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Fear and Anxiety


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"Fight or Flight"


Excellent piece regarding this in WAPO.


Excellent piece. I have an appreciation and interest with this topic. 





Fear and anxiety can help. Here’s how to use them to your advantage.

In the field of mental health, fear and anxiety are usually seen as pathologies. But there is necessary and appropriate fear and anxiety, which can be helpful.

Advice by 
October 27, 2023 at 6:00 a.m. EDT
(Illustration by Celia Jacobs for The Washington Post)
8 min
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As a psychiatrist and neuroscientist, I have seen and studied how fear and anxiety work in our brain and body, and how they can prevent us from functioning well in our lives.

One of my patients, a police officer with work-related post-traumatic stress disorder, had become a recluse and rarely left her home because of anxiety that something bad could happen and a fear of facing the perpetrator.


Another patient, a business executive, had an intense fear of heights and flying. He would take anxiety medications when he had to go into a city for a few hours of work, and he would stay in motels on the outskirts to avoid even a glimpse of tall buildings.

For other people, it may be a fear of activities such as public speaking or being around large groups of people, dogs, enclosed spaces, or worrying about everything.


What causes fear and anxiety in the brain?

The evolutionary purpose of fear is to keep us safe. Fear is a response to a direct threat such as a gun pointed at us, and it encourages us to act to protect ourselves. Anxiety is a general sense of apprehension related to the possibility of a threat, such as when we think someone with a gun could be in the neighborhood.

Our brain’s fear circuitry is complicated and often engages most of our brain, but there are a few main regions that play a key role in fear and anxiety.

The amygdala is an almond-shaped part of the brain in the temporal lobe near our ears. Its job is to detect the emotional relevance of everything we perceive.

When we see a predator or an angry or scared face, the amygdala triggers the sympathetic nervous system’s fight-or-flight response — a rapidly beating heart, increased breathing, dilated pupils and alert muscles.

The hippocampus sits next to the amygdala and helps us to learn and memorize what is dangerous and what is safe.

It also puts fear in context. For example, if we see a lion in the African Sahara, the hippocampus confirms that we should run away. If there are bars between us and the lion and a sign says this is a zoo, the hippocampus inhibits the fear response.

The frontal brain sitting right above our eyes is engaged in more complicated cognitive fear processing. If you see a snake and you are ready to run, but a friend tells you it is their pet boa, then the frontal lobe slows the fear response. Frontal-brain processing can also trigger a fear response, such as when a neighbor tells you that their house was robbed.

The insula is the brain region that helps us be aware of our fear and the related bodily reactions such as chest tightness, pounding heart and the weird feeling in our stomach.


What are healthy fears?

In the field of mental health, fear and anxiety are usually seen as pathologies. But there is necessary and appropriate fear and anxiety, which can be helpful.

Fear that warns us

The need for fear is more obvious for a situation of robbery or assault, but there are other, subtle situations in which fear tells us there is something wrong — perhaps with a job, a relationship or the car we are about to buy. If fear did not exist, more people would stay in jobs that are eating their souls, remain in abusive relationships or be scammed.

Fear that motivates us

When scared, we are more alert, more sharply focused, mentally faster and have better selective recall. This energy and focus can be used productively.

If we are too relaxed and bored about a public speech, we may not function ideally. To do our best, we need to be nervous just enough to cultivate the mental energy and focus it on the talk.

The energy of fear can also help us to stop procrastinating and prioritize what matters most. And it can push us to engage in learning new skills to face challenges. Many of my patients seek treatment only when the fear and pain motivate them to try something new.

Sometimes we can use one fear as encouragement to walk through another fear that has a greater detrimental effect on our life. Fear of losing youth, happiness, productive age and other opportunities to an unsatisfactory or abusive relationship can motivate people to overcome the fear of being alone or going through a breakup.

My business executive patient recognized that he was losing opportunities and freedom to his fears. We used graded exposure therapy  which consists of exposure in a stepwise manner, starting from the least scary situation — to help him fly. A year later, he traveled to Europe, held business meetings in high-rise restaurants and enjoyed a trip to the Grand Canyon.

Fear that is fun

Many of us love to be scared, or there wouldn’t be so many fans of horror movies and books.

By scaring the primitive human inside us in a controlled environment, we activate the overlapping neurobiology of excitement and enjoy the ride. These experiences also provide an opportunity for bonding with friends and loved ones and practicing survival skills (for example, by continually thinking how the movie characters could have avoided the murderer).

Thrilling experiences such as skydiving, mountain climbing and even riding a roller coaster are highly mindful and absorbing (as fear is), and help us detach from life challenges and anxieties and recharge. Experiencing reasonable levels of real fear with such activities might also put our imagined fears in perspective.


How to manage and even benefit from fear and anxiety
  • Fear is a signal — do not ignore it. Look at what scares you and see how much of it is real. This can reduce the automatic fear by engaging the frontal brain.
  • Get a more objective perspective about your fears by asking others. This will help in seeing the feared situation in the more logical perspective of someone who cares about you.
  • Look at your past and see how often you overestimate the anticipated risk and negative outcome. Next time you are afraid, use your cognitive frontal brain to modulate your anxiety.
  • Don’t avoid your fear if it is not justified. Every time you avoid a situation and nothing bad happens, your brain will consolidate the belief that if you avoid that situation, you will be fine. Instead, engage with what scares you, and sit with it until your hippocampus develops new learning that you are safe.
  • Turn to the positive when you begin to fear a situation. Consciously try to remind yourself of the positive aspects, your skills, previous positive experiences and the anticipated gains.
  • Learn the skills needed to handle the situation you dread. That will provide a sense of control, which is a great antidote to fear.
  • Exercise. It has proved to be an effective tool for strengthening the hippocampus and reducing baseline anxiety. Even 10 minutes a few times a week is better than none.
  • Do something fun and a bit scary once in a while. It is a great mindful experience, a respite from worries, an exercise for your fear brain and can put your imaginary fears in context.
  • If the fear is too distressing or is impairing your ability to function socially, occupationally or academically, seek professional help.

I used many of these strategies to help one of my patients, the police officer. I began by acclimatizing her to digital humans in the augmented-reality technology in my clinic. Gradually, she started going out with her grandfather and using her love for her son as a motivation to take him to his school activities. A year later, she went to her graduation ceremony and was promoted to detective rank.

Arash Javanbakht, MD, is a psychiatrist and neuroscientist, and director of the Stress, Trauma and Anxiety Research Clinic (STARC) at Wayne State University School of Medicine. He specializes in research and treatment of anxiety disorders and PTSD, and is the author of the book “Afraid: Understanding the Purpose of Fear and Harnessing the Power of Anxiety.

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It's where the term 'I was shitting myself' comes from, as the adrenaline rush makes you want to use the toilet ASAP.

Drug addicts also go through it, from even the rush/anticipation of going to score, to the actual rush of the hit, especially crack. 

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