Overcoming Our Fears when Living with Myositis: Focus on Falling (Part I: Defining Fear and Overcoming It with a Four-Step Approach)

Introduction

Dr. Jayasinghe began by explaining that this presentation would include the following:

• An explanation of the brain/body basis of the human fear response
• A definition of phobias
• A review of how fears are learned
• A four-step approach that can be taken to help overcome phobias and build confidence. This would also be applied to help with the common fear of falling among people with myositis.

Our speaker went around the room and asked the members to name a fear that each one had. The responses included fear of fractures due to newly diagnosed osteoporosis and a fear of falling and being unable to get up from the fall. At the same time, there was concern that certain behaviors to prevent a fall might look bizarre to others and cause embarrassment.

The Human Fear Response / Defining Phobias

Dr. Jayasinghe stated that there are two different systems that cause the brain to react to a fear or threat in different ways:

The first is through the amygdala, which causes us to react very quickly to fear or threat. When fear is processed through the sensory cortex part of the brain, there is more time to decide what to do.

Some of the physical reactions to a fear or threat include a racing heart, sweating, and enlargement of pupils. The thoughts involved are that one is not safe in a particular situation, and we are put in a position to decide if we fight, run, or freeze (this is also known as the “fight or flight” response).

A certain amount of fear is healthy. It can warn us of danger and prevent harm. However, certain fears have little basis in reality and can cause one to feel a lack of control over his or her environment.

A phobia was defined as persistent and disruptive fear that can affect everyday life. Phobias involve behavior: one tends to escape or avoid a situation because of them. It was stated that 19,000,000 people suffer from phobias. Common phobias include fear of storms, blood, injections, planes, and elevators.

How Fears are Learned

Fears develop for various reasons:

• It may be that we are biologically predisposed to be fearful of some things, such as storms.
• As mentioned above, it may be that we were taught to be fearful by our ancestors; thunderstorms signaled danger in centuries past, when shelter may have been unreliable and exposure to the elements posed the threat of harm or death.
• Also, we might take cues from others - a concept known as modeling..If one has had a bad experience, such as a turbulent airplane flight, he or she may develop a type of anticipatory fear of flying, where one might fear this happening repeatedly.
• Another way that people develop fears is through a “conditioned” response (a response to a stimulus that was previously considered neutral. Dr. Jayasinghe gave the example of “Pavlov’s Dog,” an example of classic conditioning and “learned response”:
  • Before conditioning, the dog would salivate when presented with food.
  • Then the dog is exposed to the sound of a bell, and there is no response to the bell.
  • Then the bell is rung when food is presented, and the dog salivates.
  • The dog now salivates when he hears the bell, because he associates it with food.

We can learn to condition ourselves to be less fearful. Before undertaking any activity, it is important to first speak with your physician and healthcare team. If you have an increased fear of walking but have been told that you are capable of doing so, a step-by-step exposure to decrease the fear and gain confidence might look like this:

1. Imagine (visualize) yourself walking up and down the hall (30 feet) with assistance from someone.
2. Walk up and down the hallway on someone’s arm.
3. Walk up and down the hallway with someone present at your side.
4. Walk up and down the hallway with someone behind you (to catch you if you fall).
5. Walk up and down the hallway with someone present but at a distance.
6. You can slowly increase the amount of time you are able to walk, with or without someone present.

In much the same way, people learn negative associations to stimuli that were previously neutral, such as walking. Usually we do not associate walking with danger. However, after we have a fall, it is common to develop fears about falling because in that instance the person might have actually been injured or worried that they were going to become injured. The action of walking becomes associated with the experience of actual or potential harm.

A Four Step Approach to Overcoming Fears

Our attitude, then, affects our fears and phobias. To help with this, Dr. Jayasinghe offered the following four steps:

STEP 1:
Recognize your fears and make your decision by gathering facts and information. Assess danger and risk and recognize that nothing is without risk. Ask: How important is this to me? How much time and effort am I willing to invest in overcoming this fear? It is important to remember that we must be able to tolerate a certain amount of anxiety and discomfort in order to face and overcome our fears and that it does involve work.

STEP 2:
Learn relaxation techniques that can help you tolerate anxiety-provoking activities or situations: Just as the body is capable of a fear response, it is also capable of a relaxation response. One of the most effective ways to relax the body is through deep breathing. Dr. Jayasinghe demonstrated a technique known as diaphragmatic breathing (the diaphragm is a muscle below the abdomen) where one inhales slowly through the nose for eight counts and then breathes out through the mouth for eight counts. This can help symptoms like a racing heart.

STEP 3:
Become aware of your thought processes. Thoughts can cause a fear response. For example, we may tell ourselves after a fall, “If I walk around I will fall again.” “I’m not steady enough.” “I’m safer sitting down.”

Positive thinking can help overcome fear. When we are afraid of falling, for example, we might try to say things to ourselves that are positive, to remember our strengths, and to try not to “overthink” a situation and create unnecessary fear. For example, reminding ourselves realistically of our strengths and other ways of thinking about the situation: e.g., “If I don’t keep active I will become deconditioned. I follow what my doctor or physical therapist recommends to be mobile safely.”

STEP 4:
Expose yourself to situations as another way to help overcome fears. This should be done in a gradual and systematic way. Once one is able to learn to tolerate the uncomfortable feelings and anxiety and that nothing bad will happen in the situation, the fear begins to lessen. Make a list of situations/activities to which you can expose yourself, grading each one from low level of challenge to high level of challenge. For each item on the list, develop a plan for how you will approach this challenge, what resources you will use, and how you might overcome anticipated obstacles. Once you put yourself in the situation, stay with it until you feel less and less uncomfortable. This will take at least 20 minutes.

Confronting Your Fear of Falling

With relation to the fear of falling: try to know your own capabilities and risk factors. Is balance an issue? Again, one can then learn to take small risks and build up strength and confidence in order to lessen the fear of falling. It is by doing, then, that we begin to experience less fear and gain more control of our lives.

Get recommendations from a physical therapist on how to be safely mobile. Start with small steps (for example, short distances with assistance, as described in the example above) and build from there.

Dr. Jayasinghe ended her presentation by offering some further suggestions and thoughts to consider related to members’ expressing their fear of falling and inability to get up from a fall:

• Consider a home safety evaluation by an occupational therapist, which can be requested from your physician.
• Speak with your physician about an evaluation for physical therapy.

It was suggested that various techniques can be learned, such as ways in which to get up from a fall. Learn to find ways to adapt related to your disability. Speak with your physician and discuss what may have contributed to your falling. Has your condition changed, for example, and what can be done about it?

Specific tips regarding the fear of falling can be found in the second presentation about this topic, entitled Focus on Falling - Part II: From Fear of Falling to Confidence.

About the Myositis Support Group at HSS

Learn more about the Myositis Support Group, a free support and education group held monthly at Hospital for Special Surgery

Summary by Suzan Fischbein, LCSW, Myositis Support Group Coordinator

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