Fears: where they come from and how to overcome fear

Everyone knows fear: a pounding heart before an important conversation, legs like jelly at a height. Fear in itself is not the enemy. It is an ancient protective system that keeps us careful: we step back from the edge and look twice before crossing the road. It becomes a problem when it appears where there is no danger, lingers or makes you rearrange your life around it. Then it is worth working on, and the good news is that fears respond well to therapy.

Fear, anxiety and phobia: what’s the difference?

• Fear is a response to danger here and now. A dog rushes at you, a car pulls out in front of you. Once the danger passes, fear quickly settles.
• Anxiety is the anticipation of a threat that isn’t here and may never come: “What if I get ill?”, “What if something happens to the children?” It is vague, lasts longer and jumps easily from one subject to the next.
• A phobia is an intense fear of a particular object or situation (heights, flying, dogs, blood, injections, enclosed spaces), far out of proportion to the real danger. People often know they are “too” afraid, yet can’t get past it and start to avoid it.

Phobias are common. WHO-led surveys in 22 countries found that about 7 in 100 people have a specific phobia at some point in life, usually starting in childhood.

Where fears come from

Fear rarely has a single cause. Usually several things come together:

• A frightening experience. A dog bite, a flight with heavy turbulence, a panic attack on the underground. The brain remembers: “this place is dangerous”.
• Watching others. We can learn fear by observing people around us. If a mother freezes at the sight of a spider, her child learns that spiders are frightening.
• Temperament. Some people are naturally more sensitive and anxious, and this often runs in families.

Fear is not a sign of weakness or a “bad character”. It is a learned response, and what has been learned can change.

Sudden attacks of fear and the body

Fear is always felt in the body too. When the brain senses a threat, the body releases stress hormones such as adrenaline and cortisol. Your heart beats faster, you breathe more quickly, you may shake, sweat, feel sick or weak at the knees. The body is getting ready to run or defend itself.

Sometimes a wave like this hits suddenly, for no obvious reason: intense fear, a racing heart, a feeling that you can’t get enough air, that you are losing control or dying. This is often a panic attack. It is very frightening, but it usually lasts 5-20 minutes and passes on its own. Fear “for no reason” has causes too; they are just out of sight: tiredness, built-up tension, fear of the fear itself.

If the attacks are new, see a doctor first: some heart and thyroid problems can cause similar sensations.

If you have sudden, severe chest pain, pain spreading to your arm, jaw or back, or you find it hard to breathe, call 911 straight away.

Why avoidance keeps fear alive

The natural urge is to stay away from what frightens you: not to fly, to keep clear of dogs, to take the stairs. And straight away you feel better. That very relief is what strengthens the fear. The brain concludes: “I avoided it and survived, so the danger was real.” Each time we avoid, the brain misses the chance to learn that nothing terrible would have happened.

Over time the circle of avoidance widens: first planes, then long journeys, then anywhere you might “suddenly feel unwell”. Life gets smaller and the fear gets bigger.

Avoidance can be subtle too: carrying a pill “just in case”, sitting near the exit, only going out with someone. These are also ways of never quite facing the fear.

How to overcome fear, step by step

In cognitive behavioural therapy (CBT), fears are treated by facing them gradually, a method called exposure. It is one of the most studied approaches: in a meta-analysis of 33 randomised trials, exposure-based therapy for specific phobias worked much better than no treatment and also better than placebo. The principle: don’t jump in at the deep end and don’t run away, but move towards the fear in small steps.

• Build a fear ladder. List 8-10 situations linked to your fear, from easiest to hardest, and rate each from 0 to 10. For a fear of dogs: look at photos, then videos, stand by a fence with a dog behind it, walk past a dog on a lead.
• Start with the lowest rung that makes you moderately uneasy, around 3-4 out of 10.
• Stay in the situation until your unease starts to fall, rather than leaving at the first spike. If you don’t cut it short, a wave of fear usually ebbs away.
• Repeat each step until it feels noticeably easier, then move up to the next.
• Gradually let go of your “safety nets”: the pill in your pocket, the person who comes with you, the seat by the exit.

Working with the body helps too. Slow breathing with a long out-breath (in for a count of four, out for a count of six) helps you ride out the wave without running. Breathing should help you stay in the situation, not become a new way of avoiding it. In my work I combine CBT with body-oriented methods and, when a fear is linked to a distressing event, with EMDR.

If the fear is very strong or linked to trauma, don’t climb the ladder alone: with a specialist, the steps are chosen more carefully.

When to see a specialist

It is worth asking for help if:

• Fear gets in the way of work, study, travel, seeing people or medical care, for example you keep putting off the doctor because you are afraid of needles.
• You find yourself avoiding more and more situations.
• You worry almost all the time about all sorts of things.
• The fear began after a frightening or traumatic event and hasn’t eased.
• You can only calm down with alcohol or sedatives.

For a child’s or teenager’s fears, a parent or guardian registers on the site and books, and the work goes ahead with their consent.

To see how much room anxiety takes up in your life, take the GAD-7 test on this site, and the HAM-A scale if your fear shows up mostly in the body. The tests are not a diagnosis, but they help start the conversation. If you would like to work on your fear together, book a free 15-minute intro call. Sessions are online or in person in Yerevan, held in Armenian or Russian.