How might an individual live into their 80s with a crippling fear of people? In a lifetime with so many opportunities to interact with others — hundreds of possible exchanges each day — how can this be?

The answer is actually very simple and deserving of sincere empathy. As I’ve found in both research and my clinical experiences as a psychologist, anxiety is an incredibly prevalent, and at times debilitating, concern for our aging citizens. Anxiety can cause us to flee from experiences, freeze up at critical moments, and interrupt our learning. When anxiety catches hold, it can dig its claws in deep and remain for decades.

What begins as a scary experience — a car accident, an unforeseen encounter, a social embarrassment — transforms into fear. Fear that it will happen again, fear that it will be worse next time, fear of the unknown.

Fear: one of the strongest motivating forces we know.

Soon it is no longer just the experience, but fear of the experience that shapes behavior. There is a rising tension as the feared object is approached. Thoughts begin to race, the brain injects adrenaline into the bloodstream, and the body begins to itch with discomfort. One might begin to hyperventilate, the fear of the dreaded thing is so strong.

How much easier it is to just avoid the anxiety-provoking thing altogether.

In fact, how rewarding it feels to not engage with the fear. Avoiding situations associated with the feared stimulus can offer instant relief from such anticipatory anxiety. Instead of heart-pounding disaster, one can choose to not engage or just remain at home. The body relaxes, the breathing slows, and the tension recedes. In this way avoidance is like an instant treat we give ourselves for opting out of confrontation.

Think back to the last party or event that you chose to stay home from, and this may capture the essence.

The problem is, though, that avoidance comes with a cost.

Much like procrastination, what we put off dealing with today may offer temporary relief, yet the problem does not go away. By avoiding the scary thing, we deprive ourselves of the practice needed to tolerate it.

I won’t overcome my fear of elevators unless I eventually get into an elevator.

In this way overcoming anxiety means overcoming the short-term rewards inherent in avoidance and also tolerating the discomfort of practice. With time, the individual gets used to the discomfort and can engage more easily with the thing once feared. We call this “desensitization,” and it is the key to anxiety treatment. A mental health practitioner can support clients through this difficult process.

When it comes to older age, though, I typically see two mental barriers in my work that interfere with treatment. The client may think:

1. “I haven’t been able to change after so many years, so I never will.”

and/or

2. “I’ve been dealing with this for so long, so why change now?”

Such statements are thinly disguised representations of avoidance. They speak to the habit of steering clear of feared situations that can develop over decades — what represents the scary thing for many about engaging in anxiety treatment in older age. Avoidance can be taken as a given when in reality it is anything but.

It certainly is easier to maintain the status quo, and I believe this is a valid perspective. I will honor anyone who upholds such a view.

Nevertheless, there is a very special reward for those who do face their anxiety, even in their later years. One patient who exemplifies this comes to mind.

…..

N. was a resident of a nursing home where I was contracting to provide mental health services, and when staff first requested I meet with her, I was painted a very bleak picture.

“She scares all of her providers away. No one will work with her.”

When I met with N., I was pleasantly surprised to find that she was overall soft-spoken and very kind. She liked things done a certain way — maybe to a greater degree than the average person — but as I was more than happy to adapt as needed, this wasn’t an issue for our work. N. liked hymns and organizing her belongings. She enjoyed reminiscing about growing up on the family farm homestead and the different support groups she had been a part of. To all intents and purposes, the referral appeared to be a mistake. I found myself wondering if I had gotten my wires crossed (It wouldn’t have been the first time) and was seeing the wrong patient.

Then one day, I saw the issue.

When N. was working with a new caregiver, she became a different person. She snapped, she bullied, and she criticized. I even heard a foul word or two. After the interaction, N. burst into tears before my eyes.

As I comforted her, I wondered at this transformation. Not only was I shaping a theory around obsessive-compulsive disorder, but I could tell that something else was going on.

It turned out that N. suffered from severe social anxiety. Though she and I seemed to click right away, the majority of her interactions with others had been characterized by a fear response — fear of rejection, fear of retaliation, and fear of disappointment. Her fear manifested in the form of rudeness and even verbal aggression. Such anxieties had followed her through much of her life, even resulting in a brief inpatient hospitalization when she left her small town. There were periods in her life when she felt better able to cope than others, yet transitioning into a nursing home took away much of her control and coping skills.

In here, she was forced to constantly interact with others.

When I broached the subject of anxiety treatment, N. was initially scared. She shared versions of the two statements featured above: what would be the point at her age, and how realistic were her chances for success, really? I honored her views yet encouraged her to try, and she agreed.

We worked together for years, practicing with real-time situations she experienced related to roommates, other residents of the facility, and especially care providers. While in some ways a trigger, her constant contact with others gave her many opportunities to practice the physiological relaxation, social skills, and cognitive reframing techniques characteristic of anxiety treatment.

With time, her anxiety levels went down. They never fully went away, but the improvement was notable by all. Soon she developed very close and supportive relationships with the nursing facility staff.

When I asked what motivated her to accomplish her goals, she replied, “I wanted to say that I could. I was tired of carrying around my anxiety. And, I imagined you telling me that I did a job well done.”

And so I did.

…..

N., who had many co-morbid and life-limiting health conditions at her age, very easily could have maintained the status quo. But, because she chose to work on herself after decades of carrying around excess baggage and with no guarantee that it would work, she was able to achieve a higher reward than any offered by avoidance.

She had integrity.

She could say to her family, to her friends, and to herself that she did it.

I’ve seen many patients make impactful changes, armed with the right knowledge and tools. It’s never too late to build a new life habit, and mental health therapists are here to help.

…..

Note: The above qualities of persons and settings have been altered to protect individual identities. Characteristics from multiple patients and nursing staff have been combined, though the content and overarching message are true reflections of my experience as a mental health provider.

…..

If you’re interested in exploring these ideas more, check out my first book available on Amazon: The Golden Rules of Retirement: A Psychologist’s Guide To Living Life to the Fullest, No Matter Your Financial Situation. Kindle and paperback editions are available now!

As well, check out my new book, The Golden Rules of Life Satisfaction: A Psychologist’s Guide to Living a Longer, More Satisfying Life No Matter Your Age!

And, stay tuned for details, including release date, upcoming sales, and future books in the Golden Rules series by visiting my website: lifecanbegolden.com/

-Lee Penn, PhD