Everybody has a fear. Everybody fears something.
Fred had developed some traits of generalised anxiety disorder since high school and Covid did not make it easy. Fred walked into the first session with the energy of a volcano, he spoke at a lightning speed, shooting all his worries and racing thoughts unreservedly at me. I had to admit that was a lot of anxiety to hold. I asked him to breathe and take it slowly before I asked him to continue. He leaned back and told me that “I haven’t left the house for four months now, I’m starting to worry I may never be able to leave the house by myself again”. The fear of public space and crowds stopped him from taking a step outside, even thinking about leaving the house makes his palms clammy, his heart pound like hammers and legs soft like jelly.
The last time when he was in a public space, Fred remembered he was in the Tesco superstore. Fred felt his heart skip a beat when a group of men walked past him, the closer they were, the more it escalated, he felt so overwhelmed and nauseous that he nearly puked. When he had a moment to breathe, his mind went blank, he felt super lost and scared. He couldn’t make sense of these bodily reactions and feelings, neither did his family nor him know what to do.
To understand more about his fears, I suggested we untangle his racing thoughts and dig out what his core beliefs were. Fred documented a thought diary for a week, with which we discovered that the most occupying thoughts were “Public places are not safe for me”, “I can’t leave my house”, “The crowds always give me heart attacks”. Those thoughts formed a belief which says “I can never handle public places and crowds” and he was trapped at home by this thought for four long months.
With the thought diary, we could also delve into understanding when and how this fear developed. I was curious to know if Fred had experienced any unpleasant event in a public space or a crowd. Fred leaned forward to the screen and squinted pensively, “oh… this might have stemmed from that, that park, that gang”. When he was about 13 year-old, a couple of life-threatening incidents happened to Fred, he was physically assaulted by a group of 10 to 12 teens in a park. He was done up so badly that he was covered in blood and resulted in the care of the hospital. Fred recalled vividly the pain in his lungs and forearms and those pounding sounds of his heart beating so hard to survive. These life signals seemed to be seared in his body and magnified to become hypervigilant.
After understanding where the fear came from, Fred was ready to develop some soothing techniques to calm himself. To attenuate the bodily sensations and worries, we tried an integrated approach with Cognitive Behaviour Therapy (CBT) and Compassion Focused Therapy (CFT). In eight weeks of talking and practising some emotional regulation skills, Fred learnt how to calm his nerves when needed and seek support from his family. Slowly he started to feel safe again in public spaces and comfortable enough to go out by himself.
Self-help guidelines to calm yourself:
Talk to someone you trust
Listen to music
Listen to some whitenoise, like waves, birds chirping, raining, thundering etc.
Count 100 backwards in sevens
Make yourself a cup of tea
Write down the racing thoughts and imagine what a friend may say to calm you
Playlist such as: lofi hip hop radio - beats to relax/study to
Music:
Florence + The Machine - Free
Films:
Batman
Spirited Away