All of us admire the courageous and brave. Often times these same people are described as fearless. But, fearless is not the same as courageous or brave. Courage is doing the task despite being fearful. Fearless is more associated with foolish. Fear is one of our six basic emotions. It is ubiquitous. Fear is not the same as anxiety or worry but we often worry and are anxious about things we fear. Fear need not be a physical entity but may also be events such as loosing a job, social rejection, or in severe cases fear of loosing the basic necessities of life.
Fear activates the fight or flight mechanisms reviewed in the blog on the stress response.This response is adaptive in the short run to help us avoid a fearful stimulus or to help us conquer that stimulus. Fear becomes maladaptive when we do not flee or conquer the feared stimulus but rather remain fearful without action. This leads to the chronic stress response that involves other factors such as cortisol that over the long run has deleterious effects on various parts of the brain.
A person may also become conditioned to fear. Most people are acquainted with Pavlov's dogs. Pavlov took his dogs natural tendency to salivate when presented with a tasty treat and paired it with a the sound of a bell. Over a period of time the dogs learned to associate the bell with food so that when Pavlov rang the bell but did not present food the dogs still salivated. This same phenomenon is demonstrated in people that have been in very fearful situations. A common scenario is the person who has been in a car wreck. A certain percentage of these people will develop fears with the concomitant stress response to cars, driving, and sometimes even the thought of driving. There may be no good way to "get over" this but there ways to "get through" this fear.
The process by which one faces the fear and learns to overcome the fear is called extinction. Although other areas of the brain are involved in the fear response, the fear is primarily an amygdala based response. The inhibition of the amygdala based response is largely accomplished through the action of the prefrontal cortex (the thinking part of the brain). Extinction involves experiencing the feared stimulus in a safe environment and staying with that stimulus until the stimulus is no longer feared in that safe environment. Physiologically, the prefrontal cortex develops enhanced cortical suppression of the amygdala based response. Psychologically, the person develops a new story about the fearfulness of the previously feared stimulus.
A psychotherapy that is utilized in dealing with fear is called cognitive processing therapy (cpt). CPT "focuses on emotions such as anger, humiliation, shame, guilt, and sadness which trauma survivors often experience in addition to fear and anxiety". (1). This therapy utilizes the Socratic method and helps the patient confront and discard secondary thoughts and subsequent emotions related to the original fearful experience.
Experience has shown us several useful ways of facing fear and using fear as an opportunity for personal growth.
First, use fear as a guide. Fear is a normal part of life. When afraid focus on your goal at the time and your mission at the time. This may not be as severe a a soldier taking an objective in combat but in patients with agoraphobia may be a goal and mission to go to the grocery store. Don't focus on the fear, focus on the mission.
Second, view fear as an opportunity. Carrying out your mission and goal in the face of fear helps you develop courage, self-esteem and mastery. You may not conquer the fear but when you succeed in your mission despite the fear you build both confidence and competence.
Third, learn as much as possible about what is feared. The unknown elements in an activity or decision that has to be accomplished are often the most feared. In the absence of concrete information about activity or decision and the processes and actions that must be taken to accomplish the activity or decision, our minds make up all sorts of fearful scenarios that are often not based in reality. Think back and remember a situation, such as coming to see a psychiatrist for the first time. The is usually some sort of fear involved about this unknown encounter. Then think back to how good it felt to accomplish this task. This usually results in thinking the phrase, "now that wasn't so bad". Learn as much about the feared activity or object ahead of time and you will be better prepared to undertake courageous actions.
Fourth, practice the skills necessary to succeed in facing the feared object or situation. This includes such things as facing the fear with a friend, having a back-up plan, and utilizing the stress reduction techniques addressed in other blogs.
Fifth, face fear with spiritual support. We are all acquainted with the Psalm: "yea though I walk through the shadow of death, I shall fear no evil, thy rod and thy staff they comfort me" Perhaps the psalmist overstates the lack of fear but he does address the comfort of being able to trust in a divine presence as a protector greater than any earthly force that may be aligned against us.
1. Southwick, SM and Charney, DS. Resilience. The Science of Mastering Life's Greatest Challenges. Cambridge University Press. 2012.