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Fears, Phobias, and Anxiety

Everybody experiences fear at some time or another. Fear is a powerful emotion that arises in situations that are interpreted as dangerous. The purpose of fear is to alert you to take protective action—usually to fight, flee, or seek assistance. For example, if you were hiking in the woods and encountered a snake, you would naturally interpret this situation as dangerous which would produce the emotion of fear, which, in turn, would motivate some self-preserving behavior—probably an attempt to escape. If, however, you recognize that the snake is harmless, your interpretation of the situation as dangerous and the ensuing emotion of fear would have been erroneous. Notice how important the cognitive act of interpretation is in experiencing fear.

If fear is the response to a situation interpreted as threatening, anxiety is the response to an imaginary situation—usually something in the future that has not yet happened—that is interpreted as threatening. The purpose of anxiety is to warn you of potentially threatening situations. For example, anxiety about encountering a snake while on a hike, while heightening your awareness of this potential danger, could make the hike very unpleasant or prevent the hike from taking place at all, even if there were no snakes to encounter.

A phobia involves intense fear that can seriously disrupt a person’s life. Some common phobias are fear of heights (acrophobia), fear of open spaces (agoraphobia), fear of dirt and germs (mysophobia), fear of snakes (ophediophobia), and fear of animals (zoophobia). Phobias produce severe, often incapacitating anxiety and even panic reactions.

Panic attacks are extreme reactions to fear. A panic attack can produce chest pain, palpitations, sweating, chills or hot flashes, trembling, shortness of breath, sensations of choking, and fear of losing control or dying. In some instances, a panic attack is a response to a life situation that seems overwhelming; for example, some people experience panic when a lover breaks up with them (separation panic). In other instances, panic attacks seem spontaneous, i.e., they happen without a situation that seems threatening.

Panic attacks can be so debilitating that individuals require professional help to manage them. One form of therapy involves helping patients control their thoughts and breathing while experiencing a panic attack. The physiological sensations of panic are so intense and terrifying that they create greater panic, so patients are taught to remind themselves that they are unlikely to die during a panic episode. They are also taught deep breathing to avoid hyperventilating and thus exacerbating a panic episode. If patients can identify the source of their panic, they can learn to confront their fears using imagery, followed by actual exposure to the fearful stimulus.

Whereas we all may wish never to experience fear, or to be so brave as to confront all that is deemed fearful, Chogyam Trungpa, a Tibetan Buddhist teacher, reminds us that true fearlessness is not the absence of fear, but accepting and understanding it—what he refers to as “going beyond fear” (1977).

Medications can also help people manage panic attacks. Tricyclic medications (e.g., imipramine) or selective serotonin reuptake inhibitors (e.g., fluoxetine) may be effective treatment. Lorazepam (Ativan) is a short acting benzodiazepine that may be prescribed for immediate control. Tranquilizers (e.g., alprazolam), while effective, are not recommended because of their potential to cause chemical dependency.

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