The best way of dealing with any fear, rational or irrational, is to confront it. I think this is conventional wisdom. Everyone has the experience of growing up and being afraid of all sorts of things: the monster under the bed, standing up in class, being left home alone, being threatened by a bully, and so on. These fears go away after a time when the young person looks under the bed, stands up in front of class repeatedly, spends enough time home alone and develops the physical skills and experience to stand up to bullies. It is appropriate, however, for young people, and adults too, to be afraid in certain circumstances.  Indeed, we teach our children to be afraid of intruders, of falling from too high a height, of crossing a street against the light, and so on. We also, sometimes, inadvertently, teach them to be afraid in general: of illness, of strangers, of not eating enough or sleeping enough. Some children grow up to be frightened adults. They are said then to be suffering from an anxiety disorder. They recognize that their fears are exaggerated, but these fears persist, sometimes indefinitely, because they do not confront their fears. For that reason, the essential treatment of phobias, for instance, or obsessive-compulsive disorder, is to require patients to expose themselves to the things they fear.

Not uncommonly, anxious people have trouble figuring out whether their fears are justified or not. Either way, they must confront them. If it turns out there is a real danger of some sort, perhaps the chance of being in an automobile accident, for instance, there is the opportunity to take measures that make the danger less severe, perhaps by wearing a seat belt. If the danger is not real– for example, the infinitesimal danger of an airplane crashing– repeated exposure will make the frightened person unafraid–unfailingly. Sooner or later.

Two things are worth considering:

1. As much as possible, the anxious person should try to determine the chances of whatever he fears actually happening. In the case of a cancer, for instance, it may turn out to be as little as one in ten thousand. The chance of dying in a plane crash are approximately one in two million. The anxious person is not entitled to think superstitiously that he is destined to be that one. Anxious people are no more in danger from life than anyone else.

2. Paradoxically, even if the danger is extremely unlikely, I encourage patients to imagine that worse case scenario. It is not usually the case that the individual is imagining death itself; but rather some intermediary catastrophe. Like cancer, for instance. But cancer is not always the end. There is a “well, then…” that comes after “What if…?” “What if I get cancer?” “Well, the cancer you are imagining can be treated.” In such a way, it is possible to desensitize oneself from imaginary fears.

“What if my car breaks down in the middle of the night?”

“Well, then, you can call the police to send someone to fix it.”

“But what if they can’t fix it?”

“Well, then, you can call someone ot pick you up.”

“But, suppose I can’t reach anyone?”

“Well, then you can call a taxi.”

And so on.

 (c) Fredric Neuman 2012     Follow Dr. Neuman's blog at

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