Phobias have been found to occur frequently in people with traumatic brain injury (the word ‘traumatic’ here means physical trauma rather than emotional). However, I would guess they can also occur with PTSD as a distortion of triggers.
Note: The below method is a way of dealing with fairly simple phobias and panic, but it’s important that anyone experiencing psychological symptoms from trauma or BI also gets professional help.
In the year after the accident I acquired a ridiculous number of phobias. They seemed to appear at random. I became scared of the dark, crossing the road, insects, mice, conversation, sleep, lack of sleep. Some of these phobias I still have a little now, but for the more concrete ones I was able to come up with a method for getting rid of them.
My understanding of how a phobia sticks around is this:
- Usually, an incident causes us to associate danger with the phobia – let’s use Trevor’s phobia of the dark as the result of falling down stairs in the dark, as an example. With a BI, the phobias seem to appear without cause, but the effect is exactly the same – fear associated with specific stimuli.
- Every time afterwards, when Trevor is in the dark, he experiences fear, not just thoughts and emotions, but tangible physical feelings. His heart rate increases, he finds it difficult to breathe, he starts to panic.
- These intense reactions feed into the fear. He becomes more afraid because his body is reacting in an extreme way that is, in itself, scary ie. positive feedback.
- Having experienced the frightening symptoms of terror in 3. while in the dark, his brain (not the conscious bit, but all the automatic processes he has little control over) adds a few new red flags to the idea of ‘dark’ and his phobia grows.
This can also be shown by a nifty diagram
In order to overcome a fear it is necessary to control the physical reaction to it and stop the positive feedback, this means creating new, calm associations with the phobia, to work at its blurry edges.
So Trevor starts to inch his way into darkness, using the following:
- He stands in a lit room, but at the doorway to a dark room, not scared.
- He breathes slowly, calmly, reassures himself that nothing can happen, the light is right there, he can see fine. He concentrates on the sensations in his feet, his hands; still not scared.
- When he feels completely calm, he takes a step forward into the darkness. He starts to feel a little panic, slight increase in heart rate and speed of breathing.
- So he stops. Repeats 2. until he feels calm again, all the while not moving.
- Repeats 3.
- Repeats 2.
If he reaches a point where he can’t calm himself, then he takes a step back into the light and repeats step 2. It’s important that his final association with the dark is one of calm, this is way more important than getting as close to his fear as possible.
Sometimes this takes a few attempts, and it is a slow way of challenging anything, but it seems to work.
If your phobia is one you can’t physically approach in this way, then there are substitutes. For example: looking at photos of it, reading about it or writing about it. With each of these methods, it is still important to approach the fear slowly, giving yourself time to be calm.
It’s also a method that can also be used in a number of other situations when fear and panic take over. Panic is very destructive for people with a BI, because it causes the brain to shut down functions that are already struggling. Whether trying to have a conversation, read a train timetable or cross a busy road, it’s very easy for someone with BI to panic when they find something difficult. This leads to irrational thinking taking over, eg I can’t do this! Why can’t I do this? I can’t do anything! or even I don’t know what’s happening! I’m in danger! But that panic then further shuts down reason and cognitive skills, leading to increased panic – the positive feedback shown above, and shown in the diagram below.
The truth is, you can’t make the BI go away, the difficulties will ease, but it takes time. However you can stop the positive feedback from making the problem worse. This also has the long term benefit of reducing stress, which in turn gives your brain and body the peace they need to heal.
Whatever it is you’re trying to do, when it starts to get difficult, as long as you’re not in immediate danger, pause for a moment and go through the following steps (this is almost identical to above, but to reiterate…):
- Breathe slowly, calmly.
- Reassure yourself that nothing can happen, you are fine.
- Concentrate on the sensations in your feet, your hands.
- Keep breathing and be aware of your breath.
- When you feel in control, carry on.
Remember it’s ok to find things difficult, and most of the time it’s fine to wait, there’s no danger involved. The danger only comes when panic takes over and you make bad decisions (speaking as someone who has panicked crossing the road and then walked out in front of cars, leading to a phobia about crossing the road!)
This method does not work instantly, it takes time and practice to be able to control panic like this. The best time to start practicing is when you don’t need it and already feel calm.
This method uses techniques I learnt from meditation and mindfulness. Both of those are more difficult and take commitment and are not necessary for this method to work. However, if you can learn them, they are incredibly valuable.
If you have any questions about this, please free to ask in the comments below.