🧠 Understanding the fear of going out post-stroke

A stroke is a brutal event that confronts one's own vulnerability. Overnight, the body has become unpredictable, potentially treacherous. This experience leaves deep psychological marks, well beyond visible physical sequelae.

The fear of going out after a stroke is not a quirk or a weakness of character. It's a normal psychological reaction to trauma. It affects up to 30% of stroke survivors to varying degrees and can take several forms: fear of having another stroke in public, fear of falling, fear of others' scrutiny, fear of not being helped in time.

The different forms of fear

Factors that maintain fear

• Hypervigilance: After the stroke, one becomes extremely attentive to the slightest bodily sensations, interpreting each symptom as a possible new stroke
• Traumatic memories: Images, sensations, and emotions of the stroke can resurface abruptly and trigger intense anxiety
• Loss of confidence in one's body: The body that worked "automatically" has become a source of uncertainty
• Isolation: The less you go out, the less chance you have to verify that going out is possible, and the more fear grows

🔄 The vicious circle of avoidance

When faced with fear, the natural reaction is avoidance: you no longer go out, or less often, or only with company. In the short term, avoidance relieves anxiety. But in the long term, it worsens it by creating a particularly harmful vicious circle.

How the circle sets in

Imagine: you are afraid to go shopping. You decide not to go. Immediately, you feel relief. Your brain records: "avoidance = relief." Next time, avoidance will be even more tempting. But at the same time, the outside world becomes more and more threatening in your mind. The fear grows instead of diminishing.

Breaking the circle

The only way to break this circle is through progressive exposure: gradually confronting feared situations to allow the brain to relearn that going out is not dangerous. Each successful outing is concrete proof that weakens fear. This is the principle of re-exposure, at the heart of behavioral therapies.

"Fear does not disappear by avoiding it, it grows. It diminishes by facing it, gradually, at your pace, with the right support. Every step outside is a victory over anxiety."

— Behavioral therapy principles

💭 Recognizing and accepting your fears

Before you can overcome fear, you must first recognize and accept it. Denying your anxiety or feeling guilty ("I shouldn't be afraid") only adds suffering to suffering. Your fear is legitimate, understandable, and above all, surmountable.

Identify your specific fears

Take time to put words to your fears. What exactly scares you? Falling? Having another stroke? Others' scrutiny? Not being able to return if you're tired? The more you accurately identify your fears, the better you can address them.

Assess their intensity

On a scale of 0 to 10, assess each situation: stepping outside onto the landing (2/10), going to the mailbox (3/10), walking around the block (5/10), taking the bus (7/10), going to the supermarket (8/10). This hierarchy will help you build your progressive re-exposure program.

🧘 Techniques to manage anxiety

Before facing feared situations, equip yourself with tools to manage anxiety when it arises. These simple techniques can be learned and practiced daily.

Abdominal breathing

When anxiety rises, breathing becomes rapid and shallow, amplifying unpleasant sensations. Abdominal breathing reverses this process: inhale slowly through the nose while inflating the belly (not the chest), then exhale slowly through the mouth while contracting the belly. 5 cycles often suffice to calm the nervous system.

Sensorial anchoring

When anxiety overwhelms you, bring your attention to the present by focusing on your senses: 5 things you see, 4 you hear, 3 you touch, 2 you smell, 1 you taste. This technique interrupts the spiral of anxious thoughts.

Cognitive restructuring

Anxious thoughts are often exaggerated or catastrophic. Learn to question them: "What is the real likelihood of this happening?", "What happened in previous instances?", "Even if it happened, how could I cope?". Replace catastrophic thoughts with more realistic ones.

📈 Progressive re-exposure program

Progressive exposure is the most effective method for overcoming fears. The principle: face feared situations starting with the least anxiety-inducing ones, then gradually progress to the more difficult ones.

Building your exposure ladder

List all the outing situations that scare you and rank them from the least anxiety-inducing (1-2/10) to the most anxiety-inducing (9-10/10). Your program will start with the easiest situations.

The rules of exposure

• Gradual progression: Only move to the next level when the current level generates only mild anxiety (3/10 max)
• Regular practice: Practice every day if possible, at least 3 times a week
• Adequate duration: Stay in the situation until anxiety decreases by at least 50%
• No fleeing: Do not leave the situation at the peak of anxiety (this would reinforce the fear)
• Patience: The program may take several weeks, which is normal

Typical week

Week 1-2: Level 1 and 2. Step out onto the landing, go to the mailbox, several times a day. Use breathing techniques if needed. Note progress.

Week 3-4: Level 3 and 4. Extend the perimeter. Walk around the building, go to the end of the street. Always accompanied if needed at first, then alone.

Week 5-6: Level 5 and 6. Outings with a purpose (bakery, pharmacy). First social interactions outside.

Week 7-8: Higher levels according to your personal scale. Transportation, shops, busier places.

🎒 Practical advice for outings

Some practical preparations can reduce anxiety and make outings more serene.

Prepare a "go-out kit"

• Charged phone with emergency and close contacts' numbers on speed dial
• Card with your name, a close contact's phone number, and "stroke survivor" mention
• Small water bottle
• Usual medication if necessary
• A reassuring item (photo, small lucky charm)

Choose the right time

Plan your outings when you are at your best: avoid times of great fatigue, moments of stress. For first attempts, choose quiet hours (mid-morning, early afternoon) and uncrowded places.

Identify rest spots

Before a new outing, mentally or on a map spot places where you could sit if needed: benches, cafes, building halls. Knowing that a break is possible reduces anxiety.

👨‍👩‍👧 The role of the entourage

The entourage plays a crucial role in regaining confidence. But be careful: poorly calibrated support can be counterproductive.

What helps

• Accompany without overprotecting: Be there for reassurance, but allow as much independence as possible
• Encourage without forcing: Suggest outings, value efforts, but respect the pace
• Normalize anxiety: "It's normal to be afraid after what you've experienced"
• Celebrate victories: Every successful outing deserves recognition

What doesn't help

• Doing it for them: "Stay, I'll go for you" (reinforces avoidance)
• Minimizing: "You have no reason to be afraid" (invalidates the feeling)
• Dramatizing: "Are you sure it's wise?" (amplifies anxiety)
• Forcing: "Come on, make an effort" (creates guilt)

"The best support is one that accompanies without hindering, reassures without overprotecting, encourages without forcing. A delicate but essential balance."

— Advice for caregivers

🩺 When to consult a professional

Self-help has its limits. Certain signs indicate that professional support would be beneficial.

Consult if:

• Anxiety does not decrease despite your efforts for several weeks
• You haven't gone out at all for several weeks
• Anxiety is accompanied by depression (persistent sadness, loss of interest, dark thoughts)
• You have panic attacks (intense anxiety attacks)
• Traumatic memories of the stroke invade you regularly
• Anxiety significantly disrupts your sleep

The professionals who can help