What Are You Afraid Of? A Guide to Dealing with Your Worst Fears
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What Are You Afraid Of? A Guide to Dealing with Your Worst Fears

Everyone has fears and phobias. But are yours normal -- or not? We asked experts to weigh in with a diagnosis.

The Roots of Our Fears

During these tough times you may feel as though you've lost some of your coping skills, allowing your concerns, quirks, and strange little habits to bubble to the surface. If you're not careful, you can even end up worrying about your worry. But take heart: Whatever you're feeling or doing, someone else is, too. We promise. Probably a lot of people. And getting your fears out in the open is the first step to understanding and, ultimately, conquering them. So we ran some common scenarios by top experts for their big-picture advice.

"Lately I'm increasingly reluctant to go out. It's just more safe and comfy to stay home. My husband's worried about me, but what's the big deal?"

Clear distinctions between normal behavior (I prefer to stay home) and ones that require professional help (I can't leave home) are often hard to find. But one bold indicator is what the people who love you think. Your husband's worry is a red flag. At the very least, it'd be worth asking what concerns him -- and really listening to what he has to say.

As to what's the root cause, there are two possibilities depending on your answer to the question, "What's unsafe about going outside?" Is there a specific place out there you're avoiding? Could it be something bad that happened to you recently: a traumatic experience at work, a car accident? Identifying that and addressing the problem with the help of your husband or a therapist could really help, says psychiatrist Jennifer Yashari, MD, a clinical instructor at UCLA.

If everything beyond your door seems dangerous, you may have agoraphobia, or fear of crowded public or vast open spaces. For many people the real fear is having a panic attack in a public space where they have no control. This can be a serious and debilitating problem and you should see a therapist to discuss treatment options.

"I can't sleep. I worry about us losing our jobs, losing the house, not being able to pay for our kids' college. How I can get some peace -- and some rest?"

First, don't beat yourself up for worrying. We've been barraged by bad economic news for months and months -- of course you're worried! "But recognize that those endless reports of bad news can make it easy to go from having healthy concerns (I could lose my job and should consider other possible ways to make money) to psychologically creating your own catastrophic future (I am going to lose everything!)," says Amanda Baten, PhD, a clinical psychologist in New York City.

Dr. Baten suggests you ride the "what-if" train. What if you do lose your job? Well? (A) the earth won't implode, and (B) you can probably figure out a way to survive -- such as doing consulting work, learning new job skills, changing fields, or even moving in with your mom and dad. Having a contingency plan can pull you out of the panic trap.

If you've lost sleep over these worries for a long time, however, it could be something more serious, says Dr. Yashari. Ask yourself: Are you consumed by this for hours a day? Is it impairing your work or relationships? Do you also have any physical symptoms, such as shortness of breath, sweating, muscle tension, or panic attacks? Even one little "yes" to any of those questions means you should talk to a doctor. You may have a generalized anxiety disorder. The right treatments could make a world of difference, offering both the peace and the rest you deserve.

More Common Fears

"I blush and my heart races if anyone pays attention to me; even when a waiter takes my order, or my boss asks me a question. I'm afraid I'll say or do the wrong thing."

Regular old shyness usually happens when you're in a "first-time" situation; familiarity allows it to evaporate. This is different, since your anxiety is affecting the quality of many realms of your life. You may have what's called social anxiety disorder. For that doctors recommend a combination of cognitive behavioral therapy with a psychologist or psychiatrist and an anti-anxiety medication. The therapy will get at the root cause of how this anxiety developed and it will help you see that you're far less likely to embarrass yourself than you think -- and that even if you do it's not as disastrous as you've imagined.

"I've been asked to speak at a big meeting and now I'm terrified. How I can I conquer this fear and keep my job?"

Actually, you don't have to "conquer" it. This is run-of-the-mill performance anxiety and, unless they have ice in their veins, all podium jockeys have felt it at some point. The goal is simply to work with it. "Accepting this kind of anxiety as part of life is a very valuable lesson," says Dr. Yashari. "The key is to tolerate it and keep it under control." There's a reason actors and musicians and other performance artists rehearse: You see in a low-stakes setting that you can do it. And it becomes almost automatic so fear can't shut you down.

Practice with PowerPoint, if you're using it. Make note cards and do a run-through three or four times so you become comfortable with the presentation. Memorize your opening five sentences; say them over and over to every family member who will listen to you. That way you won't falter in the first minute and you'll feel confident right off the bat. If you need more help, consider professional training, through Toastmasters International or with a public-speaking coach.

After you're off to a good start, just focus on the material. You know it. And while you're at it, also focus on the fact that your boss picked you. Kudos!

"I go nuts if there's a bug in my house. I'd have a nervous breakdown if I found bedbugs or saw a mouse. Is this normal?"

In one sense it is very normal -- instinctual, in fact. "Fear of insects, snakes, and rodents is found even in young chimps, probably as an evolved protection against disease or injury," says Nando Pelusi, PhD, a psychologist in private practice in New York City. In another sense it is a little nuts, but in a common way. You're dreaming up your own self-fulfilling horrifying scenario. By saying you'd have a nervous breakdown, you make it so by telling your brain to shut down the functions that help you make good decisions. "Try rephrasing to, 'If I find bedbugs, or a mouse, I won't like it but I'll deal with it,'" says Dr. Baten. "See how your victimized thoughts turn to ways to solve the problem."

For people with verified phobias (and you may have one), this power of positive thinking can help but it can be challenging. You might consider a form of therapy called (it's a mouthful) progressive systematic hierarchical desensitization. You'll sit with a therapist and imagine a series of scenarios, starting with the easiest or safest feeling and going on to the hardest, which, in your case, may be critters crawling on you while you sleep. Along the way the therapist will help you learn how to handle it.

How to Deal

"I have a total phobia about throwing up. I can't go near vomit. I'm pregnant and don't know how I'm going to handle motherhood because babies throw up, right?"

First of all, you're not bonkers. You just have emetophobia, from the Greek word emesis for "vomit." You can find information and kindred spirits at the International Emetophobia Society web site, emetophobia.org. You can even help them compile a database of movies, starting with Alien, that emetophobes should avoid seeing.

Now, more practically, what can you do to prepare for your imminent bundle of burp-ups? "You're going to have to accept it," says Dr. Yashari, who specializes in helping new mothers and has had several patients with this worry. "Our brain helps us naturally get used to things. Every time the baby throws up it'll get a little easier to deal with." You also need to realize that you've never dealt with this phobia with your own baby and that mothers are hardwired to care for their sick children. Have some faith in your maternal instinct. Your baby's welfare will trump your fears.

"Whenever I feel nervous I pick my cuticles until they bleed. I know this is disgusting, but I can't stop. Am I crazy?"

Lots of people pick cuticles, bite nails, or twirl hair, so "am I crazy" is not the right question. The right question is, Do I need help? The answer is a definite yes. Idly picking at your dry cuticles from time to time is one thing, but making several fingers bleed every time you're stressed out is something else. You are hurting yourself, and you should see a doctor to find out why you're doing it.

You would think this would have a single cause. But the human psyche is so complex that our experts see three possible diagnoses. The first is anxiety -- it's a classic nervous habit. The second is a compulsive disorder, commonly defined as having three components: tension that builds to a need to do something; immense relief upon giving in to the compulsion; then guilt or disgust, or both, for having done it -- a rather cruel psychic whiplash.

The third, most serious possibility is self-mutilation. Attacking your cuticles is not that different from pulling out your eyelashes or cutting yourself. It's a symptom of crushingly low self-esteem or distress, says Gary Felton, PhD, a clinical psychologist in Los Angeles. "The psychology is, if I make myself bleed, then I must exist. There's a me in here somewhere, so I'm not truly worthless or of no value." Therapy for this is deep and longstanding. Please go see a doctor. Homing in on the right diagnosis is critical. And you can't do it by yourself.

"My mother is in her 80s and lives alone and I worry nonstop about her dying. It's terrible but I have to be prepared for it, yes?"

Death is one of life's toughest chapters, and fearing the loss of a parent is built into our nature, says Dr. Pelusi. There's no denying that your mom is getting older and will, of course, die. But rather than just worrying about your impending loss, let the reality of the situation bring you closer together in new ways, suggests Dr. Felton. Encourage your mom to talk about her feelings and her fears, what she still wants to accomplish, and what still makes life fun for her. And don't let your fears interfere with spending quality time together. "One of the most important things I try to do for people is help them live in the present," Dr. Felton says. Do something fun with your mom, and make the best of however much time you have left together. May it be many happy years.

Originally published in Ladies' Home Journal, September 2009.

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