Dawn Huebner on Rethinking Anxiety: Learning to Face Fear (Transcript)

He started panicking whenever he needed to go outside afraid he might encounter a bee, and it became difficult for him to touch anything made of wood.

Life went on as it does, and Eli became fascinated by history. When he was about 10, we decided to go to Fort Ticonderoga, a wooden fort with plenty of splinter potential. We did lots of planning: he would wear shoes, close-toed shoes, long sleeve shirt, long pants, no exposed skin. We promised him he wouldn’t need to touch anything, and he was actually really excited to go.

The day we went was a beautiful 90-degree day. We tramped around the fort for hours until we were exhausted. My husband and I plopped down on a bench to rest, a wooden bench. A wooden bench, Eli absolutely could not sit on nor could he move himself close enough to sit on one of our laps because he still might touch the bench. He couldn’t sit on the floor of the fort because it was a wooden floor or leaned against a wall — a wooden wall.

So he stood; rivers of sweat running down his face, utterly exhausted, utterly defeated by his fears. He stood because there was nothing else he could do. He stood, and he sobbed. It seems obvious in retrospect that we let things go too far, but somehow, the view from inside was different. We didn’t realize how bad things had gotten, how debilitating his fears had become not until that moment, that pivotal moment, when it became crystal clear that we needed help.

I brought Eli to a therapist who quickly deduced he’s 10 years old: he’s afraid of splinters, shots, and bees; long, sharp objects that poke. Clearly, this was a fear of penetration related to — get ready for Freud-Oedipal issues, his wish to overthrow his father to have possession of me.

I set there listening to this well-respected psychologist thinking how can this possibly help us, and the answer was it couldn’t. So I went on a quest determined to find a way to help my son.

I landed on cognitive behavioral therapy also known as CBT, an approach to treatment based on the premise that we all have an inner triangle based on our thoughts, our feelings, and our actions. The idea is that these are all interrelated: our thoughts influence our feelings, thoughts and feelings drive our actions, actions link back to what we think and believe, and so on.

So the way to change a problematic feeling like paralyzing anxiety is to change the associated thoughts and actions. That made sense, and it was specific, it gave us something to work on. Rather than continuing to help him avoid the things he was afraid of, we needed Eli to change what he was doing, to pay attention to the action part of the triangle. We needed him to go to the movies, go outside, touch wood, to see that he could do these things without getting hurt. Changing what he was doing would help change what he was thinking, and his feelings would change from there.

We decided to start with bees and went on a campaign to get Eli to go outside. He’s maybe 11 at this point, and it isn’t much of a stretch to say that his life revolved around Legos: big sets, complicated castles, and forts, and islands, and ships. He would do just about anything for money for Legos.

You can probably guess where this is going: I bribed him. “Just go outside,” I said, “You’re not going to get stung. And if you do, I’ll give you ten dollars.”

I’m going to pause the story for a moment.

I made two major mistakes with that intervention: the first was telling him, in a definitive way, he wasn’t going to get stung. How crazy is that? How could I possibly know whether or not he gets stung? What I should have told him was that a sting was unlikely which would have been more accurate and also more useful because an important part of overcoming anxiety is learning to take a chance, to take action even though you feel unsure, to be nervous and do something anyway.

My other mistake was offering a reward for the bad thing happening. What I should have been rewarding was the part of the CBT triangle I wanted him to be paying attention to: the action. I should have rewarded his going outside. I could have bought the Lego set he wanted and given him a single piece every time he went out. That would have been rewarding his bravery, his willingness to face his fear, step into the uncertainty not the bee sting.

But I didn’t know then what I know now, so I did the wrong thing. Although it accomplished something important: got him to go outside.

My husband was on the same page, dangling the same carrot, a bigger carrot. “If you go outside,” he said, “and get stung, I’ll give you 20 dollars.”

So, Eli went outside with great trepidation but fueled by the possibility of a pay-off, and he did get stung, something like five minutes after we told him he wouldn’t. He handled the sting itself pretty well, which is typically how it goes. The possibility of a bad thing is often worse than the actual bad thing, and he was delighted that we now had to fork over 30 dollars; that was half a Lego ship back then. Money well spent as far as we were concerned, because he saw that he could survive the sting.

He went outside more willingly after that, nervous but liking the financial gain, and gradually, his fears abated. It wasn’t the perfect cure although he did get over his fear of long, sharp objects that poked enough to take up fencing which was enough to propel me further into CBT as a theoretical orientation.

I learned more about how to use cognitive behavioral strategies without the bribes, and it transformed the way I worked with children, anxious children, who got better, so much better that I decided to write a self-help book to bring these skills to a wider audience.

My first book was for anxious kids on What to Do When You Worry Too Much, and it took off. Sales were higher than my publisher and I ever anticipated, and then I wrote another book, and another, all teaching cognitive behavioral strategies directly to children empowering them to help themselves.

I started being contacted by the national media, and by parenting groups, and professional groups wanting me to come speak, but oddly enough, I was never available. The timing of a conference wasn’t quite right, I had other plans, couldn’t take time off from my practice. These were the excuses I gave one after another as I turned down invitation after invitation, “I’m sorry. I just can’t make it.”

I turned down public speaking invitations for two years. I was aware at some level of what I was doing. I knew I was afraid I would fall flat, get tongue-tied, not be interesting enough or funny enough. I told myself that public speaking just wasn’t my thing, and that that was OK.

But eventually, the irony of this particular fear jumped up and slapped me in the face.

Here I was: a psychologist with a best-selling book about anxiety, a national expert on the treatment of anxiety; anxiety — the very thing that was keeping me from standing up and talking about it. I’d like to be able to tell you my first thought was, “Great, this will be an opportunity to practice all those skills I’ve been teaching,” but I’d be lying.

My first thought was, “If I want to be able to face myself in the mirror, I need to do something about this.”

One of the primary cognitive behavioral interventions for dealing with anxiety is exposure with the aim of desensitizing to whatever we’re afraid of. Let’s imagine we’re putting together a tool box; exposure’s our first tool. How does it work? Well, think about jumping into a swimming pool; it’s cold, but if you stay in the water, start swimming, or playing, or whatever, pretty soon it feels fine; you’ve desensitized. The water’s just as cold as it was when you first jumped in, but you don’t notice the cold anymore, you’ve gotten used to it.

One version of this exposure technique is called flooding. It’s like exposure on steroids, the literal equivalent of jumping into a cold pool, all at once, “Just deal with it.” Afraid of spiders? Plunge your hand into a jar of them. Afraid of germs? Go to a pediatrician’s office, touch all the toys in the waiting room, rub your hands on your face.

The technique actually works if you can get yourself to do it, but flooding isn’t the way most people choose to face their fears. It’s kind of harsh.

Fortunately, there’s another version of exposure, a more gradual method, the equivalent of slowly lowering yourself into the pool, taking one step in and letting your feet get used to it, and then taking another step and another. It was this gradual exposure, this step-by-step method that I decided to use.

I set up a hierarchy for myself and started small: toes in the water stuff, raising my hand at conferences, commenting during group meetings, eventually agreeing to give a brief talk to a smaller group, writing the whole thing out, holding my script, reading it verbatim, I forced myself to look up — that was a triumph — and slowly, painstakingly but doggedly I made my way through this hierarchy of challenges: bigger groups, letting go of the script, culminating in this.

So there’s hope not just for me but for all of us because all of us are wired to shrink away from things that might hurt us. That’s a good thing — shrinking away from things that might hurt us. As long as we’re accurate in our assessment of what’s going to hurt us and how serious the harm will be.

But all too often, something goes wrong, we lose the ability to gauge risk, and we begin to assume that if we’re afraid, we must be in danger even when we aren’t. Fortunately, there’s another tool we can put in the toolbox: we can learn to recognize and correct thinking mistakes.

What’s a thinking mistake? It’s a misperception, a misperception that fuels anxiety. There are three common ones. The first: overestimating likelihood. Here’s what this one sounds like, “If a bad thing could happen, it will happen, I know it, and even though it hasn’t happened yet, I’m pretty sure it will, and anyway, I’m not taking any chances,” which is closely linked to thinking mistake number two: catastrophizing. “That bad thing that’s going to happen, it’s not going to be a little bad thing. It’s going to be a big, bad thing, an awful thing, the worst ever. I’ll never get through it.”

That last part, that’s actually thinking mistake number three: self-doubt. “The bad thing is going to happen; it’s going to be awful. I’ll never survive it, forget it, I’m not going to do it.”

Sound familiar? We all have these thoughts anticipating the worst envisioning failure, underestimating our own resourcefulness, telling ourselves we can’t cope. But our thoughts are just our thoughts not necessarily useful, not necessarily true. And when we have a mistaken thought we don’t need to hold on to it, we can toss it aside, or better yet, correct it. It helps to externalize anxiety which is actually our third tool. This one involves thinking about your worry or fear like a pest, a little creature, whose sole aim is to make you feel scared.

Every time you listen to that worry, every time you chase it down it’s what-if rabbit hole and follow the rules it sets up, “Don’t go there,” “Don’t touch that”, “Don’t do that,” every time you listen to your worry, you’re feeding it, and every time you feed your worry, you’re making it stronger. But when you don’t obey your worry, when you talk back to it, challenge it, correct it, well, that’s a win for you.

I’ve actually presented the tools in reverse order so I’m going to flip them around to show you how a person might use them — a child. Let’s imagine you’re eight years old, and you happen to be afraid of going up stairs alone because there might be one of those scary dolls that comes to life, or a ghost, or maybe you’re not sure what you’re afraid of, you just don’t want to go up there.

But let’s say you’ve started to learn this skill set, so first, you’d externalize your anxiety: tell yourself, “That’s my worry talking to me. I don’t need to listen.”

Second, you’d find and correct your thinking mistakes, “The chance of something grabbing me is really small. I’ve been upstairs a ton of times, and nothing bad has happened.”

Third, you’d remember the pool; you’ve got to get in. You can jump in — just go upstairs all at once — or you can do it gradually: practice going up, just a little bit at a time. If your mom can stand at the bottom of the stairs while you go up and back down again, and then go up and touch all the doorknobs and come back down, and then maybe your mom can move further away while you go further up and stay a bit longer.

The goal, when it comes to facing fear, is facing it not waiting to not feel afraid, not accommodating the fear, not wishing it away or even breathing it away. You have to do what you’re afraid of while you’re afraid to see that your fear is a false alarm. It isn’t giving you useful information, and you don’t have to obey it. It’s a feeling, an uncomfortable feeling but a feeling, and like all feelings, it’s temporary.

You, your kids, anyone can learn to do this to start treating anxiety like background noise, like a jackhammer blasting away outside. Sure you can hear it; you can’t help but hear it. But you don’t have to wail against it or remain frozen in place until it stops; just let it be, turn your attention to something else.

That’s where deep breathing comes in, and mindfulness exercises, and various forms of distraction — these are additional tools best used not to avoid the things we’re afraid of but to help us settle our minds and our bodies so that inner alarm, that false alarm can quiet itself allowing us to remember that being afraid is not the same as being in danger.

So we have a choice: we can follow our instincts, shrink away, capitulate to our fears, and stay stuck or we can face our fears, move towards them.

Anxiety is like a Chinese finger trap, that woven tube you put your fingers into; and the more you pull against it, the more stuck you get. The trick is you have to relax your hands, stop fighting against the tube, move into it, and suddenly, you’re free.

Thank you.

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