Some fear is rational, keeping us appropriately cautious in the face of dangerous animals, hot stoves and contagions that could make us ill. But rational caution can turn to irrational panic about imagined terrors that are unlikely to occur or cause much actual damage if they did.
While we all face fears, phobias are intense fears that have become irrational. Common phobias include fears of falling, injections, animals, blood and flying, and social phobia.
Suma Chand, Ph.D., associate professor in the department of psychiatry at Saint Louis University and a clinical psychologist, helps patients with phobias that have begun to overtake their lives.
"The time to address a fear is when you find that it is causing you a lot of distress and it is affecting your life in a significantly negative way," Chand said. "For example, many people fear snakes, which of course can be dangerous. But they are not preoccupied with this fear and they don't find that it is impairing their lives very much.
"On the other hand, some people fear cats, which are unlikely to cause much harm. They may find themselves regularly panicked by visits to friends' homes if they have cats and so begin avoiding such situations."
Chand uses exposure therapy -- small controlled steps that build gradual exposure to the fear-causing event -- to counter the debilitating effect of these life-controlling terrors. Studies exploring exposure exercises for people with phobias have demonstrated positive results, including changes in the brain.
"Functional brain imaging studies have actually found that exposure exercises bring about changes in brain activity," Chand said. "We know this works. It is simple but effective."
Chand describes fear as a trap that shrinks your world as you rearrange your life to avoid the thing that you are afraid or phobic of.
"The more you feed it, the stronger it grows," Chand says. "Fear traps people. Fear puts you in a box. Your world gets smaller and smaller.
"After a while, you're avoiding the discomfort of the fear itself, rather than the thing you fear. When you avoid the things you fear you feel safe and comfortable and you don't want to do anything that will shake this safe cocoon of comfort. However you pay a heavy price -- your freedom to live your life like the way you really want to live."
Exposure therapy combined with cognitive restructuring is the way out.
For older people, fear of falling is a common concern. While this can begin as a rational fear, it can grow irrational over time.
"I saw an elderly lady who had a fall and broke her hip," Chand said. "It was very traumatic for her. After she recovered, she didn't want this experience to repeat itself. She became very cautious and avoided walking anywhere where there was a possibility for falling.
"Although the fear had initially translated into rational attempts to exercise caution it turned into avoidance as she went overboard with being cautious. The avoidance made her feel safe but caused her fear to grow. She stopped going to the store, the mall and to yoga, all of which she had enjoyed. Her social interactions became restricted as she began to stay home more, and avoided her favorite activities, because she was overly fearful about falling. She began to feel low and hopeless as she saw her isolated, limited existence stretch ahead of her.
"While the treatment is to face the fear, it is done in a manner that does not overwhelm the patient. The graded approach made this patient feel less overwhelmed and also more willing to face her fear. Once she began to attain success in facing her fear and recognized that what she feared was not happening, it was like a switch was turned on, and she went faster. Soon, she was fine and back to her old activities again."
Another common source of fear is social anxiety. Some people long to have friends or find a partner, but are trapped by their worry, Chand says.
"With a social phobia, people have lots of fearful thoughts about the possible outcomes," Chand said. "They'll think 'No one will talk to me, I'll look foolish, he or she will not like me, I will have a horrible time.' All of these thoughts dictate your behavior. You are believing those thoughts and you are breathing life into your fears and making them real. Start challenging those thoughts.
"I had a patient who had social phobia which was exacerbated in certain social situations more than others. The physical sensations of anxiety made her feel even more uncomfortable and self-conscious in such situations and she dealt with her fear by avoiding the triggering situations. She was particularly anxious about going on dates since the idea of her date recognizing her anxiety and knowing what she was experiencing horrified her. 'I would rather die than face such an embarrassing situation,' she said. However what she longed to do was to find someone with whom she could have a committed relationship leading to marriage and a family. Realizing the irony of her situation was a first step to help her move towards getting out of her self-built trap.
"I asked her to look at her choices. If she were to choose to step into the situations she feared in gradual stages there's a chance that she would realize her dreams. However if she were to opt for the choice to avoid them she was guaranteed that nothing would change. The good news is that she opted to face her fears and challenge her fearful thoughts. Today she is dating someone and they are well on their way to a long term relationship."
It's about developing a plan of action and putting it into play, Chand says. However, this is where patients need additional professional help to develop and sharpen their social skills and learn strategies to help regulate their anxiety as they face their fears. It helps people feel more empowered as they step into the arena to fight their fear.
While facing the fear is the way to get past it, Chand says a patient with a phobia would probably say that this is easier said than done.
"Facing one's fears is not easy," Chand said. "However having a professional who is in your corner and guiding you with an evidence based treatment is what will help.
"Talking to a professional can give people more confidence and help them find a way. Fear goes hand in hand with avoidance. It's a natural tendency. You do it not only physically but also mentally. You don't want to think or talk about it. But, once you come in for help, you are thinking and talking about the issue in a constructive helpful way."
Finally, while fear may seem all-consuming in the moment, it will not last forever.
"The most reassuring thing I can say to anyone about fear is this: All emotions change. You will never stay in a panicky state for the rest of your life. Persevere, and the fear will dissolve."
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