How you can help yourself overcome the fear of falling

A self-help guide

"The best way to never fall is to never get up from your chair... but it wouldn’t be much of a life!"

About this booklet

Many of us will, at some time, have a fear of falling. For example, experiencing slipping on ice on a winter’s day can leave us feeling shaky. As a result we may walk cautiously for a while afterwards, and it may take some time to return to our normal self.

This is quite normal and understandable – it makes sense to be careful. But a more ongoing, lasting fear of falling can cause problems, by stopping us enjoying life to the full.

Living with a fear of falling can create a lot of worry for family members, friends and ourselves.

A fear of falling can also lead to us dropping out of activities we like to do and staying at home more. This can result in a loss of confidence and feelings of boredom, frustration and loneliness.

This information booklet is for anyone who has a fear of falling, his or her relatives and friends.

The booklet looks at:

The emotional effects of the fear of falling
What it feels like to be anxious
How anxiety can affect how you walk
How you can help yourself
How other people can support you

The emotional effects of a fear of falling

We may feel out of control of our body and our situation generally. Therefore we may feel that there is nothing that we can do.

Worry about falling can make us feel more aware of ageing and health problems. We can feel vulnerable. We might feel less confident to go out and do the things we enjoy.

Sometimes it can be difficult to talk about how we feel with those close to us. We may not want to worry or upset them. We may feel that no-one else will understand. We may feel lonely, isolated, embarrassed or ashamed.

What it feels like to be anxious

There are three parts to the feeling of anxiety - how our body feels, how we think, and how we behave:

How our body feels

Physical feelings include:

Shaky legs
Tight chest or fast shallow breathing
Churning stomach
Sweating
Trembling
Racing heart
Headache
Stiff neck or painful shoulders

Physical feelings of anxiety can be unpleasant. However, it is not physically harmful - it’s our body’s natural way of reacting when we feel in danger.

What physical feelings do you notice when you are anxious?

How we think

Worrying thoughts about falling can pop up in our minds when we are thinking about or doing activities, and can be very hard to ignore.
We may fear the worst e.g. “I will not be able to get up if I fall”.
The way we think fits with our mood. So when we feel anxious we notice worrying things more than good things. For example, “I can feel my legs are wobbly; I might fall” rather than “I’m walking, I’ve not fallen, I’m getting there!” These worrying thoughts can make the anxiety worse.
What goes through your mind when you are thinking about walking?

How we behave

None of us like to feel unsafe, so we often try to get away from things that make us feel anxious.
We may sit down or we may hold on to something.
We try to get tasks over and done with as quickly as possible, so we rush.
We might ask someone else to do a task for us.
Whilst this makes us feel safer in the short term, it means that we never get a chance to learn what we can do.
We may avoid places or activities or only go out when someone is with us.
Over time this further reduces our confidence and limits what we do.
What do you do when you feel worried about falling?

How anxiety can affect how you walk

When we are anxious our muscles can tense up. This can make it harder to walk naturally or save ourselves if we do trip.
Worrying thoughts not only trigger physical feelings of tension; they also distract us from what we are trying to do.
If we do less because we are anxious, this can make us unfit and weaker in the long term.

How you can help yourself

A step by step guide

There might be lots of very good reasons why you worry about falling. Your doctor, nurse, or therapist can help and advise you.

However, the physical effects of anxiety and worrying thoughts can add to the problem. By tackling the anxiety you may well find that walking becomes easier and you rediscover your confidence.

Dealing with physical anxiety

When we are anxious our breathing can become fast and shallow – trying to slow down your breathing can help you to feel calmer.

Anxiety can make you tense – relaxation can help you to notice this and reduce tension. Try to practise a relaxation exercise every day. There are examples at the end of this booklet. Then if you do feel tense, you will have the skills to manage it.

Dealing with worrying thoughts

When we are anxious we tend to notice the bad things and ignore or dismiss the good things.

Try to get more of a balance in your thoughts: take time to notice what went well and think encouraging things, to help you feel more rather than less confident.

Dealing with avoidance

If your usual activities seem too daunting, set yourself a smaller goal – one you aren’t too afraid to try.

Even walking a few steps across the room is a good start to getting your confidence back.

Have a goal in mind that matters to you. Even very small goals are important as long as they relate to the things you value in life.

Here are some examples of ways that people have helped themselves to get more confident with walking

Getting ready

Don’t rush!
Get up when you feel ready.
Remember to think about your breathing and try to relax.
“I can only do one step at a time; I’ll concentrate on one step then move on to the next step.”
“I can do this, I have done it in the past.”

Walking

“What do I need to do first, what do I need to do next?”
“I’m doing alright as I am.”
“One step at a time!”
“Never mind what others might be thinking, it’s not relevant.”
If you feel tense, shaky or panicky, stop and take a few slow, deep breaths.
Tell yourself that the unpleasant feelings are only anxiety, and will pass in time.
Don’t rush! Go at your pace. If you’re with someone, explain that you’ll walk better at your own pace

After

Notice your achievements.

“I did it!”
“It wasn’t that bad was it, I made it”
“I felt uncomfortable, but I coped”
Even if it wasn’t perfect, I still did it.
Congratulate yourself - give yourself a treat!

Preparing for next time

Remind yourself of what you achieved last time

“These worries are thoughts, not facts – I don’t have to let them control what I do.”
“I had these same worries before, yet I managed – my worst fears didn’t come true.”
“I did it before, so I can do it again.”

Build on your success!

Once you have achieved your goal AND feel fairly confident about it, extend your goals – try going a little further.

"I can overcome my fear of falling!"

It is not easy, but by working on it and learning from experience, you can reduce your anxiety.

Can you think of a time when you were pleased with your walking?

What did you do? Perhaps you did something you didn’t think you would be able to do. Perhaps you went a bit further than before. Perhaps you did what you normally do, but didn’t feel as tired or stressed.

How did you feel in your body when you were walking? If you felt anxiety symptoms, how did you keep them from stopping you?

What was going through your mind? If you noticed worrying thoughts, how did you manage them? What positive or encouraging things did you say to yourself?

If you felt discouraged at any point, what did you do or say to yourself to stick with it?

Now that you know that you’ve achieved it, what would you say to yourself if you were worried about walking in the future?

What will be your next goal?

How other people can help you

People who care about you may want to support you to improve your confidence, but may not understand how you feel or know what to do for the best.

People may also be keen to keep you safe, but this can sometimes make them nervous if you want to try to do more for yourself.

Try to explain how you feel and what you want to achieve. It may help to share this booklet with family and friends.

Talk to family and friends about what they might notice if you are getting nervous. Some people get shorter-tempered, some people go quiet, some people talk a lot.

What would people see when you are nervous?

Rather than telling people what isn’t helpful, say what you would find helpful. Some examples include:

Walk beside me so that I set the pace and I’m not rushing to keep up with you
Talk through what I’m doing well e.g. “you’re lifting your feet nicely, one step at a time etc.”
If you see me getting nervous, remind me to slow down and take a few moments to relax, then ask when I’m ready to carry on.

You know what your goal is and what you can achieve and feel confident about. If people push you to go beyond this, you may well manage it, but it might be unpleasant and stressful so it won’t help your confidence. For example, practising walking little and often is better than a bigger trip out less often.

Building your confidence means taking things one step at a time and sometimes doing things differently, so it takes time and effort. For example, set aside time specifically for walking practice; don’t try to combine it with another goal, like doing a big supermarket shop.

When people are most helpful in building your confidence, what do they say? What do they do?

“The best way to never fall is to never get up from your chair, but it wouldn’t be much of a life.”

We can’t promise that you will never fall again but getting the right help from professionals, and using this booklet to help yourself overcome your fears, should make you more confident.

If you do have another fall, try to put it down to experience:

Were you rushing?
Did you have the right walking aid?
Was it something beyond your control, like a slippery floor?
Try to think positively, rather than let yourself slip back into a vicious circle of worry and avoidance.
Think of all the times that you haven’t fallen.
Think about how you successfully regained your confidence before – you’ve done it before, so you can do it again.
Try not to avoid activities

Relaxation techniques

Physical anxiety can make us even more worried and tense.

The most effective way of reducing bodily tension is by relaxing.

This is different from watching TV or having a hobby (although these recreations are important too), it is a skill to reduce unnecessary physical tension. Like any skill, it has to be learned and takes practice.

When our bodies are less tense, our minds tend to be relaxed.

General guidelines

Plan ahead – decide where and when you will practice. It can help you to stick to your plan if you add relaxation practice onto your existing routine. For example, you might practise in bed last thing at night or when you first wake up, or you might practise after a meal or a favourite TV programme.

Choose a time when you are likely to be fairly calm, so it will be easier to get the hang of it.

Many people prefer to practise lying down, but the important thing is to choose a place where you will be comfortable.

Try to make sure the room isn’t too hot or cold, and pick a time and place where you won’t be disturbed.

Breathing

Try to breathe through your nose, slowly and regularly. It is important that you do not take a lot of quick deep breaths as this can make you feel dizzy or faint or even make your tension worse.

It is often easiest to start with a breath out, then let your breath come in naturally. Imagine you are breathing out a long, slow, gentle sigh.

If you place your hands on your stomach you will feel it move with your breath. Feel your stomach flatten as you breathe out; hold it for a moment, then feel it fill out and expand as you breathe in.

Simple relaxation routine

For this short routine you will need to imagine a ‘Happy Image’. This can be:

Repeating in your mind a sound or word which you find relaxing e.g. the sound of the sea or the word “Calm”
Gazing on a fixed object in the room e.g. a picture or ornament, which you particularly like
Thinking of an image which you find calming or soothing e.g. a quiet country scene, a flower, etc.

The Procedure

This simple method involves focussing on your breathing and on the pleasant / happy image.

Sit in a comfortable position. Close your eyes. Think about deeply relaxing your muscles, beginning at your feet and moving up to your face. Keep your muscles relaxed.
Breathe in through your nose and become aware of your breathing. Focus on your own Happy Image and breathe out through your mouth.
Do not worry about whether you are good at the exercise. Keep a passive attitude and allow relaxation to happen at its own pace.
Distressing or distracting thoughts will probably come into your mind. Do not criticise yourself or try to push them away; simply notice them, remember they are thoughts and nothing more, and then return to your Happy Image.
Continue for 10-20 minutes. When you finish, sit quietly with your eyes closed for a few moments and then with your eyes open. Take your time when you start to stand up and move about.

Cued relaxation

When you are able to achieve a relaxed state using the above exercises, you can begin to practise applying these skills throughout the day.

All you need is something which will catch your eye regularly to remind you to:

Drop your shoulders; relax the muscles in your body; check your breathing pattern; relax.

As a cue or reminder, you might use a small coloured spot on your watch or clock, which you look at regularly. Every time you see the spot, you will be reminded to relax. Work out what catches your eye regularly throughout the day and use it as your reminder. This way, you will be practising your relaxation skills several times each day.

Quick muscle relaxation

Sitting on a chair, tense up all the muscles in your legs. Hold for a few seconds, noticing the tension.

Now let go and relax, taking a deep slow breath out at the same time.

Notice how your legs feel loose, floppy and relaxed now. Sit and enjoy the relaxation for a moment.

Now do the same with your arms. Tense them up, hold for a second, then let them go loose and relaxed, taking a deep slow breath out as you do.

Different exercises suit different people. Try all three then practise the one that you like best, every day ideally. With practice, the relaxation response will come with less effort.

You are bound to experience stress, anxiety and tension at some time - this is normal. But you should be more able to notice it before it takes over, so you will be more able to use your skills to keep it at a manageable level.

Further Information

We hope that you have found this booklet useful.

Helping professionals, such as occupational therapists and physiotherapists, may be able to help you feel more able and confident with walking and everyday activities. They can discuss the ideas in this booklet with you in more detail.

If you would like more support around anxiety, you can ask your doctor about a referral to a psychological therapist.

Ask your doctor or therapist for more information.

Booklet compiled by

Caroline Wallace, Falls Clinical Specialist Dr Jessica Read, Clinical Psychologist
Lancashire & South Cumbria NHS Foundation Trust
Based on “Fear of Falling: Understand It, Beat It” ©2005 Bolton Salford and Trafford Mental Health NHS Trust and Salford NHS Primary Care Trust, with thanks to the authors for their permission.

Patient Advice and Liaison Service (PALS)

If you have some concerns, questions or need advice on our services, you can contact the Patient Advice and Liaison Service (PALS) on 0800 234 6088 or email the PALS Team.

Feeling low and need someone to talk to?

Call 0800 915 4640

Monday to Friday 7pm to 11pm Saturday to Sunday 12pm to Midnight

Need urgent help?

Call 0800 953 0110 24 hours a day, seven days a week

This leaflet is available in alternative languages and formats upon request. Please speak to a member of our staff to arrange this.

Back to Patient information leaflets