Overcoming safety behaviours and avoiding situations

MindWell self-help activity

You will need to print off the worksheets or download them to a computer or laptop to complete this activity.

It’s common for people who are experiencing panic to want to find ways of coping (safety behaviours) or to avoid certain situations all together.

When you do this your anxiety quickly comes down and you get some short-term relief from the unpleasant symptoms.

Unfortunately, this can encourage you to continue to avoid similar situations in the future, setting up a pattern of avoidance. And the next time you are faced with a feared event you will feel just as anxious. This can keep panic attacks happening.

You can use the Identifying safety behaviours and things you do to avoid situations worksheet to help you identify any safety behaviours or situations you may be avoiding.

Now that you have a list of situations that you fear and avoid you can use the The ladder of avoidance worksheet to rate each situation in order of how anxious each would make you feel. Remember some situations, like going to the supermarket, may be easier or more difficult at certain times of the day.

It’s a good idea to start overcoming your anxiety gradually by confronting the situations at the bottom of the ladder first – easier situations which cause you the least fear. This technique is often called Graded exposure.

Experiencing situations that you normally fear and avoid without using safety behaviours can seem scary at first. Staying long enough in these situations, however, can help you to:

• Test out and challenge your catastrophic misinterpretations (or frightening thoughts) ‘I travelled on the bus without wearing my headphones today. I did not faint or stop breathing’.
• Reduce anxiety about being in similar situations in the future. ‘I travelled on the bus to work today. Nothing bad happened so I will feel less anxious about the journey tomorrow.’

Remember to repeat the evidence you have learnt to discredit your catastrophic misinterpretations. ‘I can feel dizzy on the bus and think I’m going to faint. The dizziness is really a symptom of anxiety and not a sign that I’m about to faint.’

You could also have a reassuring thought ready which you can repeat when necessary. ‘This situation can’t hurt me and the anxiety will pass. The next time I deal with this situation it will feel easier.’

You can use the Graded exposure diary to record your progress. Start with the situation at the bottom of the ladder and make a note of the date, whether you needed to use a safety behaviour and your levels of anxiety at the start and end of the session.

You should try to stay in the situation with your anxiety feelings until they come down to a level that feels as comfortable as possible. Aim for at least 50% less than when you started. So, for example, if your anxiety rated 60 at the start of the exercise it should come down to 30 by the end. You can then repeat the same exercise until it is no more than 30 at the start of the session. You can repeat the exercise as many times as necessary. When you are ready you can then move up the ladder to the next situation and repeat. You should try to complete 4 to 5 exercises per week.

Sometimes people feel they need to use some form of safety behaviour to get them started (which may involve taking a friend for example). This is alright to begin with but it is necessary at some stage to drop any things that you are using to help you feel better during the exposure sessions. Remember to make a note in the diary of when you have dropped these safety behaviours.

If you try a particular situation and find you can not stay long in the situation don’t be discouraged. Try it again as soon as possible and try to stay a bit longer the next time. Or try a situation that you find a bit easier. As you become more and more confident that situations will not harm you – you will find it easier to stay in situations longer without using safety behaviours. It will take time and you may have some setbacks so sticking with it is the key.

If you need more support – talk to a GP or you can self-refer to Leeds Mental Wellbeing Service, a service in Leeds that helps people with common mental health problems like panic.