Drowning, fires and reptiles. According to a recent survey, these are the top three phobias of adults in Singapore (Ho, 2019). It is normal to be fearful or anxious of something. For some people, their stomachs sink at the thought of having to speak in public. For others, taking the plane may lead to heart palpitations. Most of the time, our fears and anxieties do not impinge upon our everyday lives and we can function as per usual (It’s not every day that you come across a reptile or have to take a plane). However, these fears become problematic when either 1) anxiety peaks uncontrollably even when the threat is low (and you simply panic) or 2) when one has to face the anxiety-inducing situation/object (e.g. you fear public speaking but presentations are part of your job scope).

The natural response to fear- Avoidance

For most, coming face-to-face with a feared stimuli evokes stress and anxiety. Although uncomfortable, fear and anxiety are extremely powerful cues in signalling danger. Refer back to the top three phobias highlighted above. It is understandable if you have a phobia of these stimuli as they may seriously endanger your life.

Fear and the anxiety may trigger a fight-or-flight response, whereby one combats the stressor in the former or flees from it instead. How many of us would choose to combat a reptile (say, a snake or a crocodile) if we somehow find it in our path? Most of us would run away. This is the flight response. Of course, there are some situations where the fight response is more adaptive, such as building confidence for public speaking if it is a crucial part of your job.

Avoidance is a commonly used long-term strategy to manage anxiety. Avoidance enables us to feel safe without having to face the anxiety-provoking stimuli. I mean, why would you want to put yourself in a situation where you are feeling anxious, and decide on the spot whether to flee or combat it right? Avoiding something that we feel may be dangerous to is an easier and safer solution. You will surprised at the efforts taken by my highly anxious clients to avoid the facing the feared stimuli. I have met clients who have chosen to take the stairs only to avoid their fear of enclosed spaces or being trapped in the lift (one did it for over twenty years even though she lived on a high floor). Some may check the store directory of the shopping centre that they are in to ensure that they are a certain distance away from stores which sell whatever that they have a phobia of.

Avoidance is one of the types of safety behaviour utilized when faced with danger and anxiety. You may refer here to read more on a study seeking to identify the various types safety behaviours and how they are utilized by individuals experiencing panic attacks.

The problems with avoidance

Avoidance can be classified into ‘behavioral avoidance’ and ‘experiential avoidance’. Behavioural avoidance occurs when you physically avoid the activities, animal, situations or anything that leads to anxiety or fear. Examples of behavioural avoidance include not taking the lift for someone with claustrophobia or when someone with fear of public speaking call in sick from work on the day he has to make a presentation. On the other hand, experiential avoidance can be defined as the unwillingness to engage with private negative experiences (e.g. fearful thoughts and anxious emotions). This can be illustrated by an individual suffering from panic attacks who is attempting to suppress anxiety-provoking thoughts.

A study by Panayiotou, Karekla and Leonidou (2017) found that individuals who engaged in higher levels of behavioural avoidance and experiential avoidance are more likely to experience the symptoms of various disorders, including social anxiety, generalized anxiety and panic attacks.

This finding was supported in Fonseca, Monteiro and Canavarro (2018) who examined coping responses to anxiety of postpartum mothers. Postpartum mothers who avoided thinking about their parenting inadequacies due to fears that they might feel worse about themselves (i.e. experiential avoidance) displayed more anxiety and depression symptoms as compared to mothers who did not intentionally avoid their thoughts about their qualities as a mother. This is because the experiential avoidance strategy reinforces the perception of their weaknesses or failure in their role as a mother. To cope with these additional feelings of guilt, mothers would avoid thinking about their parenting roles once again and the avoidant-anxiety cycle continues.

Thus, avoidance can be problematic as it increases your anxiety to the stimuli and reinforces irrational fears (Hofmann & Hay, 2018). The sense of relief that you feel when you avoid the feared stimuli is only temporary and increases the likelihood of you avoiding the situation again should a similar situation present itself (Hofmann & Hay, 2018). Over time, avoidance has an opposite effect than desired; the fear actually grows. This is continuous avoidance prevents you from developing the skills needed to handle the feared situation as well as lower your confidence in your ability to cope. This cycle would continue until you have developed ways to cope effectively with the stressor, which would typically require you to face the stressor first.

Coping with your fears and anxieties

The following are some steps you can take to help you gain better control of your fears and anxieties:

1. Gradually face the situation that you are anxious about

As established, excessively avoiding your anxieties might lead to increased anxiety. As such, you can start by slowly expose yourself to the anxiety-provoking stimuli or situation. Doing so gradually enables you to practice to cope with the situation, and thereby builds your confidence as well.

Write down what is it you are anxious about and want to overcome (e.g. I am scared of drowning). Then, draw up the small steps that you can take towards achieve your goal. Start with a level of anxiety that you are comfortable with (e.g. walking about in a 1-metre pool) and work your way up to slightly more anxiety-inducing steps (e.g. walking about in a 1.3-metre pool).

Facing your anxiety will definitely be uncomfortable. Thus, it would also be useful for you to learn some coping strategies to regulate your anxiety, such as deep breathing exercises and positive affirmation. Continue managing your anxiety and resist the urge to avoid your fears.

2. Rationalise your fears

Irrational beliefs tend to underlie anxiety even though the assumed terrible consequences may not the most logical or rational ones. For example, Moller, Nortje and Helders (1998) found that individuals with a fear of flying tends to overestimate the threat of taking flights (e.g. “There is a 10% chance that the plane may crash”) and lack belief in their ability to cope with their anxiety (e.g. “I would be so anxious in the plane and other people will think that I am crazy”). Start by writing down the irrational belief(s) that underlie your fear. Think about why your anxieties over a situation might not be warranted and write them down (even if you might not be entirely convinced) . In the case of the fear of flying, a simple Google search will show you that air travel is actually the safest mode of transportation.

Understandably, fears and anxieties which have taken years to grow and fester can be tough to extinguish. After all, they have kept you safe all these while! However, writing down the evidence that challenges your fears and looking through them when you feel anxious could help ease your anxieties.

3. Think back to the first time where you felt anxious about the situation

For many, our fears and anxieties date back to such a long time that we might not even be sure when it ‘originally’ started. However, for some, it is possible to track the origins of one’s fears. Understanding how your anxiety started could help you gain more clarity about your fears and target the root cause of the issue.

For instance, Tom has a fear of public speaking even though he knows that his current classmates are nice and non-judgemental. He also understands that logically, it’s not the end of the world if he messes up when he presents to the class.. However, he just can’t shake off feelings of the dread whenever he thinks about public speaking. Tom was a confident speaker but his anxiety about public speaking started when he was criticised by his teacher for answering a question poorly in front of the class when he was in secondary school. Since that incident, Tom has subconsciously associated public speaking with feelings of embarrassment. Thus, whenever he has to speak in public now, he feels anxious.

By trying to find the origins of the anxiety you may realize that the anxious feelings does not derive from the threat posed by the situation. Rather, it is maintained by the continued association that you perceive between the situation and the negative emotions experienced during the once-off incident. As mentioned above, continued use of avoidance to cope with the anxiety prevents the formation of new positive memories that can override the negative emotions associated with the anxiety-inducing situation.

4. Seek professional help

The first three steps mentioned above appear simple. However, it would be extremely difficult for situations that you have had anxiety for a long period of time (probably maintained by avoidance). Seeing a psychologist or a counsellor would enable you to confront your fear in a safe and structured manner. Instead of telling to you take the lift and assuring you that the chances of the lift getting stuck is very low (something that you are probably aware anyway) if you have claustrophobia or panic attack, the mental health professional would be able to provide you with the support suited to your individual need and bring to awareness certain information from your past that you may not even have realized previously.

Conclusion

Our fears and anxieties have a part to play in keeping us alive and well. However, when our fears and anxieties are not very rational and are holding us back from our full potential, avoidance hinders our progress by reinforcing our anxieties. Therefore, even though it might be terrifying, it is often necessary to face our fears in order to overcome them.

References

Doorn, K. A.-van, Zilcha-Mano, S., Graham, K., Caldari, A., Barber, J. P., Chambless, D. L., & Milrod, B. (2019). The Role of Safety Behaviors in Panic Disorder Treatment: Self‑Regulation or Self‑Defeat? Journal of Contemporary Psychotherapy, 49, 203–212. doi: https://doi.org/10.1007/s10879-019-09432-9

Fonseca, A., Monteiro, F., & Canavarro, M. C. (2018). Dysfunctional beliefs towards motherhood and postpartum depressive and anxiety symptoms: Uncovering the role of experiential avoidance. Journal of Clinical Psychology, 74(12), 2134–2144. doi: 10.1002/jclp.22649

Möller, A. T., Nortje, C., & Helders, S. B. (1998). Irrational cognitions and the fear of flying. Journal of rational-emotive and cognitive-behavior therapy, 16(2), 135-148.

Ho, K. (2019, October). Singaporeans' greatest fears revealed. Retrieved January 9, 2020, from https://sg.yougov.com/en-sg/news/2019/10/31/singaporeans-greatest-fears-revealed/.

Hofmann, S. G., & Hay, A. C. (2018). Rethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders. Journal of Anxiety Disorders, 55, 14–21. doi: 10.1016/j.janxdis.2018.03.004

Article written with Charmaine Leong. Charmaine is a psychology undergraduate from the National University of Singapore (NUS). Charmaine is an aspiring clinical psychologist who is passionate about raising awareness of mental health issues in Singapore. She is currently on internship with ImPossible Psychological Services under the supervision of senior clinical psychologist, Haikal.