What are common fears? Most people can identify something that makes them frightened and which makes them either avoid the situation or experience it with considerable anxiety. In a recent national survey 60 % of the people interviewed reported that they feared some situation or thing. The most common fears were fears of bugs, mice, snakes, bats, heights, water, public transportation, storms, closed spaces, tunnels and bridges. Many people reported that they feared several things and that they consciously avoided them. In fact, 15 % of the people indicated that their fear was severe and impaired their lives in some way. These people indicated that their fears were persistent, associated with intense anxiety, that they avoided or wanted to avoid certain situations, that they realized that their fears were excessive or unreasonable, and that their fears resulted in distress and difficulty in their normal lives.

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In this handout we are limiting our discussion to a fear of a specific object or situation (for example, a fear of snakes, heights, blood, injection, or flying) where you are less concerned with people seeing that you are afraid (which we call “social phobia”) and you are more concerned that there is something dangerous or intolerable about the situation.

What are the causes of fears?

There are several causes of fears. Psychologists make a distinction between the acquisition of fear (that is, how you learned to fear something) and the maintenance of your fear—that is, why you still fear something even years later.

There are several ways of acquiring fear. First, many situations that people fear may reflect the fact that these situations were dangerous in prehistoric times. For example, bugs, mice, snakes, heights, strangers, bridges, animals and water are all potentially dangerous for prehistoric humans. People with these fears may have had ancestors that actually were very adaptive because they avoided contamination, poison bites, falling off cliffs or bridges, being murdered by strangers, or drowning. These people may be predisposed to having these fears in today’s technological world in which these prehistoric dangers are minimal. (It is interesting that few people have fears of technological danger, such as electricity. The fear of flying and of roller-coasters is simply a fear of heights.) A second origin of fears is through learning—either by associating a bad experience with the thing you are afraid of (for example, being bitten by a dog and developing a fear of dogs) or by observing someone who is afraid and simply imitating their fear—for example, perhaps a family member had a fear of flying and you simply copied that fear. A third reason for fear may be distortions in thinking—for example, incorrect information that you may have about certain things, a tendency to predict the worst, an increased ability to and your belief that you cannot tolerate anxiety.

Recommended Reading: Are We Born to be Afraid?

There are a number of ways in which your fear is maintained. The most important reason is that you avoid the situation that you fear. For example, if you fear flying you feel less anxious every time that you decide to avoid getting onto a plane. Each time you avoid flying you teach yourself that “the way to reduce my fear is to avoid”—that is, you learn to avoid. This is like taking a drink every time that you are anxious—you learn to drink more because it temporarily reduces your anxiety. But by avoiding the thing you fear you never learn that you can overcome your fear.

Another way that you may maintain your fear is by engaging in “safety behaviors”. These are superstitious things that you do or say that you think protect you. For example, you may hold the side of the elevator or hold your chair when you are flying or you may repeat prayers or seek reassurance when you are in the feared situation. This leads you to believe that the safety behaviors are necessary for you to overcome your fear.

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How can I overcome my fears?

The first thing to ask yourself is what are the advantages and disadvantages of overcoming your fear—how will your life change? In order to overcome your fear, your therapist will have you make a list of the situations that you fear, how intense your fear is, and what your beliefs are about the feared situation (for example, do you think that you will be contaminated, die, be attacked, or go insane?). You will be taught how to relax when you are feeling tense. Your therapist may ask you to form images in your mind about the feared situation and to practice the image until you feel less anxious. You may observe your therapist doing the things that you fear and, later, you might imitate him or her. Your exposure to the things that you are afraid of will be gradual—your therapist will explain everything before you do it, you are free to refuse to do anything, there will be no surprises sprung on you, and you will determine the pace at which you make progress. Most patients using these techniques find that they feel much less tense, they are able to do things that they feared, and they feel more effective in their lives. Many patients are able to improve rapidly with a few prolonged sessions (for example, two to three hour sessions) that allow intense exposure to the feared situation. Depending on the fear, between 74-94 % of patients improve using these techniques. Although some patients may use antidepressants or anti-anxiety medications for these fears, the treatments which we describe do not require these medications.

Recommended Readings:

Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy
The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy

Blog Posts on Fears:

Clinicians may find the following books on cognitive behavioral therapy to be helpful in treating anxiety:

Leahy, R. L., Holland, S. J., & McGinn, L. K. – Treatment Plans and Interventions  for Depression and Anxiety Disorders (2nd ed.)
Leahy, R. L. – Cognitive Therapy Techniques
Sookman, D. and Leahy, R. L. – Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission

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