Emotional Resilience Blog from The Fear Course

The latest research, realisations and thinking in the world of emotional resilience, anxiety and fear reduction from around the world.

Robin Williams 1951 - 2014

Robin Williams 1951 - 2014

As I was posting my last blog about the problems Experiential Avoidance can escalate into, including suicide and addictions, a heart-breaking drama was playing itself out in the Californian home of the Oscar winning actor and comedian Robin Williams who was 63.

Robin had long been diagnosed with severe depression and had battles with drink and cocaine addiction for which he had famously received treatment for at a rehab centre.

Reporting the death of Robin in the early hours of this morning (UK time) the Marin County sheriff's office stated they suspected suicide by asphyxiation.

Robin's wife Susan Schneider said this morning "This morning I lost my husband and best friend, while the world lost one of its most beloved artists and beautiful human beings. I am utterly heartbroken,"

Robin openly talked about his battles with alcohol and cocaine in the early 1980s, and his relapse in 2006. He appeared to have recovered however last month he returned to rehab in Minnesota.

Suicide is often seen as a selfish act, however as one who had in the past seriously considered such action whilst suffering from depression myself, having dealt with depression and anxiety in many other people therapeutically and having attended suicides and prevented a number of suicides as a police officer, all the individual often wants is relief from the symptoms of the crushing depression.

In an interview in 2010, asked about his depression and had he felt happier, Robin replied : "I think so. And not afraid to be unhappy. That's OK too. And then you can be like, all is good. And that is the thing, that is the gift."

This comes back to the heart of the dangers of Experiential Avoidance.

My heart goes out to Robin's family and friends. We have lost a true talent and extraordinary fellow human being in very sad circumstances.

If you recognise and think you too may be avoiding feelings, thoughts, memories, physical sensations and other internal experiences please get help.


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Why the Fear of the Fear is More Damaging than the Original Fear

Why the Fear of the Fear is More Damaging than the Original Fear

When someone gets anxious or has a fear the feelings, thoughts, memories, physical sensations and other internal experiences the the fear or anxiety bring about are frequently so unpleasant that the individual will do just about anything to avoid them. This fear of the fear, or more correctly the fear of the effects of the fear is so distressing for many people that even talking about the issue is a problem. The distress is often heightened when there is no apparent direct cause or fear as occurs with GAD or General Anxiety Disorder or SAD Social Anxiety Disorder. There is a fear that these feelings could strike at any time.

It is not surprising then that people with fear and anxiety often end up not just avoiding the object of the anxiety, if there is one, but also of the resultant feelings, thoughts, memories, physical sensations and other internal experiences. This second type of avoidance is known as Experiential Avoidance.

Recent research has shown that how one reacts to the emotions and feelings that result from the anxiety makes a huge difference as to whether the individual is likely to get worse or not.

A swath of research is showing that people who are unwilling to experience the feelings, thoughts, memories, physical sensations and other internal experiences associated with the anxiety are much more likely to find the symptoms escalating and deeper problems arising.

Part of the problem is avoidance can only ever be a temporary relief and will never 'fix or solve' the problem. It merely side-steps the issue, which means that it is left still to face later. This is one reason why people who engage in avoidance as an emotion regulation strategy keep having the same and often escalating problem.

Another issue is that avoidance of anything psychologically reinforces the idea that the thing, in this case the feelings and thoughts, being avoided are bad or even dangerous in some way.

In order to avoid something requires that you end up focussing on and in many cases often obsessing about the very thing you are trying to avoid. This then means that the individual is focussing and obsessing about a negative. This takes time and effort and in effect crowds out all the other experiences of being a human, many of which are positive and joyful. As the individual focusses more and more on avoiding the horrible feelings and experiences, less and less concentration is placed on the positive things in life. In effect it becomes a negative vortex, dragging the individual down, often resulting eventually in depression, OCD, resorting to drugs and alcohol, self-harming, restricting food intake and even suicide.
We are finding that all of these problems frequently stem from Experiential Avoidance.

This is one of the reasons I deal with the avoidance as a matter of importance whilst treating the presenting anxiety and help the individual develop better and more effective emotion regulation strategies.





Chawla, Neharika; Ostafin, Brian (2007). "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review". Journal of Clinical Psychology 63 (9): 871–90. doi:10.1002/jclp.20400.PMID 17674402.

Gámez, Wakiza; et al (2011). "Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire". Psychological Assessment23 (3): 692–713. doi:10.1037/a0023242. PMID 21534697.

Hayes, Steven C.et al (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press. ISBN 1-57230-481-2.

Hayes, Steven C. Et Al (1996). "Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment". Journal of Consulting and Clinical Psychology 64 (6): 1152–68. doi:10.1037/0022-006X.64.6.1152. PMID 8991302.

Losada, A. etal (2014) Development and validation of the experiential avoidance in caregiving questionnaire (EACQ). Aging & Mental Health. Volume 18, Issue 7, 2014


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The Top 10 Fears / Anxieties And How Long It Takes To Treat Them

The Top 10 Fears / Anxieties And How Long It Takes To Treat Them

Every year I do an audit of the anxieties and fears we treat and how long it took to treat them. There are five numbers to look at.

  1. Frequency - the number of people presenting with a particular fear or anxiety.
  2. Control average - The average time (in days) it took to get the fear or anxiety to level 3 (0 = no feelings of anxiety or fear. 10 = Maximum anxiety and fear feelings). Level 3 is a definition of the disorder being under control by the individual. Most people present to us at levels 8-10.
  3. Control range - How long in days (quickest to longest) it took to get the disorder to get to level 3 (see notes above).
  4. Discharge average - the average time (in days) it took individuals to feel they had the fear or anxiety under control enough to discharge themselves from the programme. Usually at level 0.
  5. Discharge range - How long in days (quickest to longest) it took to get the disorder under complete control (to get to level 0 or 1) and to discharge themselves or leave the programme having been successfully treated.
Anxiety / Fear   Frequency 

 Control Av 

 Control Rng   Discharge Av   Discharge Rng 
1. General Anxiety Disorder 403 12 4 - 21 16 11 - 33
2. Social Anxiety Disorders * 368 9 3 - 16 16 13 - 21
3. Fear of Rejection 360 10 7 - 14 16 12 - 22
4. Fear of Failure 337 11 7 - 20 17 14 - 31
5. Fear of Meetings 324 9 5 - 17 15 7 - 20
6. Panic or Anxiety Attacks 211 7 2 - 9 10 6 - 19
7. Public Speaking Anxieties 209 8 5 - 16 15 7 - 19
8. Agoraphobia 194 7 3 - 22 19 8 - 34
9. Sexual Performance Anxieties  162 14 7 - 30 23 11 - 38
10. Fear of Flying 131 9 7 - 18 16 12 - 19


*Social anxiety disorders (SAD) include fears and anxieties around being in social situations, meeting people, dating, having to talk to people unexpectedly, going to gatherings etc.


  1. The top three fears and anxieties tend (but not always) to be versions of a fear of rejection.
  2. When I started conducting therapeutic interventions the presence I was surprised about the predominance of a fear of meetings. At first I assumed a fear of meetings was a subset of public speaking anxieties, however over the years I have come to recognise both the prevalence of this disorder and its grounding in a fear of rejection, social anxieties and public speaking issues.
  3. The treatment times are only for the period until the disorder is brought down to levels 0 (no anxiety) or 1 (aware of a minor heightened sense of arousal) this does not include the confidence and assertiveness phases of the programme. I firmly believe that to just treat an anxiety or fear is not enough as it leaves the client susceptible to forming similar fears and anxieties at a later date. To prevent this I usually include a confidence and assertiveness skills course to prevent this occurring.


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First Emotional Resilience Video Research Brief

Please let me know what you think. Is this useful?


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This weeks Emotional Resilience Podcast

This weeks Emotional Resilience Podcast

Here is episode 13:

Download this episode (right click and save)

Get the pocast from iTunes


All notes and references for this episode can be found here

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Do Better Emotion Regulation Skills Help With Depression?

There is a growing and very strong body of evidence to show that enhancing your emotion regulation skills can make a significant difference to things like anxiety disorders, fear, nerves and general confidence and shyness issues. There is also a common perception in the medical and therapeutic circles that better emotion regulation skills can help with depression as well. However this last perception had not been scientifically tested... until now.

A study published in the Journal of Consulting and Clinical Psychology did just that. Researchers in Germany assessed 152 people who had been hospitalised with Major Depressive Disorder (MDD) for their levels of emotion regulation skills (the techniques we teach) four times in just a three week period. Over that period they showed the patients how to do a series of emotion regulation skills.

What they found was quite startling.

They discovered that learning emotion regulation skills has a clear positive effect and significantly reduced the symptoms of the disorder. Additionally they discovered that the techniques which enabled the patients to tolerate negative emotions and to actively modify undesired emotions were the most effective in reducing the severity of the depressive symptoms.

The researchers concluded with a call for emotion regulation techniques to be shown early in the diagnosis of depression.

I would add my agreement with this and go further that these should be the first line of defence. In fact teaching emotion regulation techniques at school, I believe would reduce the incidence of depression and anxiety significantly. Given the costs of these two disorders (see my last blog The Cost of Anxiety) such prevention would pay dividends to the individuals, society at large and reduce the burden on the health services.




Radkovsky. A., etal (2014) Successful emotion regulation skills application predicts subsequent reduction of symptom severity during treatment of major depressive disorder. Journal of Consulting and Clinical Psychology, Vol 82(2), Apr 2014, 248-262

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The Cost of Anxiety

The Cost of Anxiety

It is widely known in the medical research community that anxiety disorders are the most common disorders there is, bar none. Not only are anxiety disorders the most frequently suffered disorder there is, a research paper published in journal Neuropsychopharmacology worked out that in the US alone in 2002 anxiety cost about 100 Billion dollars or £58,326,044,000 per year, which is the last reliable estimate of the general cost of anxiety. Given that this was firstly back in 2002 and secondly just in the US, which only accounts for about 4,44% of the worlds population you can start to get some idea of the size of the problem.

The cost obviously goes way beyond the financial burden, in terms of the incalculable effects it has on people's lives on a daily basis. Especially when you take into account the reduction in opportunities anxiety causes. Right now as I write this I have personal clients who:

  • couldn't go out,
  • wouldn't fly,
  • found it hard to speak at meetings,
  • got flustered and avoided social events, meetings, dating and a whole host of other social situations,
  • couldn't go shopping,
  • wouldn't drive,
  • wouldn't be a passenger in a car being driven by someone else,
  • couldn't go for job interviews,
  • wouldn't take a promotion,
  • avoided public places,
  • avoided intimate relationships,
  • were putting off an operation,

and that is just the start. The cost to these people in terms of the reduced opportunities and social functioning cannot be put into monetary terms. Not only that the emotional cost is almost impossible to articulate. Until you have had a panic or anxiety attack, or found yourself avoiding things or had depression, it is very difficult to understand what this does inside to a person.

The cost does not end there. There is now a growing body of evidence about the direct and indirect health costs of anxiety disorders. For example people with an anxiety disorder are 3 to 4 times more likely to develop cardiovascular disease, and twice as likely to die from some form of heart problem or a heart attack as the people without anxiety. Additionally as I reported in 'People with anxiety are more likely to develop depression' people with anxiety are 50-70% more likely to develop depression than the general population. Further there are a whole host of other health problems associated with anxiety which greatly effect the quality of life like cancer and cost the individual in mental and emotional ways beyond just financial costs.

And yet if you go to the doctors with any anxiety disorder the frequent response is to be put on a waiting list for online CBT or anti-depressants. Whilst I understand the primacy physical illnesses like coronary and cancer ( See 'Links between anxiety and cancer' ) care has, it is about time anxiety disorders also got the attention and priority other illnesses have form the medical professions. Anxiety which often either underlies, predicts or complicates the physical illness or as reported here '(The effects of pre-operation anxiety on the recovery of heart surgery patients') actually exacerbates or worsens the prognosis of the patient.

Anxiety treatment and prevention needs to become a priority for all of the health services. It's not like there is a lack of evidence.




Bardeen, J.R. etal (2014) Exploring the relationship between positive and negative emotional avoidance and anxiety symptom severity: The moderating role of attentional control. Journal of Behavior Therapy and Experimental Psychiatry. Volume 45, Issue 3, September 2014, Pages 415–420

Chalmers J, Quintana DS, Abbott MJ and Kemp AH (2014). Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Front. Psychiatry 5:80. doi: 10.3389/fpsyt.2014.00080

Fagundes, C.P. etal (2014) Attachment Anxiety is Related to Epstein-Barr Virus Latency. Brain, Behavior, and Immunity (2014), doi: http:// dx.doi.org/10.1016/j.bbi.2014.04.002

Jacobson N.C. & Newman, M.G. (2014) Avoidance mediates the relationship between anxiety and depression over a decade later. Journal of Anxiety Disorders. 28 (2014) 437-445.

Kessler, R. C., & Greenberg, P. E. (2002). The economic burden of anxiety and stress disorders. Neuropsychopharmacology: The fifth generation of progress, 67, 982-992.

Kravitz HM, Schott LL, Joffe H, Cyranowski JM, Bromberger JT (2014) Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS). Psychological Medicine [2014:1-10] DOI: 10.1017/S0033291714000075

Mohanty, S. et al (2014) Baseline anxiety impacts improvement in quality of life in atrial fibrillation undergoing catheter albtion. J Am Coll Cardiol. 2014;63(12_S):. doi:10.1016/S0735-1097(14)60395-8

Rubertsson, C et al. (2014) Anxiety in early pregnancy: prevalence and contributing factors. Archives of Women's Mental Health June 2014, Volume 17, Issue 3, pp 221-228

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