When Barbara Rothbaum crashed her bike on a hill and broke both her elbows a few years ago, she “needed to be her own therapist,” she says—luckily, she’s a clinical psychologist. Rothbaum was hesitant to hop back on the saddle after her injuries, but she knew had to face these feelings head-on and move past them.
Our evolutionary instincts can seed lingering fears after scary experiences like her crash, but this built-in system of danger avoidance is essential for our survival. Our ancient ancestors encountered myriad threats—from hungry crocodiles to deadly infections—so humans have evolved intricate physiological responses that keep us on our toes.
“We are hard-wired for fear,” says Rothbaum, a professor of psychiatry at Emory University School of Medicine in Atlanta. “We are animals, and we live in a dangerous world—that hard-wired system will help us survive.”
Similar defensive impulses are found in most mammal species, so dissecting rodents’ brains has allowed scientists to glean detailed insights on the neurological underpinnings of fear. Studies have also mapped people’s brain activity as they experience and work through fears in lab settings.
You need to ride out your fear in order to overcome it.
After sensing a threat, the human brain quickly kicks off a domino effect of responses throughout the body. The brain’s amygdala immediately dictates how we behave—squaring up with a foe, fleeing, or freezing, depending on our proximity to the threat, says Michael Fanselow, a psychologist at the University of California, Los Angeles. Our brain also revs up the nervous system and propels us to produce useful stress hormones such as adrenaline and cortisol. Our heart and breath rates shift, and blood flows toward our limbs to prepare for a tussle or quick escape.
But these responses can go haywire, leading to irrational and persistent fears—referred to as phobias—and conditions such as post-traumatic stress disorder. PTSD may be associated with reduced connectivity between the amygdala and prefrontal cortex, Fanselow says, and increased gray matter volume in the amygdala. Such changes can inhibit one’s ability to process fear in a healthy way.
Read more: "How Evolution Designed Your Fears”
Exposure therapies, the gold standard methods used by professionals to treat phobias and other conditions related to fear processing, can help people recover. In fact, you can conduct exposure therapy on your own, Rothbaum says, as long as the fear is mild and doesn’t interfere with your daily life. The key is to immerse yourself in the stimuli that triggered a given fear—whether it’s dogs, driving, heights, crashing a bicycle, or any other specific experience that makes you anxious. “When we avoid [these situations], we don’t get to see that the fear is not necessary—that the threat isn’t at the level that it feels like in our bodies,” Rothbaum says.
You need to ride out your fear in order to overcome it, she explains. She did that, quite literally, while biking, continuing to peddle as her panic spiked and eventually settled. If you’re fearful of dogs, for instance, you can spend time with a small, calm, well-behaved canine and wait for your distress to fizzle out.
Rothbaum and Fanselow also recommend escalating exposure in increasing doses—that might look like hanging out with larger dogs over time, riding down increasingly steep hills, or driving farther from home, depending on the given stimulus. Having loved ones present could make exposure therapy more effective, Fanselow says, based on past findings linking social support and fear inhibition.
“Fear in a truly dangerous situation is a good thing.”
It’s important to get professional help if “your life is compromised,” Fanselow says. “If you can’t do things you want or need to do, then you should seek therapy.”
Therapy is effective to address fears, Fanselow says. But in the long run, he has noted that it’s common for people’s longstanding or intense fears to return. Exposure therapy helps to develop a “safe” association with a certain stimulus, he says, but it tends to be limited to the specific context where people learn it, such as a therapist’s office. People still retain the “dangerous” association, which the mind may retrieve in other, non-controlled environments. To treat a fear of flying, for instance, Rothbaum says she used to accompany patients on actual flights—but this is often impractical.
Virtual reality exposure therapy is one way to help overcome this limitation. Rothbaum is a pioneer in the practice and has researched it for decades, including as a treatment for combat veterans with PTSD. Because virtual reality is highly customizable, Rothbaum says it can be used to mimic settings that would otherwise be difficult to visit. It can also serve as an especially useful stimulus for PTSD patients by enabling therapists to match the memories they describe. Scientists are also exploring whether exposure therapy can be enhanced with certain drugs, including hallucinogens, along with brain stimulation.
But it’s important not to be afraid of fear itself, Fanselow notes, and to keep the benefits in mind when it’s working as intended. “People should recognize that fear in a truly dangerous situation is a good thing,” he says. “These are biological systems that evolved to do something good for us.” Whether you encounter a grizzly in the woods, or perhaps a misbehaving Chihuahua, you have millions of years of evolution backing your next move. 
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Lead image: Wikimedia Commons
