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Fear

Why Do We Feel Fear?

Fear is a vital response to physical and emotional danger that has been pivotal throughout evolution. If people didn’t feel fear, they wouldn’t be able to protect themselves from legitimate threats—which often had life-or-death consequences in the ancestral world.

In the modern world, the stakes are lower. Although public speaking, elevators, and spiders generally don’t present immediately dire consequences, some individuals still develop extreme fight-flight-or-freeze responses to specific objects or scenarios.

Many people experience occasional bouts of fear, such as when giving a high-stakes presentation, or feelings of "nerves," such as going on a first date. But when a fear is persistent, specific to certain threat, and impairs one’s life or growth, that person might have what’s called a specific phobia.

When Does Fear Become a Disorder?

A phobia is a distinct fear or anxiety about a specific object or situation, according to the DSM-5. It consistently provokes fear or causes distress, and the sufferer endures it with discomfort or avoids it entirely, such as taking the stairs to avoid an elevator. The fear is also disproportionate to the true danger the object or event poses.

Phobias fall into five broad categories:

  • Animals, such as a fear of spiders, dogs, or bugs
  • The natural environment, such as a fear of heights or storms
  • Blood, injury, and injection, such as a fear of needles or medical procedures
  • Situational, such as a fear of flying or riding in elevators
  • Others, such as a fear of vomiting or choking

Seven to 9 percent of Americans experience a specific phobia in a given year, according to the DSM-5, and women experience phobias twice as often as men do. It’s also common to have multiple fears: three-quarters of those diagnosed with specific phobia have more than one.

Some people can pin the origin of a phobia to a specific event, like news of a terrible plane crash or being attacked by a dog as a child. But many cannot identify a particular incident that prompted their fear.

What Are Social Anxiety Disorder and Agoraphobia?

Fear can take forms other than specific phobias. One such fear is social anxiety. In contrast to shyness—a normal trait that varies by personality and culture—social anxiety disorder encompasses a deeper fear of judgment, evaluation, and rejection by other people. When the root of the fear is social judgment, whether being introduced to someone new or eating in front of others, an individual may have social anxiety disorder, also called social phobia.

Agoraphobia refers not to fear of a specific threat but to any situation that would be difficult to escape or get help, such as in a movie theater or subway car. Rather than a specific scenario, people with agoraphobia fear broad categories including public transportation, open spaces, enclosed spaces, crowds, and being away from home.

Post-traumatic stress disorder may develop after surviving severe stress or danger, such as a car accident, earthquake, assault, or combat.

How to Overcome Fear

If fear is disrupting or overtaking an individual's life, seeking therapy can help. A qualified therapist can identify ways to develop coping mechanisms and release the fear.

One primary treatment for fears is exposure therapy. A therapist guides the patient to gradually and repeatedly engage with the phobia in a safe environment to strip away the threat associated with it. For example, someone with a fear of flying may be prompted to think about planes, view pictures of planes, visit the airport, step onto a plane, and eventually complete a flight.

Virtual reality has become a useful delivery tool for exposure therapy. Evidence suggests that the modality is particularly effective for specific phobias and anxiety disorders, and the treatment outcomes appear to be no different in virtual and real settings. Virtual reality may also offer an opportunity to reach more people with accessible and affordable care.

Another key treatment is cognitive-behavioral therapy, often practiced in conjunction with exposure therapy. CBT helps people challenge and reframe the harmful beliefs they hold about their fears.

Medication may be a component of treatment for the short-term or specific incidents, like a medical procedure. Clinicians may prescribe beta-blockers, which block adrenaline and lower heart rate and blood pressure, or benzodiazepines, which act on receptors in the brain to induce relaxation.

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