Overcoming avoidance

Avoidance means avoiding feared places, people, situations and activities, or even certain movements, which make you anxious or worried. This may seem to help reduce anxiety at the time. However, the disadvantage is that it keeps the symptoms of anxiety going for longer and more severely.

For example, a person with chronic pain may hold the unhelpful belief that he or she should not do or try certain movements because in the past they have caused more pain. This belief leads to the negative prediction that these movements might cause more pain now. It is true that avoiding bending movements may result in less pain more of the time. But it also means becoming stiff and tight in spinal muscles and joints. So, when moving to bend or trying to be active, the pain increases, thus proving the negative prediction.

An alternative, balanced, realistic response would be to gradually and steadily increase the feared movements or activities. This would actually stretch tight, tense, muscle groups, strengthen the joints, and improve stamina (see Chapter 9), helping the person to be:

•   more active, despite the pain

•   less anxious and physically tense

•   in less pain

It is possible to overcome avoidance through a gradual process of graded exposure (or facing your fears, step by step) to people, places, situations or pain experiences that make you anxious:

•   Choose a situation or activity where you become anxious or worried.

•   Break this anxious situation or activity into small, achievable steps (see the goal ladder in Chapter 6, p. 107).

•   Start with the step which is the least worrying or fearful.

•   Think of breaking each step down further if necessary.

•   Move up each step, staying with the anxiety sensations, perhaps using coping self-talk and relaxed breathing.

This is called a graded exposure to the feared activity or situation.

Note: Regular practice is the best way to make changes and become more confident. Doing it occasionally only helps a little, as you gain more confidence but it doesn’t last. Remember to reward yourself for your efforts, repeatedly. Taking too many steps at one time can sometimes cause setbacks or flare-ups.

Here’s an example:

Maria was very fearful of getting out of the bath. She had fallen badly on two occasions. Her unhelpful belief was a negative prediction: ‘She would fall again and make her pain problems even worse.’ Her shower was faulty. So she decided to tackle her fears about taking a bath.

MARIA’S GRADED EXPOSURE TASK

Maria works her way ‘up the ladder’ to achieve this goal, starting with the least frightening step.

Changing unhelpful behaviors

Some activities can increase or cause anxiety.

Tick any of these behaviors you have noticed in yourself and think about changing them steadily:

   Rushing round from one activity to another

   Drinking too much coffee/tea/cola

   Not allowing enough time to do particular tasks or activities

   Being in noisy, busy, places

   Being tired

   Being in pain

   Other activities, e.g. children always late

TEA/COFFEE/COLA – DRINKS WITH CAFFEINE

Maybe you could check out your caffeine intake and gradually make changes, if needed. How many cups or mugs of tea or coffee do you have in 24 hours? The sensible amount of tea or coffee per day is between two and three (cups or mugs). Caffeine stimulates the release of adrenaline so increases all your anxiety symptoms. It is important to have plenty of fluids, though, so you could try drinking more water. You could also have a go at herbal teas, fruit juice or decaffeinated coffee and tea.

PART II SUMMARY

•   Anxiety is a normal feeling and can help you to perform at your best and deal with dangerous situations. But, if high levels of anxiety interfere with your life, and happen when there is no real danger, then anxiety is a problem.

•   Identify what would be helpful to change, such as unhelpful thinking, unhelpful behaviors or avoidance of feared situations or movements.

•   Reducing anxiety can help you manage your life and pain better. Trying out and practising changes gradually and regularly can be helpful to reduce anxiety or worry.