What is the difference between fear and anxiety?

Fear is a vital and healthy emotion, needed for a person's survival. It reflects the need for caution in the face of a tangible threatening situation, and prepares them for the possibility of being forced to fight or to flee. Even if fear sometimes seems unjustified to us, or does not correspond to what we expect from ourselves or from other people, it has its place and justification. We are afraid when there is something that endangers our safety, or that of people dear to us.

Anxiety differs from fear in that it arises in anticipation of encountering a threat, and is disproportionate to the level of threat that the actual current situation poses. It often has no logical cause, and therefore cannot be rationally alleviated. The anxiety can be about public speaking, clowns, sharp objects, or anything else.

Anxiety has physical characteristics like fear: increased heart rate, increased breathing rate, chest tightness, increased sweating of the palms, cold sweat, stomach and headache, nausea. It also has emotional characteristics such as: terror and helplessness. When anxiety persists, and is experienced repeatedly in a way that does not correspond to the actual threat facing the person, we call it an anxiety disorder.

There are different types of anxiety disorders: panic attacks, social anxiety, phobias, and generalized anxiety; but what characterizes them all is the impairment of functioning. The anxious person avoids situations that may trigger anxiety attacks, thereby impairing his functioning, limiting his integration into the community, and preventing him from maximizing his abilities and the possibility of bringing himself fully into the world.

In children, anxiety can also harm emotional and social development, and even physical development, if it causes them to avoid activities that are essential for their development. The child shows distress in the face of the anxiety factor, avoids dealing with the situation or factors that caused anxiety, his functioning is impaired, and along with it, the functioning of the family that tries to help the child cope is also impaired.

The cause of anxiety varies from person to person. Anxiety may stem from a traumatic event, learned helplessness, a genetic predisposition to anxiety sensitivity (serotonin underregulation), or emotional factors throughout a person's childhood, such as the behavioral models they experienced from their parents.

The goal of treating anxiety is not to eliminate anxiety completely, but to allow the person a behavioral choice of whether to respond to it because it is based on a real, current threat, or to overcome it because it is not.

Most therapists treat anxiety on land, but in addition to regular psychotherapy, or in combination with it, I also offer anxiety treatment in the pool.

So why actually go to the pool to treat anxiety?

There are three elements in the pool: the patient, the therapist, and the water. The water is there with us, consistently and steadily, as a mediating regulating and supporting factor. On the other hand, the pool, with its various elements, materializes various anxieties, and allows them to be brought concretely to the here and now. The boundaries of the pool are a concrete metaphor for the boundaries of the body that may not be clear or safe enough. Detaching the legs from the bottom of the pool and floating on the surface of the water or in the therapist's hands is a metaphor for relying on others. Swimming from the therapist to the wall is a metaphor for separation from a parent or a significant other. Putting your head in the water and holding your breath requires trust in your abilities as a swimmer and faith in yourself, and in the water that will support you.

Allowing anxieties to materialize in the here and now, allows them to be treated here and now, not as a metaphor, but in a concrete way.

The first step in treating anxiety will always be establishing a therapeutic relationship and the patients confidence in the aquatic environment. Trust in the therapist and a sense of competence in the pool will allow the patient to cope better with anxiety, because the patient is not alone in facing the danger.

The second stage will be establishing independence in the water, and practicing water skills. Is it possible to enter the water without fear, how to turn from prone to back, how to turn from back to prone, how to move from a floating position to a standing position, and from standing to floating, how to deal with water that is too deep for you to stand in.

The third stage will often include learning to swim. Learning to swim has several goals. The first is the goal of integration into the community, meaning the acquisition of an ability that allows you to go with your family and friends to spend time in the sea and pool, and not be left out of the action. The second goal is a sense of achievement and self-pride in your ability to acquire a new life skill, while dealing with fears.

Each of the stages is accompanied, as needed, by active exercises for regulating anxiety, some taken from the worlds of EMDR, some from the worlds of mindfulness. These are exercises that can and should be taken from the aquatic environment, and used in anxiety situations on dry land.

Each of the stages is accompanied, as needed, by conversation. What arises now, is it possible to allow both fear and the ability to continue living and being, and perhaps even swimming, to exist simultaneously? Speech and conversation allow the patient to generalize the current coping with anxiety, including the anxiety they experience on a daily basis.

In conclusion, something personal. I have a lot of experience treating people with anxiety in general, and anxiety about water in particular. The youngest person who came to me with anxiety and I treated her through water games and teaching her independence in the water was two years old. The oldest person who came to me with anxiety about water and I taught him to swim was eighty-two years old.

It is never too late, we have enough time, and if we have faith and hope, we can go far. Waiting for you.