Rethinking anxiety: learning to face fear | Dawn Huebner | TEDxAmoskeagMillyardWomen

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

We are hard-wired to shrink away from the things that scare us - to fight, flee or freeze in the face of danger. That's a good thing, but anxiety is about perceived danger, which is different from actual danger. When we act based solely on nervous feelings, our worlds can become very small. Our desperate attempt to avoid discomfort and uncertainty fuels anxiety, and avoidance locks it in place. Yet we can take back control. We can learn to face our fears rather than running from them.

Dr. Dawn Huebner believes we can all be taught to overcome fear and anxiety. In this engaging talk she explains how anyone, at any age, can conquer debilitating fear. A clinical psychologist in private practice, she treats children with a variety of emotional, behavioral, and developmental concerns.

Huebner is the author of "The What To Do Guides for Kids" series, which not only reflect her beliefs about empowerment but also provide practical advice for parents and children. Her personal journey as a parent, however, led Huebner on a quest to find ways of using cognitive-behavioral therapy as an approach. With simple language and humor, she presents sophisticated concepts in a way easily understood by everyone. These concepts, in book form, have been translated and sold in 12 different languages worldwide.

A little anxiety is a good thing.

I kept telling myself
that in the lead-up to today,

but a little anxiety is good.

It sharpens our senses
and gets us ready to take on challenges.

A lot of anxiety is another story,

it's a hindrance rather than a help.

A lot of anxiety makes it difficult
to take productive action,

it sets off a primitive response
deep in our brains,

the old fight-or-flight response

which actually has
a third part: freeze.

All three are protective mechanisms

with important evolutionary advantages
when we're faced with danger,

but anxieties about perceived danger

are very different from actual danger,

and in the case of anxiety,

fighting, fleeing, and freezing
are all problematic

causing us pain, preventing us
from moving forward,

making our world small.

I became a psychologist in 1987

and had my first and only child
several years later.

Before you too get too concerned
for him, "Poor kid!

A psychologist mom

who gets up and talks
about him on a TEDx stage"

(Laughter)

please know he's an adult now,

and he's given me permission
to tell this story.

Anyway, when he was little,
Eli was anxious.

He was afraid of the scary characters,

and Disney movies, and haircuts,
and shots, and splinters, and bees,

normal-seeming fears
although there were quite a few of them.

Initially, we did what most parents do

we reassured him,

and when that didn't work,

we helped him avoid
the things he was afraid of:

we stopped going to movies,
we let his hair get shaggy,

we stayed away from flowers -
because of bees -

and rough wood because of splinters,

but like some weird monster,

his level of fear continued to grow.

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 as 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.

(Laughter)

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 give 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.

(Laughter)

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."

(Laughter)

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

(Laughter)

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.

(Laughter)

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.

(Laughter)

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.

(Applause)

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 things 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 incorrect
your thinking mistakes,

"The chance of something
grabbing me is really small.

I've been upstairs a ton of times,
and nothing bad's 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.

(Applause)