updated 10/26/2007 6:56:06 PM ET 2007-10-26T22:56:06

Do you sweat at the thought of flying, giving a speech or even going to a party?

  1. Don't miss these Health stories
    1. Splash News
      More women opting for preventive mastectomy - but should they be?

      Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

    2. Larry Page's damaged vocal cords: Treatment comes with trade-offs
    3. Report questioning salt guidelines riles heart experts
    4. CDC: 2012 was deadliest year for West Nile in US
    5. What stresses moms most? Themselves, survey says

Join the club: Anxiety disorders — including specific phobias, obsessive-compulsive disorder and post-traumatic stress disorders — afflict 40 million Americans aged 18 and older (18% of that group), according to the 2005 National Co-Morbidity study, a mental health survey.

While fear is a natural (and practical) response to danger, phobias are exaggerated responses to situations that, in the cold light of day, aren't really all that dangerous. And yet they remain terribly difficult to overcome.

A big reason has to do with the way most people respond to fear — by avoiding it. Whether it's closed spaces or packed audiences, the more you duck those tough spots, the more you'll fear them.

"Catastrophic thoughts lead to fear, which leads to avoidance, which leads to more catastrophic thoughts," says Dr. Dennis Greenberger, psychologist and professor of clinical psychology at the University of California at Irvine. "It's a vicious cycle that exacerbates the fear over time."

One weapon is Cognitive Behavioral Therapy (CBT), a form of psychotherapy that involves changing behaviors and thoughts to overcome depression, self-loathing and fear. CBT proponents believe that bad feelings begin with bad thoughts; meet those head on, they say, and almost any fear can be tamed.

CBT has been around for decades but has become more popular among therapists in recent years. Unlike more traditional Freudian therapy, which is based on the notion that fear bubbles up from repressed childhood memories, CBT focuses on treating fears in the here and now by rewiring our perceptions of them.

One nice thing about CBT: no pills. Anti-anxiety drugs, most invented by Roche and mainly sold only on prescription, include various forms of benzodiazepines such as clonazepam, diazepam and lorazepam, as well as newer formulas like BuSpar and Xanax.

The trouble with taking pills is that, while they may alleviate anxiety for a short time, they don't really address the fear long term; worst case, they lead to dependency. The other problem, says Greenberger: Anti-anxiety medicines can limit the effectiveness of exposure-therapy (such as CBT) by altering the "phobic conditions."

Results from CBT can be speedy. Dr. Barbara Rothbaum, a psychologist at Emory University School of Medicine, says most phobias--even extreme ones--can be cured within several weeks or months. (As part of her treatment program, Rothbaum also uses virtual-reality computer technology to simulate real-life stressful scenarios.)

While you could shell out big bucks for a therapist to help you beat your fears, you can also give yourself a crash course in CBT.

The first step: drill down. You can't wrestle with fear if you don't understand what you are afraid of. Start asking some fundamental questions: What's the worst that can happen? What is the hard evidence that disaster will strike? How great will life look if I conquer this fear? This may sound easy, but when you're wracked with fear, even simple logic can be elusive.

Next: Line up your fears in order of acuteness. If you're claustrophobic, for example, perhaps taking a large and fast elevator is mildly frightening but sitting in a small room with no windows for 10 minutes is terrifying. List about 20 different situations and rank them from mildly annoying to downright debilitating.

Now comes the really scary part: putting yourself in all of those situations, starting with the easiest ones first and building up. Breathing exercises help, too.

Many therapists assign patients reading and often a workbook for charting their progress. For suggestions, check out the Anxiety Disorders of America Web site at

If you can, try tackling the items on your list for 10 to 30 minutes each day. Do that, says Greenberger, and you should see improvement within the month. If not, call in a pro.

Science notwithstanding, the CBT clan has one thing right: There's no need to make life scarier than it already is.

© 2012


Discussion comments


Most active discussions

  1. votes comments
  2. votes comments
  3. votes comments
  4. votes comments