“Each of us must confront our own fears, must come face to face with them. How we handle our fears will determine where we go with the rest of our lives. To experience adventure or to be limited by the fear of it.”
~Judy Blume
Note: This article focuses on fear in terms of phobias.
The American Psychological Association defines fear as: “a basic, intense emotion aroused by the detection of imminent threat, involving an immediate alarm reaction that mobilizes the organism by triggering a set of physiological changes.” These include but are not limited to rapid heartbeat, tensing of the muscles, and a general mobilization of the organism to take action like fear response; flight-or-fight response. Fear differs from anxiety, in that the former is considered an appropriate short-term response to a present, clearly identifiable threat, whereas the latter is a future-oriented, long-term response focused on a diffuse threat.
Persistent and irrational fears of an activity situation or objects is known as phobia. Three major types of phobias are specific (simple) phobia, social phobia, and agoraphobia. Specific phobia is further divided into five types namely- a) Animal type (eg: dogs, spiders, snakes); b) Natural Environment type (eg: height, water); c) Blood-Injection-Injury type (eg: fear of seeing blood); d) Situational type (eg: airplanes, elevators, closed spaces); e) Other types (eg: avoidance of loud sounds, costumed characters like clowns). A study conducted in 2018 argued that phobias have a lifetime prevalence of around 3% to 15% in the world with fears and phobias of heights and animals being most common. It also reported that even though phobias develop more often during childhood their incidence peaks during midlife and old age. Phobias are also predictive of anxiety, mood and substance-use disorders. The National Health Service (NHS) describes the causes of phobias as an early childhood negative experience, family environment, genetics and brain chemistry. NHS has distinguished the symptoms associated with phobias under physical and psychological symptoms. The physical symptoms are panic attacks, sweating trembling, chills, hot flushes, shortness of breath or difficulty breathing, nausea, to name a few and the psychological symptoms are fear of losing control, fear of fainting, feelings of dread, fear of dying. Another study conducted in 2016 reported physical comorbidities associated with phobia, the findings suggested that specific phobia was associated with conditions like cardiac diseases, gastrointestinal diseases, respiratory diseases, arthritis, migraine, and thyroid.
A study conducted in 2008, evaluated which psychological approach works best to treat phobia. Results from this meta-analysis suggested that exposure-based treatments, especially in-vivo contact with the phobic situation, outperforms all the other approaches like - no treatment, placebo treatment and non-exposure-based treatments to treat phobias and the fear and anxiety caused. Results also suggested that multi-session treatment plans are more effective than single-session treatment plans.
A 2015 article in the journal Dialogues in Clinical Neuroscience on the use of cognitive-behavior therapies for anxiety disorders described the use efficacy and effectiveness of using CBT based approaches for treatment of phobias. The article highlighted that along with exposure-based treatment Beck’s Cognitive therapy (CT), which focuses on thoughts, feelings, behaviors and cognitive restructuring, can be used as an alternative line of treatment for specific phobias. Research support is less for CT when compared to use of exposure-based treatments, but it is still significant. It finally suggested that the first line of treatment should be exposure-based treatments, however, if it is not possible one can consider using CT for treatment of specific phobias.
Another recent approach for treatment of specific phobia is an ongoing clinical trial to understand the effectiveness of one-session treatment (OST) with multi-session CBT therapy in terms of clinical and cost-effectiveness and whether OST helps children recover quickly from their phobias. The trial aims to explore - 1) if outcomes from OST are no worse than outcomes from multi-session CBT; 2) is OST acceptable to children, their parents, and practitioners who use it and 3) does OST offer good value for money. The trial’s final follow-up is scheduled for 2020.
Fear can not only be explained from a psychological perspective but also from a biological and socio-political perspective. Dr. Ralph Aldophs in his article The Biology of Fear advocates for a pragmatic approach for understanding fear; he has operationally defined fear as an intervening variable between context-dependent stimuli. He explained that fear is caused by particular sets of stimuli in a context-dependent way and it is fear that links sets of stimuli to patterns of behaviors. The central nucleus of amygdala is mainly considered as the main output regulator for mediating fear responses which in turn are mediated by the specific subdivisions of the central nucleus. Dr. Michael Davis, in his paper, Neurobiology of Fear Responses: The Role of the Amygdala also provides evidence that amygdala plays a crucial role in fear responses. Electrical stimulations of the amygdala show a pattern of behaviors that simulate natural and conditional fears.
German sociologist Thomas Lemke and others in their 2011 editorial have explained fear as a central concept in both sociological and political theory. They argue that fear plays an important role in neo-liberal government. It also plays a segregatory function, and finally, they argue that fear also plays a role in medicalization of society. The editorial also highlights that fear has played a constitutive role in the analysis of state, sovereignty, and forms of domination. It has also cited Brian Massumi’s (1993) conceptualization of fear, where Massumi suggests that the government operates on ‘technologies of fear’ which represent society as an exposed community; thereby promoting an individual threat to privacy.
Lastly, now that one has decoded the theories of fear one should take steps to overcome it. Following steps may be useful: 1. Face your fears, one step at a time; 2. Learn to calm down quickly; and 3. Challenge negative thoughts about your phobia.
Divya Mirani
