1 Managing Fear after an Accident Patient Information Booklet Talis Consulting Limited
2 Why can Fear be a Problem Following an Accident? There are many reasons why you may experience fear following an accident: An accident can be traumatic; it is sure to be a marked life experience. This can cause feelings of fear or apprehension about similar circumstances; for example, it is commonly reported that those who have a motor-vehicle accident subsequently experience fear when travelling by car. be due to other processes. Fear due to life experiences is directed towards a specific, identifiable situation; for example a fear of travelling in a car. If you find that you feel anxious all the time, and not just in certain situations, then this type of fear may It can be difficult to know when fear you experience is a natural emotion and when it becomes a problem which requires addressing. Fear is a common reaction to a stressful life experience, and one might argue that it is sensible to feel fear when in a situation where you may come to harm. It is generally considered that when your feelings of fear interfere with the pursuit of valued goals then they become a problem. For example if you can t return to work because of fear of leaving the house then this is a fear which could be overcome and managed through formal, professional assistance. What Kind of Fears are Commonly Reported after an Accident? It is hard to estimate how many people experience problems with fear following an accident due to the subjective question of when fear becomes a problem. However it is estimated that around 25-35% of people will seek help for feelings of fear following accidents. This makes fear a common problem, and it is certainly a normal reaction to experiencing an accident. The most commonly reported fears are fear of travelling in a motor vehicle, fear of walking outside, fear of falling, and fear of not making sufficient progress during rehabilitation therapy.
3 Why do these fears not go away over time? Fears are often linked to specific situations, for example driving a car, or walking outside. This means that when fear is experienced these situations are avoided, when nothing bad happens this can cause you to mistakenly believe that avoiding the situation is beneficial. For example, imagine a person who experienced a motor-vehicle accident then develops a fear of driving; imagine then that they need to drive to the supermarket, their thoughts and experiences might play out in a similar way to this: Situation: I have to drive to the supermarket Feelings of fear: I could crash and hurt myself again Therefore I will not drive to the supermarket Feelings of fear go away and I do not come to physical harm Conclusion: It is good not to drive to the supermarket because then I don t feel fearful and I won t hurt myself This form of thinking can cause problems because the situation (i.e. driving) never occurs, therefore the person does not allow themselves the opportunity to experience it and therefore does not address their fear. This means that the fear will not go away as time passes. Overcoming these patterns of thought and avoidance can be one way to help manage your fears, and can be aided through Cognitive Therapy with a Clinical Psychologist.
4 What Can be done to Help? Can medication help? Some people are placed on medication if their fear or anxiety becomes a problem. Most commonly people are given anti-anxiety drugs (such as benzodiazepines or beta-blockers) or antidepressants to help calm their mood. Anti-anxiety medications change the way in which areas of the brain which are responsible for feelings of anxiety operate. For example benzodiazepines will produce feelings of calm and stabilisation of mood. However there are some concerns over the long-term use of benzodiazepines as people can come to rely on them, therefore they are usually only recommended for the shortterm relief of anxiety and fear. It is also possible that you may be prescribed beta-blockers. Beta-blockers will limit the physical responses associated with a fear response, for example shaking, sweating and an increased heart-rate. It is important to bear in mind that all medication has side effects, but that most people can tolerate medications very well. Your doctor should explain to you the possible side effects of any medication they prescribe to you. However if you are worried or confused about the medication you are taking then you should consult your doctor or pharmacist. If you are taking medication then: Never stop taking medication without consulting your doctor Always read and follow the instructions that come with medication carefully, and if you are confused then ask your pharmacist for advice If your medication makes you feel drowsy then do not drive or operate machinery Always consult your doctor if you are pregnant or intending to become pregnant, as some medication requires special monitoring during pregnancy. Furthermore, medication will not treat the underlying cause of your fear, it will only relieve the symptoms. This means that as soon as you stop taking the medication fears may return. Other forms of help, such as Cognitive Behavioural Therapy, are much more effective at addressing the root cause of your fear. Often people will undergo a combination of medication and Cognitive Behavioural Therapy.
5 What Can be done to Help? How can Cognitive Behavioural Therapy help? Cognitive behavioural therapy (or CBT) can help you to think differently about situations which cause you to feel fear. It is important to realise that how you think affects how you feel. There are numerous techniques which CBT can utilize to help you think differently about your fear. One such technique is that of systematic desensitisation. Systematic desensitisation works through gradually introducing you to the place, object or behaviour which you find fearful with the support of a therapist. Exposure begins gently, often just talking or thinking about the things which you are afraid of, and then progresses incrementally to give you more and more experience with these fearful stimuli. This gives you the opportunity to realise that the things which you are fearful of do not cause you any harm, and you will become less and less sensitive to these stimuli, allowing your fears to abate. A therapist trained in CBT can also help to teach you anxiety management techniques, such as relaxation training and positive self talk. Training in such techniques will allow you to deal with anxiety when it arises, or can help you to face situations where you know you are likely to be fearful. For example taking care to consciously relax telling yourself that you have the ability to overcome your fear and anxiety can get you through difficult situations. CBT says that whenever we encounter a situation there will be automatic thoughts about the situation which can then trigger fears. For example if a person has a fear of leaving the house to walk outside, an automatic thought which may arise could be: If I go outside I could fall and hurt myself ; or: there are people outside who would harm me. These automatic thoughts will then trigger a fearful reaction. CBT will help you to identify these automatic thoughts and will give you the opportunity to consider them. You may find, upon reflection, that these thoughts are unhelpful, and that they do not make sense. This can allow you to reappraise the fearful situation and can help to avoid feelings of fear when you subsequently encounter the situation. CBT allows you to work out exactly what it is about certain situations which you find fearful, and then allows you to consider whether fear is an appropriate reaction to these situational triggers. Through reappraisal of these automatic thoughts and through breaking unhelpful beliefs you may be able to overcome and manage your fear.
6 What Can I do to Help Myself? Undergoing therapy such as CBT can have hugely beneficial results, however there things which you can do to help yourself overcome fearful situations. As everyone s experience of fear is different, not all of these tips may be helpful to you, it is important to take what advice works for you and adapt it to your own situation. Slowly and gradually reintroduce things which you find fearful One of the best ways to overcome fear is to give yourself exposure to the thing which you find fearful. This is understandably a very difficult thing to do; therefore take things slowly and in small steps to gradually desensitise you to the fearful situation. As a starting point just thinking about the situation you find fearful and discussing it with others can help. When you find yourself feeling afraid, use relaxation techniques to help calm yourself down. Relaxation can help you to lower arousal when you feel afraid and it can be practiced every day. Pay attention to various muscles and tense and then relax them, concentrating on your breathing throughout. Take time to consciously relax your jaw, neck and shoulders when you feel afraid. Use positive self-statements If you are about to encounter a situation you are afraid of, then use positive self statements to help get you through it. Tell yourself that I can manage this situation if I just take it one step at a time and that I have gotten through tougher situations in the past before. Some people also find it beneficial to have a self statement which helps them work their way though the fearful situation, such as Relax. Calm down. I m in control of this. Or Let s keep focused on the present. What do I have to do?.
7 How can I Help Myself (Continued) Work out the motivation for overcoming your fear It can be very difficult and distressing to deal with fear, and therefore it is too easy to become de-motivated and to give up. To help avoid this work out what is it you hope to achieve, work out how your life will improve if you overcome this fear: what things will you be able to do that you cannot do at the moment? Talk about your fears, worries and anxieties It can be very helpful to talk over your fears with other people, be they friends, family or a therapist. Do not bottle up your fears. You may find it beneficial to join a support group, or seek out the advice of someone else in a similar situation. When you have worked out these things, write them down on a piece of paper and keep it with you. Refer to this piece of paper whenever you become de-motivated to help remind you of why you are tackling your fear. This also has the advantage of letting other people know about your fears. Sometimes it can be hard for others to recognise when you re afraid, therefore if they are aware of the problems you are having then this can allow them to adjust to situations you find difficult with sensitivity. Recognise that failure gives you an opportunity to learn It is natural to fear failure, and sometimes fear over failing to make progress can hinder rehabilitation efforts. However recognise that failures allow you to lean and progress.
8 Useful Websites: information/mental-health-a-z/fear-andanxiety/what-is-fear-and-anxiety/ - A website on fear and anxiety and common ways to deal with problems concerning fear and anxiety - A website with specific information about a fear of driving pdfs/what_is_cbt.pdf - An information sheet on how CBT can help manage fear and anxiety Talis Consulting Ltd. 2010
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