Section XXV: Phobia

Useful and Useless Fear

Goals of the Exercise

1. Identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk.

2. Verbalize the costs and benefits of remaining fearful and avoidant.

3. Commit self to not allowing phobic fear to take control of your life and lead to avoidance of normal responsibilities and activities.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Useful and Useless Fear” activity is for veterans/service members who suffer from phobias of any kind. This activity is primarily preparation for Activity XXV.B, “Understanding and Overcoming Phobias.” This activity guides the veteran/service member in seeing which fears are valid and which really are phobic (i.e., interfering with life instead of making him/her safer), then seeing the impact unrealistic fears are having on his or her life, activities, ability to perform tasks, and so on. Follow-up can start with Activity XXV.B and can also include reading assignments from books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner, and/or videotherapy using What About Bob? or films suggested for the topic of “Emotional and Affective Disorders” in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, also published by John Wiley & Sons.

EXERCISE XXV.A Useful and Useless Fear

Fear is not bad in and of itself. It doesn't feel good, but when it's valid it can save our lives—it can alert us to dangers, then trigger changes in our bodies that temporarily increase our ability to defeat or escape the threat. That kind of fear is useful, and we wouldn't survive long without it.

You may be concerned that if you feel fear, it means you lack courage, but the truth is just the opposite. Courageous people may be scared, but they find ways to do what needs to be done despite the fear. If a person felt no fear, he or she couldn't have courage and wouldn't need it, but probably wouldn't survive long.

However, some fear is useless. Fear is useless when it focuses on something that isn't really a threat that we need to react to, or is exaggerated in a way that leads to panic and makes us unable to cope with whatever situation, person, or thing we're afraid of. This exercise will help you learn to respond to fear by figuring out which kind it is, useful or useless, and to prepare you for “Understanding and Overcoming Phobias,” which will help you regain the freedom to react in a way that makes sense rather than a way forced on you by useless fear.

1. First, let's look at useful fear. What kinds of situations, people, and things do you think it's wise and reasonable to be afraid of?

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2. How has fear benefited you, or others, in dealing with the kinds of things you listed in your answer to question 1? Can you think of a situation where fear saved you or someone you know from being badly hurt or killed?

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3. Now to move on to useless fear that benefits no one: Everyone has useless fear to some degree and about something. People fear all kinds of things from harmless bugs to elevators to having to speak in front of a group of people. This kind of useless fear, which is called a phobia, can either be fear of something that is really harmless, like the one about public speaking, or of something that actually would be bad but is very unlikely to happen, like people who travel by car due to a fear of plane crashes, in spite of the fact that it's actually more dangerous to drive. That's one that leads people to act in a way that's actually more dangerous. These fears cause problems when they keep us from doing things we want or need to do. There's an exercise we mentioned earlier titled “Understanding and Overcoming Phobias” that your therapist may give you—it goes into more depth explaining how phobias form and how to overcome them in general. This assignment is simply aimed at helping you take the first step and test your fears to see whether they're helping or getting in your way. You may already know that some fears are useless and keep you from doing things you need or want to do. If you can see that a fear in your life is useless, what is it and what does it stop you from doing?

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4. To test a fear and see whether it's keeping you safer from a real threat or is just an obstacle wasting your time and energy, go through these steps when you find yourself struggling with fear. First, get a clear picture of what you're afraid will happen. Think about a situation that scares you and ask yourself, “What is the worst thing I'm afraid will happen?” and then write that answer here:

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5. Now ask yourself, “How likely is that to happen?” and rate its chances of really coming true, from 0% to 100%. If you don't have solid information about this, where can you find it?

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6. Now ask yourself whether you have other fears about the same situation—other things you're afraid might happen. If so, what are they? Please identify them and rate their chances of really happening, rating each from 0% to 100% on the likeliness they will take place:

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7. Now, for each of the feared events you listed for questions 5 and 6, ask yourself, “Could I cope with that if it did happen?” and think about how it would affect your life—would it kill or injure you, get you in serious trouble or damage an important relationship, cost you a lot of money, embarrass you, or lead to some other painful outcome? Please write the answers here:

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8. Finally, for each action the fear(s) keep you from taking, ask yourself, “How is not being able to do this (or feeling this fear while I have to do it) interfering with my life?” and “What goal is it keeping me from achieving, or what is the fear leading me to do that's more likely to cause me more harm or trouble than the thing I'm afraid of?” Write the answers here:

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In this exercise, we've gone over a method to test fears that stop you from doing things you want or need to do, or cause you to do things that could be worse for you than the action you're afraid to take—in other words, to identify useless fears that aren't protecting you. The next exercise, “Understanding and Overcoming Phobias,” will show you how to conquer them.

Be sure to bring this handout back to your next therapy session, and be prepared to discuss your thoughts and feelings about the exercise.

Understanding and Overcoming Phobias

Goals of the Exercise

1. Reduce fear of the specific stimulus object or situation that previously provoked phobic anxiety.

2. Reduce phobic avoidance of the specific object or situation, leading to comfort and independence in moving around in the environment.

3. Learn and use skills and strategies to reduce and manage anxiety symptoms.

4. Identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Understanding and Overcoming Phobias” activity is for veterans/service members who suffer from phobias. This is a follow-up for Exercise XXV.A, “Useful and Useless Fear.” It takes a cognitive-behavioral approach to this problem by guiding the veteran/ service member to correct cognitive distortions that feed into the phobia, then engage in progressively more direct exposures to the situation or object of the phobia. Follow-up can include reading assignments from books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner, and/or videotherapy with films listed for “Emotional and Affective Disorders” in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, published by John Wiley & Sons.

EXERCISE XXV.B Understanding and Overcoming Phobias

If you've completed the exercise titled “Useful and Useless Fear,” you will have some information written down about one or more fears that don't serve your interests, the kind of useless fears called phobias. This exercise will help you learn and use skills to understand where your phobia comes from and then to reduce or eliminate it and free yourself to do things you need or want to do, reacting in a way that makes sense rather than a way forced on you by useless fear.

1. First, let's make sure that what we're dealing with is a phobia. What is it about the fear that you believe is distorted, exaggerated, or inaccurate?

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2. What is the impact of this fear in your life—how does it limit your actions? What does it keep you from doing? What is its effect on your stress level? Describe its impact:

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3. Next we need to look at the fear's beginnings. Is this a fear you've always had, as far as you can remember, or did the fear develop more recently, and if so, when and where?

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4. Sometimes we have phobias because someone taught them to us, maybe when we were children. Thinking of this fear, is it something someone else taught you? If so, who was that and when did this happen? Do you believe they were right or were mistaken?

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5. Another way phobias can develop is when something bad does happen to us, even though it is a rare event, and we become afraid it will happen again. Is that something that has happened with this phobia and if so, what happened, when, and how?

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6. A third way phobias take root is when we have reasonable fears of specific things or events, then start fearing others with any resemblance. For example, a person who is bitten by one dog may start fearing all dogs. If something like this happened to you, please describe it:

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7. There are some phobias whose source is a mystery; we just know we have always been afraid of something without knowing why. If this fits, describe what that fear is for you:

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8. Now to start overcoming this fear you need to think of a way you can approach the feared activity, thing, or person one step at a time. To use our example of fear of dogs again, you could start by just thinking about it and picturing yourself petting a dog and scratching behind its ears. From there, you might look at pictures of dogs, and after that, watching films or TV programs featuring dogs. The next step might be to observe some dogs from a safe distance, and then gradually get closer. After that, you would take the step of getting close to a dog—a friendly one, of course—and touching it, stroking its fur, and so on. You might even go on to taking a dog for a walk on a leash, then start having contact with more dogs. When you think about this, what is your reaction, and is this an approach you think might work for your own phobia(s)? Of course, different situations call for different activities. For example, soldiers who have been traumatized by improvised explosive devices (IEDs) have found that virtual reality computer programs with increasingly realistic simulations of situations involving IEDs helped them get back to a normal and appropriate level of caution instead of being too terrified to carry out their duties. If you are having a hard time thinking of a step-by-step approach for your own fear, try brainstorming with your therapist to come up with ideas. If you have some ideas, please describe them here:

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9. Another method is to write about the situation or thing you fear, describing the event you fear in as much detail as you can. Include a lot of sensory details in your written description to make sure you're picturing it as clearly as possible. Also, please include your thoughts and emotions. The next step is to read it to yourself silently, and then to read it aloud to yourself, and then to read it to your therapist and/or a close friend or family member. Once you've done this, wait a week, and then write about it a second time, making this second account even more detailed, especially about your thoughts and feelings and the meaning of the event to you, as you can. Repeat the steps of reading it to yourself and then to someone else; afterward, compare your reactions to those you felt when you started this process and see whether your distress level is reduced. What change in yourself do you see as a result of doing this?

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Talk with your therapist about the results, and about any other strategies you and he or she think might help make you comfortable enough with your feared situation to do all the things you need to do in your daily life without it taking too high an emotional toll on you. The goal is to help you retake as much control of your mental and emotional life and your ability to do what you need or want to do as possible.

Be sure to bring this handout and the accounts you've written to your future therapy sessions, and be prepared to discuss your thoughts and feelings about the exercise.