How to Face Fear

So, if fear helps motivate us, what's wrong with injecting a bit of fear into our lives, so that we improve them? First, we can examine how well fear works as a motivator, and then see how it trips us up.
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Fear is one of the strongest driving forces in our lives. Fear motivates us to do all sorts of things. It keeps us alive when we step into dangerous situations. Politicians use it to get us to vote for them. And we use it to motivate ourselves and others on a daily basis. For example, how many of us have had a thought like, "if I don't exercise, I will get fat" or "if I don't eat healthfully, I will get sick"? How many of us have said, or been told "if you don't get that project done by the deadline, [insert terrible consequence here]!"

So, if fear helps motivate us, what's wrong with injecting a bit of fear into our lives, so that we improve them? First, we can examine how well fear works as a motivator, and then see how it trips us up.

Back to the "if I don't exercise, I will get fat" example. How well does this actually work? Maybe we set a New Year's resolution to lose 15 pounds, using that fat fear as a stick to whack us in the back and get off the couch and to the gym. This may last for a couple of weeks, but the motivation soon dies off. Why? Fear isn't that fun. And it doesn't actually work that well to motivate behavior change. For example, in a study of positively vs. negatively framed messages (e.g. quitting smoking will make your lungs healthier vs. smoking increases your chances of getting lung cancer), specialists working at the New York State Smokers' Quitline were randomly assigned to deliver positive messages or the standard negatively framed messages (Toll et al., 2010). The researchers found that the specialists not only used the positively framed messages more often, but this was associated with significantly higher rates of smoking abstinence. Okay, the carrot works better than the stick. So what's new?

Well, here's another side of fear that we may not have looked at carefully. What does fear do, besides getting us to change behaviors? It gets us to not change behaviors. Just think of all the times you haven't done something out of fear -- not talking to that cute person at a party because you were scared they'd reject you, not taking a job opportunity because of the fear of the unknown, or not quitting smoking. This last one is a particular paradox -- collectively we seem to have a healthy fear of death, and we know that smoking is pushing us that much more quickly toward it, yet we are afraid to quit. What is going on here?

I use smoking as an example because I have seen fear weigh in so often in my work as an addiction psychiatrist, though this is really a metaphor for many other fear-based non-decisions that we all make. Here's how it works: many smokers do a great job of cutting down to just a few cigarettes a day, are excited, doing great, planning for a smoke free life, and then it all comes to a screeching halt. They can't get past those last 2-3 cigarettes. And what are they afraid of? They give answers such as they are afraid of losing their identity, they don't know how to work with stress without smoking, they will lose their friends. Some even call smoking one of their "best friends." No kidding.

So what to do? Using techniques such as mindfulness, we can start to unpack the fear. We can ask simple questions like, "what does fear feel like in my body?" "Where is fear is right now? Can I point to it with one finger?" And when we do this, something remarkable happens. As I pointed out in a recent TEDx talk, we start to see that fear is just made up of body sensations, sensations that we can choose to act on or not as long as we can be aware of them. And once we see this, we can sit with fear, ride it out, and then make the decisions we need to make with a clear head.

One particular exercise that we have used, which has been directly linked to the likelihood of someone quitting smoking, is just noting the physical sensations of fear from moment to moment (Elwafi et al., 2013). For example, when fear arises, we can note to ourselves (or even out loud), "tightness," "sinking," "heat," "clenching," and so on as the fear builds, crests and subsides. This helps us see that indeed fear is just made up of body sensations, and that we don't have to act on it. We don't have to smoke to use the noting practice -this can be used anytime any of us have fear, but we do have to follow our instincts a bit. Noting what fear feels like while standing on Broadway as a bus is barreling down on us is quite different than quitting smoking or deciding whether or not to take a new job.

So next time you become fearful, see if you can stop and drop into your body for a few moments, noting what it feels like. Does this help you face it?

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Elwafi, H.M., Witkiewitz, K., Mallik, S., Iv, Thornhill,T.A., and Brewer, J.A. (2013). Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use. Drug and Alcohol Dependence 130, 222-229.
Toll, B.A., Martino, S., Latimer, A., Salovey, P., O'malley, S., Carlin-Menter, S., Hopkins, J., Wu, R., Celestino, P., and Cummings, K.M. (2010). Randomized Trial: Quitline Specialist Training in Gain-Framed vs Standard-Care Messages for Smoking Cessation. Journal of the National Cancer Institute 102, 96-106.