the helplessness that often intensifies fear. This includes:  

·        Physical activity

·        Use of humor and sublimation

·        Use of creative non-verbal outlets: dance, drawing, painting, writing, keeping a journal, and playing or listening to soothing music.  

The goal is to increase the focus on those things that give pleasure and meaning. It is useful to have a few different techniques. In particular, one needs methods that can be done briefly and /or alone (at work or in other public places). These can be added to other methods that require planning, facilities or other people.

VI.  HOW TO PROMOTE FEELINGS OF SAFETY

Psychological safety and social safety must be distinguished from physical security, which is necessary, but not sufficient. Psychological safety refers to our ability to feel that we can regulate our emotions, as discussed above. Social safety refers to our ability to feel safe in a group and to experience an enhanced sense of connection.⁶ Exposure to threats immediately intensifies a person’s need to be close to their loved ones. Following the attack on the World Trade Center , everyone felt this urge very strongly. This increased “bonding and attachment” serves as an antidote to danger and trauma and can help mitigate their intensity.  

One maladaptive response to fear is to “circle the wagons” and thus isolate oneself. In fact, withdrawal and avoidance of social contact can increase distress because it deprives one of social support, one of the most helpful counterbalances to fear. (“There is safety in numbers.”) Suggest that people build connections to family, friends, and work colleagues, community groups and religious organizations. Help them recognize what makes them feel safe and to take steps to increase those activities. It is especially important that attention to physical security not override the building of psychological and social safety. Excessive focus on locks, guards and other physical security measures may increase anxiety by serving as a constant reminder of danger.  

Efforts should be directed towards increasing the range of options that are available in a dangerous situation by helping with the development of a personal safety plan. This must be thought out in advance and mentally rehearsed.  

Expanding personal coping options, practicing how to act effectively under highly stressful conditions and knowing how to connect with close family members reduces the fear response, especially in children. By increasing the feeling of control and effectiveness, being prepared acts as a counterbalance to the helplessness induced by the inability to clearly think of options.  

When people feel unsafe there is a tendency to generalize it to all situations, rather than keeping it to a specific response. Creating an inventory of places, people and things that help one feel safe can promote the realization that the lack of safety is not all-inclusive and may increase participation in situations where they feel most safe.  

References: 1.) Le Doux, 2.) Chemtob, 3. & 4.) Rutter, 5.) Goldman, 6.) Bloom.  

Written by

Robert Abramovitz, M.D.

Chief Psychiatrist and Director

Center for Trauma Program Innovation ã 2003

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 including tips on self-care and secondary trauma, contact:

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JBFCS Marketing and Communications Department 212-632-4549.

Where to Turn to For Additional Help  

JBFCS Project Liberty ……………………………………….. (212) 397-0336

            Counseling and support services throughout New York City .

Jewish Health Healing and Recovery Network……………….(212) 399-2685

            A support network to help Jews through life’s transitions and challenges.

September 11^th Service Coordination Program/Information….(212) 532-6410