WWhen Barbara Rothbaum crashed her bike on a hill several years ago and broke both elbows, she “had to become a therapist in her own right,” she says—luckily, she's a clinical psychologist. Rothbaum was hesitant to get back into the saddle after her injuries, but she knew she needed to face those feelings and overcome them.
Our evolutionary instincts may create lingering fears after such terrible events as her disaster, but this built-in danger avoidance system is essential to our survival. Our ancient ancestors collided With threats ranging from hungry crocodiles to deadly infections, humans have evolved complex physiological responses that keep us on our toes.
“We're hardwired to fear,” says Rothbaum, a professor of psychiatry at Emory University School of Medicine in Atlanta. “We are animals and live in a dangerous world—this built-in system will help us survive.”
Similar protective impulses found in most mammalian species, so dissecting rodent brains has allowed scientists to gain detailed insight into the neurological underpinnings of fear. The research also mapped people's brain activity as they experience and overcome fears in a laboratory setting.
You need to overcome your fear to overcome it.
Sensing a threat, the human brain quickly triggers a domino effect, reacting throughout the body. The brain's amygdala immediately dictates how we behave: fight, flee or freeze, depending on our proximity to the threat, says Michael Fanselow, a psychologist at the University of California, Los Angeles. Our brain also activates the nervous system and causes us to produce beneficial stress hormones such as adrenaline and cortisol. Our heart rate and breathing rates change, and blood rushes to our extremities in preparation for fight or flight.
But these reactions can go awry, leading to irrational and persistent fears called phobias and conditions such as post-traumatic stress disorder. According to Fanselow, PTSD may be associated with decreased connectivity between the amygdala and the prefrontal cortex, as well as increased gray matter volume in the amygdala. Such changes can prevent a person from coping well with fear.
Read more: “How evolution created your fears»
Exposure therapy, the gold standard used by professionals to treat phobias and other fear-processing conditions, can help people recover. In fact, Rothbaum says, you can do exposure therapy on your own if the fear is mild and doesn't interfere with your daily life. The key is to immerse yourself in the stimuli that triggered the fear—whether it's dogs, driving, heights, a bike accident, or any other specific experience that makes you anxious. “When we avoid [these situations]“We fail to see that fear is unnecessary—that the threat is not at the level at which it is felt in our body,” Rothbaum says.
“You have to overcome your fear to overcome it,” she explains. She did this literally, riding her bike, continuing to trade as her panic grew and eventually subsided. For example, if you are afraid of dogs, you can spend time with a small, calm, well-behaved dog and wait for your anxiety to subside.
Rothbaum and Fanselow also recommend increasing the dose of exposure—this could look like socializing with larger dogs, riding up increasingly steep hills, or driving further from home, depending on the stimulus in question. The presence of loved ones can make exposure therapy more effective, Fanselow says, based on past conclusions linking social support and fear inhibition.
“Fear in a really dangerous situation is a good thing.”
It's important to get professional help if “your life is at risk,” Fanselow says. “If you can’t do what you want or need to do, you should get help.”
According to Fanselow, therapy is effective in eliminating fears. But in the long run he marked that people's long-standing or intense fears often return. Exposure therapy helps develop a “safe” association with a particular stimulus, he said, but it tends to be limited to the specific context in which people learn it, such as the therapist's office. People still retain “dangerous” associations that the mind can recreate in a different, uncontrolled environment. For example, Rothbaum says that to treat fear of flying, she has accompanied patients on actual flights, but this is often impractical.
Virtual reality exposure therapy is one way to overcome this limitation. Rothbaum is a pioneer in this practice and has researched for decades, including as a treatment combat veterans with post-traumatic stress disorder. Because virtual reality is highly customizable, Rothbaum says it can be used to simulate settings that would otherwise be difficult to visit. It may also serve as a particularly useful stimulus for patients with PTSD, allowing therapists to collate the memories they describe. Scientists are also studying whether exposure therapy can be improved with certain drugsincluding hallucinogensalong with brain stimulation.
But it's important not to be afraid of fear itself, notes Fanselow, and remember the benefits when it works as intended. “People need to realize that fear in a really dangerous situation is a good thing,” he says. “These are biological systems that have evolved to bring us something good.” If you encounter a grizzly bear in the woods, or perhaps an ill-behaved chihuahua, your next move will depend on millions of years of evolution.
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Main image: Wikimedia Commons.
