Nada Osman (Author) and Sonya A. Ashikyan (Mentor)

Whether it’s heights, planes, or spiders, we each have that one fear that defies logical explanation, yet our brains insist on sounding the alarm. But why does this happen? And why aren’t we all scared of the same things?

Phobias can come about in various ways, with behavioral theories pointing to conditioning, modeling, fear-inducing information transmission, and even instances with no prior association as the main causes. Conditioning happens when repeated connections between unrelated things or events lead to a fear response. Take my fear of dogs, for instance. The sound of their collar often resembles the jingling of car keys. Now, whenever I hear car keys, my heart races, and I instinctively scan my surroundings for any sign of a dog nearby. One theory is that fear comes about in two stages. In the first, an aversive stimulus causes the conditioning of a neutral stimulus (what we learn to fear). In the second stage, it is learned that the fear can be avoided by avoiding the conditioned stimulus. Unfortunately, this avoidance learning has shown evidence in rats that avoidance results in a harder time of getting to the point of extinction to whatever was classically conditioned (Garcia, 2017). This means that by constantly avoiding our fear, we become increasingly less likely to rid ourselves of the fear in question.

Modeling, on the other hand, occurs when someone observes another person grappling with a phobia, and that fear then gets passed on to the observer. Another thing to consider is the power of word of mouth. Just being told that something is dangerous or threatening can plant the seed of fear in an individual’s mind. A study was done that found those that were classically conditioned, observationally taught, and instructionally (verbally) taught, all learned similarly which resulted in similar fear levels to the explicitly shown stimulus (Olsson & Phelps, 2004). This provides evidence that watching someone fear something can train us to fear said thing just as much as being classically conditioned to fear it.

Lastly, there’s the enigma of developing a fear with no direct reason. Although challenging to grasp, researchers suggest it might be a genetic evolutionary instinct (Milosevic & McCabe, 2015). This makes sense because the sources of our fears have gone through changes throughout generations with natural selection. We tend to fear things that were once threatening to our ancestors’ survival. That includes animals and heights, compared to things that are actually more dangerous to us in our current environments like motorcycles (Öhman & Mineka, 2001) or texting and driving. It is quite interesting to think about how we often fear less deadly things than what we are ok with. The fact that these less deadly things are associated with threats to survival of our ancestors is an intriguing observation that keeps the evolutionary perspective as a keystone in conversations of fear science.

But how does this fear response even come about? It all kicks off with a trigger, setting off a chain reaction of neuron to neuron communication all the way to the thalamus, a brain region that processes incoming information and relays it to the rest of the brain. The thalamus then rapidly shoots signals to the amygdala, another brain region that processes emotions like fear, anxiety, and anger. The communication between the thalamus and amygdala serves as a quick system to alert the individual of potential threats by increasing their sensitivity and awareness of their surroundings and said “threats”. However, the full picture comes in after the sensory cortex, the brain region that deals with our senses and perception of them, shares such information with the amygdala. The amygdala, in turn, signals the hypothalamus, triggering the autonomic nervous system. This system is responsible for automatic bodily functions linked to fear, like a faster heart and respiration rate. These physical responses resulting from the autonomic nervous system, prepare the body to react to the fear trigger by unleashing stress hormones—leading to the actions we take to confront our fears, whether it’s running, freezing, hiding, etc, also known as the fight or flight response.

While initially brushed off, phobias can significantly impact people’s well-being. Consider the case of white coat syndrome, where blood pressure readings spike at the doctor’s office due to a fear of medical professionals. This proves that there is some sort of phobia, and this could take a toll on one’s health as it may lead individuals to neglect important health concerns just to avoid interacting with a doctor. A national survey study conducted in the United States found that nearly 33% claimed to avoid doctor visits, even when they recognized the need for medical attention due to persistent symptoms or serious health conditions. Even more surprisingly, 17% of patients with rectal tumors delayed seeking evaluation for a year or more (Taber et. al, 2015). This kind of avoidance behavior, often driven by medical anxieties, not only poses a significant threat to individual health but also worsens intergenerational racial disparities in healthcare outcomes.

Efforts to address phobias have made strides in recent times. A recent study discovered that gradual exposure to the feared thing, as well as education on phobias and fear, exhibited promise in treating phobias in youth (Ollendick et. al, 2009). Technology, particularly virtual reality, has emerged as a powerful tool in phobia treatment. Virtual reality opens up a plethora of contexts that are challenging to replicate, such as simulating plane rides. This technology is harnessed to expose patients to their fears, mirroring the approach employed in the aforementioned study. Thanks to technological advancements, the virtual experience feels remarkably authentic for the patient, increasing the likelihood of treatment (Milosevic & McCabe, 2015).

In essence, phobias vary in their intensity, and navigating life with a phobia can be challenging and detrimental to one’s well-being. That’s why interventions such as gradual exposure, facilitated by advancements in technology, and neuroeducation, play a crucial role in assisting individuals to reclaim a sense of normalcy and control over themselves.

References

1. Garcia, R. (2017). Neurobiology of fear and specific phobias. Learning & Memory (Cold Spring Harbor, N.Y.), 24(9), 462–471. https://doi.org/10.1101/lm.044115.116 
2. Milosevic, I., & McCabe, R. E. (2015). Phobias : the psychology of irrational fear (1st ed.). Greenwood, an imprint of ABC-CLIO.
3. Öhman, A., & Mineka, S. (2001). Fears, Phobias, and Preparedness: Toward an Evolved Module of Fear and Fear Learning. Psychological Review, 108(3), 483–522. https://doi.org/10.1037/0033-295X.108.3.483
4. Ollendick, T. H., Öst, L.-G., Reuterskiöld, L., Costa, N., Cederlund, R., Sirbu, C., Davis, T. E., & Jarrett, M. A. (2009). One-Session Treatment of Specific Phobias in Youth: A Randomized Clinical Trial in the United States and Sweden. Journal of Consulting and Clinical Psychology, 77(3), 504–516. https://doi.org/10.1037/a0015158
5. Olsson, A., & Phelps, E. A. (2004). Learned Fear of “Unseen” Faces after Pavlovian, Observational, and Instructed Fear. Psychological Science, 15(12), 822-828. https://doi.org/10.1111/j.0956-7976.2004.00762.x
6. Taber, J. M., Leyva, B., & Persoskie, A. (2015). Why do people avoid medical care? A qualitative study using national data. Journal of general internal medicine, 30(3), 290–297. https://doi.org/10.1007/s11606-014-3089-1