Chapter 7

You Can Face Fear

This is the first of four chapters that teach what we consider auxiliary skills. This one is about correctly assessing your ability to cope with threats. The next chapter is about using a technique called defusion to reduce worry and rumination. Chapter 9 shows how to more accurately assess dangers and threats. And chapter 10 teaches how to increase your distress tolerance.

A Warning

As you have learned so far, the royal road to anxiety management is exposure. The first half of this book has taught you how to assess your anxiety, stop safety behaviors, design systematic exposure experiences, and work through them in real life. The real-life exposure experiences are the heart of this book. If you have not conscientiously done the exercises in the previous six chapters, we urge you to go back and do them. It’s the fastest and surest way to feel better.

That said, this and the next three chapters contain instructions for cognitive behavioral skills that can help you manage your anxiety, especially for situations in which exposure is not possible or feasible at the moment.

Your Ability to Cope

In chapter 2, you learned about the alarm response that human beings evolved to handle threats effectively and survive. To review, this alarm response has four steps:

1. Perception of threat—the alarm sounds.
2. Appraisal of threat—you assess how serious the danger is and whether you have the resources to cope.
3. Physiological and emotional responses—you experience a cascade of physical sensations preparing you to deal with danger (tightened muscles; adrenaline-mediated changes in digestion, heart rate, and breathing) and the emotion of fear/anxiety.
4. Behavioral response—you try to avoid the threat, or you do something to feel safer.

Chapter 2 went on to explain that how you accomplish the second step, appraisal of threat, has a lot to do with how much fear you experience. Part of appraising threat is assessing your ability to cope with the threat. If you think that you have no ability to cope, then any threat, even the most minor, becomes overwhelming.

This chapter teaches you to face fear by highlighting your ability to cope. You will start by writing a “coping memoir.” In your coping memoir you will tell the story of difficult situations you’ve experienced in the past, and how you survived them. By mining your past for examples of how you have already coped, you will expand your thinking beyond the narrow scope of your usual anxious thoughts, allowing you to face your fears more calmly.

After you compose your coping memoir, you will use it to compose a set of coping thoughts. Coping thoughts are short statements that you can use in the future, when you face anxiety-provoking situations, to remind yourself of your ability to cope.

Finally, you will imagine your worst-case scenario—what you are most afraid might happen in the future. You will succinctly describe the disaster you fear, making it as bad as it can possibly be. Then you will draft a worst-case coping plan instead of spiraling down into a pit of worry and fear. Your coping plan is a detailed list of what you would do to cope with disaster, broken down into how you would act, feel, think, speak, and interact with others in your worst-case scenario. This is a powerful exercise that teaches you the value of thinking flexibly, realistically, and positively about the future.

The Gap Between Fear and Reality

In chapter 6 you exposed yourself to experiences and situations you fear. It’s likely that you discovered a significant gap between how well you expected to cope and how well you actually did cope. This gap between your fearful expectations and the reality of your coping experience is the opening that you need to change your beliefs, become more flexible in your thinking, and face your fears with more confidence.

Your lack of confidence in your coping ability is based upon habitual, recurring, overly cautious thoughts. These thoughts reinforce your negative beliefs about yourself, about certain scary situations, or about the future in general:

• I’ll never be good enough.
• I always screw up.
• I can’t face speaking in front of a group.
• If I drive that highway, a truck is going to hit me head on.
• Something bad is bound to happen.

Don’t blame yourself. Your mind is hardwired by thousands of years of evolution to protect you from harm. Your negative expectations and elevated level of anxiety are a result of the natural alarm response that you share with all the other humans who have ever lived. Your alarm response is just overdeveloped. It needs to be toned down, tempered by more flexible, realistic, and confident thoughts of how you have coped in the past.

Your goal in this chapter is to expand your perception beyond the overly negative outcomes you habitually foresee, to include your memories of successful coping in the past. Your goal is to enlarge and inhabit the gap between fear and reality.

Learning from Exposure

You can learn a lot about your coping abilities from your experiences with exposure in chapter 6. Review your Exposure Inventory Worksheet and recall how you acted and felt when you actually exposed yourself to the people, places, and experiences you fear.

What did it feel like as you decided on the first exposure to experience? What automatic predictions did you make? What thoughts went through your mind as you entered into the experience, passed through it, and came out the other side? What did you do and feel that surprised you? Your feelings, thoughts, and actions are the raw material of your coping abilities. Use the following worksheet to craft this raw material into some concrete insights about your coping strategies and abilities. (A downloadable version of this worksheet is available at http://www.newharbinger.com/34749.)

In the first column, briefly describe one of your exposure sessions, and rate your Subjective Units of Distress (1 for zero distress to 10 for maximum distress). In the next column, describe all the ways you coped with the experience: what you did, what you said to yourself, how you handled the fear as it rose and fell in intensity. Then rate your SUDS after the experience.

Learning Coping from Exposure Worksheet

Exposure experience	SUDS: Before	How I coped	SUDS: After

Describe and rate several of your exposure experiences, covering a variety of situations and fears. When Akram filled out this worksheet, one of his exposure experiences was going into a government office to pick up an application for a green card. This exposure combined his fear of having a panic attack in a public place and having to interact with authority figures:

Akram’s Learning Coping from Exposure Worksheet

Exposure experience	SUDS: Before	How I coped	SUDS: After
I took the bus downtown and went to the Federal Building, talked to the information person in the lobby, went up in the elevator, found the right office, and asked the clerk for the paperwork. At each step I felt scared, afraid I’d have a panic attack or be challenged by someone in authority. Wanted to run away. Wanted to say, “Never mind, it’s not important.”	5–9	I felt the fear peak and subside, peak and subside, like waves. Kept thinking, Just do one thing at a time. Focused on what I physically had to do to keep on going. Focused on my values, that a green card was important to me, so I didn’t let myself down.	3

Your Coping Memoir

Even if you are relatively young, you have undoubtedly faced some challenging situations in the past and coped with them successfully. It’s very helpful to remind yourself that you are still alive today because of your successful coping in the past. It is well worth it to spend some time composing a brief coping memoir right now. In the following worksheet, tell the story of five episodes from your life, five challenges that you have had to cope with in the past.

In the first column, write down a situation that you found very challenging. It can be a social situation, a health crisis, a financial reversal, an accident, or something that happened in your family or community. Go into as much detail as you can. Include not only what happened but also how you felt, what other people said and did that made it worse, your thoughts and feelings at the time, and your actions and reactions as events unfolded.

In the second column indicate your Subjective Unit’s of Distress (SUDS)—a number from 1 to 10, with 1 indicating almost no distress, up to 10 indicating the most distress you could possibly feel.

In the third column, write down how you coped: what you did, said, felt, and thought that helped you to cope with the situation. Ask yourself these two questions:

• How did I cope with the situation?
• How did I cope with the fear itself?

Finally, in the last column, rate the subjective distress you felt after coping. Notice how much your anxiety and other feelings decreased after you coped with the situation.

My Coping Memoir

Challenging situation	SUDS: Before	How I coped	SUDS: After

If you’re like most people, your life has not been free of challenges. Some of them may have taxed you to your limit. And yet you have survived. You are still here, still alive to cope and survive another day. And most likely, what you did to cope in the past helped lower your feelings of distress.

Example: Amara

Amara was afraid of many things: snakes, spiders, dark holes, sudden noises, traffic, bridges, tunnels, big trucks, and knives. She worried about her daughter’s health and safety in a marginal neighborhood, her son’s drug problem, and her own finances. Her best friend, Betsy, described her as a “nervous wreck at the best of times.” And yet Amara had somehow managed to survive for fifty-eight years on a planet beset with dangers on every side. How was that possible? Here is her coping memoir:

Amara’s Coping Memoir

Challenging situation	SUDS: Before	How I coped	SUDS: After
When I was a kid my dad died and we had to move from our nice suburban house into a horrible Detroit apartment. Roaches, loud neighbors, cold concrete, dirt. I cried myself to sleep.	9	At first I was devastated, but when I saw how devastated Mom was, I made an effort to be more upbeat and complain less. We sprayed for the roaches and hung heavy drapes and turned the TV up loud. We survived by setting aside the fear and dealing with concrete problems one at a time.	6
Changed to a scary inner-city school in fifth grade, bigger and tougher than my old school. Felt in the crosshairs all the time.	7	I hid out in the library and later with the school newspaper staff. Found my people and my safe places. Discovered the world of books. The fear couldn’t follow me into books.	4
Husband left me with two teenage kids and no money, almost no skills. Lonely and terrified. Drinking a lot. Mom blamed me.	8	Managed to keep the house, held down two jobs, got the kids through high school alive. Dealt with fear the wrong way, with wine. And the right way, with action.	4
Son was arrested for selling pot. I was ashamed, freaked out, furious. He was defiant and so stupid.	6	Managed to pay the lawyer, talk the judge into suspended sentence, get him into counseling. Saw that fear kept me from being strong, and I had to be strong because he was so weak then.	3
Daughter assaulted last summer at the bus stop. Cops called me and I fell on the floor in fear. Could hardly drive to the hospital.	9	Drove her to and from work for three weeks until she was strong enough to face taking the bus again. I’m still ready and able to support her as she needs it. Need to show an example of being scared but carrying on.	6

Amara tended to forget that she was actually strong and competent in the face of real-life challenges, especially when they involved protecting and helping her family. She kept a copy of her coping memoir on her computer desktop and a printout in her purse, as a reminder.

Your Coping Thoughts

Review the coping memoir you just wrote, plus your records from chapters 2 through 6, in which you wrote about your anxiety and exposure experiences. This material is full of good ideas for coping thoughts.

Coping thoughts are short, positive self-statements that remind you of your ability to cope. Here are some examples of good coping thoughts:

• It’s okay to make a mistake.
• I can be satisfied with my best effort.
• I’ve gotten through this before.
• I can do it.
• Just breathe deeply and relax.
• I know how to do this.
• Just hang in there until the end.

Use the spaces below to write your coping thoughts in your own words. Remember to compose thoughts that address both what you can do to face challenging situations and what you can do to face the fear itself. (A downloadable version of this worksheet is available at http://www.newharbinger.com/34749.)

Coping Thoughts

My coping thoughts for facing challenging situations

My coping thoughts for facing fear itself

As an example, here are Amara’s coping thoughts, based largely on her coping memoir:

Amara’s Coping Thoughts

My coping thoughts for facing challenging situations

I can deal with one thing at a time.

Keep moving forward, taking action.

It will be over soon.

I am strong for my family.

My coping thoughts for facing fear itself

I can shut my eyes for a moment, breathe deeply, and imagine my safe place.

The fear comes in waves—it always recedes eventually.

I have carried on before when I was scared.

Worst-Case Coping Plan

If what you fear actually were to happen, you assume that you could not cope with it. You have images of yourself falling apart completely, succumbing to a total catastrophe. You say to yourself, “I couldn’t stand it if X happens.”

But what if the worst possible “X” happens? What exactly would it look like? Since people do survive all sorts of horrible experiences every day, and since it is literally impossible to “fall apart,” what would you actually do in your worst-case scenario? To find out, create a worst-case coping plan.

Make a couple of copies of the following worksheet, so that you can use this exercise to make plans for all the things you fear. (A downloadable version of the worksheet is available at http://www.newharbinger.com/34749.) Then assume that the worst has happened—a cancer diagnosis, losing your job, a loved one dying, the end of your relationship—one of the main disasters you tend to worry about. Write it down on the first line of one of your worksheet copies.

Now imagine how you might cope with this eventuality. Think in terms of four kinds of coping:

• Behavioral coping. What actions would you take? If you lost your job, how would you go about looking for another one? What would be your financial resources? How would you cut expenses and/or raise extra cash? If you faced a medical emergency, what would you do to get a second opinion, explore treatment options, change your environment or lifestyle?
• Emotional coping. Next, move on to how you would deal with all the feelings that would come up. Write out how you would deal with your anxiety, anger, or depression by confronting your fears, enduring difficult situations, and persisting through painful feelings. Review your coping memoir and coping thoughts for other ways you can cope emotionally.
• Cognitive coping. Here is where you can use the coping thoughts you developed in the preceding section. Write them down here, as they apply to this worst-case scenario.
• Interpersonal coping. Who could help? What family members, friends, or colleagues could you call on for assistance? Write their names here and jot a note about how you would ask them for help.

Coping Plan Worksheet

Worst-case scenario:

Behavioral coping:

Emotional coping:

Cognitive coping:

Interpersonal coping:

Susanna was a student at a junior college, the first in her family to go to college. She had to pass her math final in order to get her associate’s degree and go on to a four-year college. With her history of poor performance on science and math tests, and her worries about failure and letting her family down, she needed to have a coping plan.

Susanna’s Coping Plan Worksheet

Worst-case scenario: I’ll stay up all night studying, be tired and spacey for the test. Too nervous to eat breakfast, I’ll feel panicky with a stomachache and shaky hands. When I get to the hard equations on the test, my mind will go blank and I’ll just stare at the page. I’ll hand in an incomplete test and get an F.

Behavioral coping: I’ll study until 1 a.m., have a piece of toast and a cup of tea, then go to bed. Get up at 8, eat breakfast, and get to the test rested and on time. On the test, if I get stuck I’ll skip that problem and go on to the end, then go back to the hard one if I have time.

Emotional coping: When I feel panicky and my hands start shaking, I’ll close my eyes and just notice what I can hear and feel in this moment, focusing on what is going on around me here and now. If my mind goes blank I will sit back and do some deep breathing.

Cognitive coping: When I start thinking about failing and letting my mom and dad down, I’ll use my mantra: “I know how to do this. I can take it one step at a time.”

Interpersonal coping: Charles has agreed to check over the practice test I did last night, and my roommate says she will make sure I get to bed on time and will have breakfast with me.

Susanna had to skip a couple of problems and go back to them after completing the rest. She completed all but one of the problems, got most of them correct, and passed with a B-minus.

One Exception

This chapter has shown you how to expand your thinking about your ability to cope, reminding you that even if the worst-case scenario comes to pass, there are things you can do to cope with life’s challenges. However, there is one time when it is not helpful to use your coping skills: right before or during an exposure exercise. In those situations, the goal is to actually experience the habitual thoughts and feel the anxiety that they inspire, so using coping mechanisms then would lessen the therapeutic effectiveness of the exercise.

The next chapter teaches a powerful technique for dealing with fear in the moment.