Fear is an intense feeling of apprehension and anxiety that creeps into the individual for the action, even momentary or sudden, of concrete or imaginary elements from which dangers or damage may result: fear of the storm, fear of examinations, fear of death, fear does not pass him more, trembling, pale with fear, do, put fear, terrify. Specifically, in ethology, an emotional state manifested outwardly by a tendency to flee, avoid or defend oneself in dangerous situations. Some ethologists say that we must distinguish fear from fear and that fear arises in situations where an animal does not have the effective possibility of escape. In these cases, a fear syndrome may occur, involving increased heart and respiratory rates, sweating, trembling, and urination and defecation reflexes.

Faced with danger, in fact, our body produces a hormone – the well-known adrenaline – that induces physical and mental changes and prepares us for action: flight or fight. If we go back to our ancestors we can understand the adaptive value of this emotion: fear protected our ancestors from wild animals or hostile neighbors.

Nowadays the stimuli that make us afraid are no longer large lions or nearby invasions, but rather the loss of a job, a change in life, or the addition of everyday problems. However, the bodily changes, thinking and behavioral reactions remain the same as those of our ancestors. Fear has therefore, like all emotions, a usefulness for man, warning him of dangers. However, it becomes a problem when it is experienced in an exaggerated way or out of context.

Reactions to fear

The two main reactions to a fearful stimulus are attack or flight: the first one allows us to face the obstacle, to fight it; the second one leads us to abandon the situation before it becomes too threatening for our survival. However, in literature, we find two other reactions of living beings in front of a dangerous situation: freezing and faint.

Freezing is a tonic immobility, the living being seems to be frozen, immobility that allows not to be seen by the “predator” while evaluating which strategy (attack or escape) is the most suitable for the specific situation. When none of these strategies seems to have any chance of success, the only possible and extreme response is the faint, the abrupt reduction of muscle tone accompanied by a disconnection between the upper and lower centers. It is a very extreme reaction, it manifests itself as a simulation of death, obviously automatic and not conscious, because generally predators prefer live prey. In this situation, through activation of the dorso-vagal system, there is a detachment from the experience and dissociative symptoms are possible, as in the case of traumatic events.

Bodily, cognitive and behavioral changes are part of the nature of emotions, especially fear, not only to cope with stress but, ultimately, to ensure our survival. They are, therefore, vital and necessary experiences. Problems arise when we fail to turn off our bodily and mental reactions to a threat that is no longer present or imminent, so that the stress response, from adaptive, turns into chronic or excessive.

Bodily changes

Bodily reactions of fear include: dry mouth, increased heart and respiratory rate, bowel motility, muscle tension, increased sweating. Our bodies are preparing for an immediate reaction. Without such changes, in fact, we would be completely inadequate in the face of danger.

In cases of excessive fear, body sensations begin to become more uncomfortable. The muscular tension, fundamental for the attack or escape response, turns into malaise that pervades the whole body: headaches, shoulder and chest pains, gastrointestinal symptoms, leg weakness. Thus, shortness of breath can lead us to feelings of nausea or shortness of breath; focused attention to the heartbeat only raises blood pressure and makes us feel faint, blurred vision and ringing in the ears.

Psychological changes

The psychological reaction to dangerous stimuli leads to a change in the way we think: the new thinking becomes adaptive in that context, as it prepares us to deal with the threat. For example, when we are under particular stress we become more focused on the problem, concentrate longer, and increase our problem-solving abilities. Similarly, we will also experience a change in how we feel, such as being more irritable or tense.

The person with an excessive fear response to numerous situations begins to focus exclusively on what they fear, generally worrying that a problem has no solution or catastrophizing it. Over time, a type of negativistic thinking develops toward oneself and the surrounding world, perceived as a source of ever-possible threats. Such forms of negative thinking form a vicious circle with bodily changes, such as: “I have a pain in my chest, I must have something wrong with my heart”, or: “this feeling/emotion is unbearable, there is nothing I can do”. In this way, stress remains consistently high, leading to increased discomfort and worry, a factor that causes people to focus on negative and insoluble events rather than positive ones.

Behavioral changes

Behavioral reactions to fear basically consist, as previously illustrated, of running away or avoiding. If I notice in the park that a tree branch is falling on me, I will find the strength to suddenly jump back and move away. Without this kind of response, I would find myself crushed by the branch. Under the impetus of fear, we are able to do things we never thought we would be able to accomplish.

Behavioral changes, if persistent, only add to the difficulties. In the grip of ‘anxiety and worry, for example, most people increase the amount of cigarettes smoked, eat in an unbalanced way and stop exercising. All this increases the sense of not feeling well and being chronically tired and less able to cope with stress. Remember that the most common response to stress is avoidance of situations that scare us or threatening objects. However, the relief we get from avoiding stressful stimuli is only temporary and increases our sense of personal distrust, so that the dreaded event seems increasingly impossible to cope with.

Whatever the anxiogenic trigger (whether real or imaginary), what maintains the stress response even after the stimulus is exhausted, is the activation of the vicious circle just mentioned and that unites all the problems of brooding, fear and anxiety.

Anxiety and fear: differences and similarities

Anxiety and fear are encoded in the same brain area, but the reasons why they occur are different. In the first case, when we feel fear, we are frightened by something real. If we had to take an exam, it is normal to be afraid, but when we would like everything to go according to our plans, that is to take absolutely an A+, and clearly there is no certainty that this thing will occur, then we will talk about anxiety and not fear. In short, anxiety is triggered when we make negative and catastrophic predictions about events perceived as important or dangerous.

Again, there are a number of physiological changes similar to those of fear: dizziness, lightheadedness, sense of confusion, shortness of breath, tightness or chest pains, blurred vision, sense of unreality, heart beats fast or skips a beat, loss of sensation or tingling in the fingers, cold hands and feet, sweating, muscle stiffness, headaches, muscle cramps, fear of going crazy or losing control. In short, a very intense experience that can be very frightening.

Anxiety is often generated by the evaluations one makes about a given event, or rather by thoughts, predictions most of the time, about what will happen in the future. In the uncertainty that an event may not go as we would like, we would like to control nefarious eventualities, at this point the anxiety increases and feeds.

Anxiety, however, could also occur without an apparent reason, manifesting itself in an excessive way and without any control. In this case you will get an excessive and disproportionate response, which will trigger feelings of anxiety in the future.

From a neurophysiological point of view, a possible explanation of some phenomena that link anxiety and fear, such as hypervigilance and hyperalarm, could be traced to the automatic activation of the amygdala, following the perception of a frightening stimulus.

Through visual perception we identify and assign meanings to the objects we see and it is based on these meanings that we react, activating a specific brain area: the amygdala.

In a study by Whalen and colleagues (1998), participants perceived facial expressions in the absence of explicit knowledge. They were presented with expressions of fear and happiness superimposed on neutral expressions, which therefore masked them, thus preventing conscious perception of the underlying emotions. While facial expressions were projected on a screen, brain activation signals were recorded by functional magnetic resonance imaging. At the end of the presentation of the stimuli, participants were then asked to describe any aspect of the faces presented; comment on the emotional expressions of the faces; and whether or not they had seen any expressions of happiness or any fearful faces.

The results of the study showed that although the participants claimed not to have perceived the facial expressions of fear explicitly, there was still an activation of the amygdala in them. This part of the brain, therefore, was also implicated in the monitoring of unconscious emotional stimuli.

Therefore, the amygdala could play a major role in the clinical phenomena observed in anxiety disorders. In fact, in these subjects, the activation of this brain area could make mistakes in processing information at an implicit level and give rise to typical phenomena such as hypervigilance, hyperalarm and lack of habituation to stimuli.

Fears in children

Fears in children can be divided into three categories: innate fears, present from birth; growth-related fears, which appear at different ages; and fears learned from traumatic events or induced by the life environment.

The primary form of fear in children is the loss of physical contact with the mother. At 8/9 months there is fear of the stranger. At 12/18 months fear of separation, which reaches its peak around the 2nd/3rd year of life. At 3/5 years old comes the fear of thunderstorms, darkness, monsters, witches, Santa Claus and the Epiphany, elements that fascinate and at the same time frighten; fear of physical dangers, injury, illness. In pre-school age, the greatest fear is that of separation from the parent and abandonment related to the beginning of school life in the community. Another typical fear of this age is that of the characters of fairy tales and stories such as the bogeyman or the big bad wolf.

During childhood, that is, between the ages of 6 and 12, some of the fears of previous years can be mastered because the child now has more skills, but precisely because he now understands more, he can grasp other threats such as those of thieves and kidnappers, physical harm, disease, blood, injections, death and abandonment. Fears related to one’s social status, as a schoolboy for example, and interactions with others make their appearance: exams, fights, bullying, as well as the fear of being rejected by peers. Fear of pets may diminish but fear of insects may appear. Fear of insects as well as exotic animals is often associated with fear of the unknown, of what is unknown and unmastered. One way to overcome this fear is to become familiar with insects by appreciating their characteristics and qualities.

Many of the fears linked to previous periods may reappear as regressions to earlier stages of development, which is explained by the condition of instability that characterizes the entire developmental age. After a strong fright, in fact, or when faced with distressing situations that last over time, it is normal for children to regress temporarily to behaviors typical of a previous stage of their development, and if this happens it is because in that stage they felt more protected and secure.

Tools for managing fear

Cognitive-behavioral therapy is highly effective in treating phobias and managing negative emotions, such as fear. The most useful tools in this regard are the ABC and Disputing.

With the ABC we analyze the situations (A) in which certain thoughts are automatically activated (B) that lead us to feel specific emotions (C). Having identified the dysfunctional thoughts, with disputing we question everything we think or do automatically.

After a phase of work on the cognitive side, it is good to work successively on the behavioral level (especially in the case of phobias) through gradual exposure to the stimulus considered dangerous by the patient.

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