Anxiety and Fear
People run into anxiety and fear in many different forms.  Whether this is a normal part of life, or becomes a controlling force that disrupts, depends partially on the intensity of the fear, partly on blood chemistry and genetics, and partly on whether you have learned skills that help you cope.

Fear is an emotion for which we have a spectrum of words based primarily on intensity.  Anxiety is a type of fear, and itself runs from a mild undercurrent to a full blown panic attack.  Fear ranges from low-level anxiety to terror.  Anxiety and fear are normal, and there is nothing wrong with feeling either.  Problems come when we attempt to push away fear, or make interpretations which spiral out of control, rather than recognizing fear as a legitimate emotion that comes and goes.

Often the best way to handle fear or any emotion is to let yourself be aware of what you are feeling, pay attention to your body, sensory perceptions and your thoughts.  You can think of your body like the banks of a river, and let the river of your fear simply run through you, without trying to obstruct the flow, or to over-react with your thoughts about the emotion.  Usually this will be enough – it may not be pleasant, but the fear will pass.  Sometimes that isn’t enough, and you can try the following two suggestions for handling fear.

To deal with anxiety or fear, one principle you can use is that generally fear lessens when you face into it.  Specifically, if you find yourself worrying or being anxious about something, look inside your thoughts and your emotions and rate the intensity of that worry on a scale of 1 to 10, with 1 being no anxiety, and 10 being absolute terror.  Then ask yourself “If what I’m most afraid of did happen, what would that be?”  For example, if you are a high school student, suppose you are worrying that your grades, outside activities and test scores aren’t going to be enough to get you into the college you want.  The answer to the fear outcome question might be, “I wouldn’t get into UC Berkeley.”  Then ask, if that happened, what is the worst thing I can imagine happening next?  “My parents would be ashamed of me and my friends would tease me.”  If that happened, what would be the worst thing that could happen?  “I might feel so much shame, I’d drop out of school.”  If what you were most afraid of then happened next, what would that be?  “I wouldn’t get a good job, and I wouldn’t want to live.”  “I might stop trying, and eventually I’d be homeless.”  “I wouldn’t survive out on the street, or I might kill myself.”  At this point, check out how you are thinking and feeling, and rate your worry again on that same 1 to 10 scale.  In most cases, I think you will find that the worry has diminished.  If you look at the specific situation for each of these steps, up until you are dead you’ll probably find that imagining that step would be unpleasant but not totally overwhelming, and the intensity of the fear goes down.  When we leave the fear vague and don’t follow it through to its absolute worst logical possibility, it has more power over us.  In other words, fear of the unknown is worse than fear of even unpleasant consequences.  This process also gives your rational self the chance to look more objectively at the likelihood of each step happening.  In the above example, it’s possible you won’t get into the college you want, but it’s less and less likely that the worst you can imagine would actually happen.  If you see that clearly, that also lessens anxiety.  You can do this process on any fear or anxiety.  It sometimes helps to have a friend keep asking the what would be the thing you are most afraid of happening next questions, and to speak the answers out loud.  Taking an internal state and speaking it out loud lets you see that internal state much more clearly.

Fear sometimes escalates into an anxiety or panic attack.  It is useful to know that anxiety and panic attacks usually follow the same pattern, and because of that you can interrupt this pattern before it reaches complete panic.  It can start at any of the three levels I’m going to describe, but from there, it usually moves in a spiraling loop through each level.  Let’s say that you have a thought that scares you.  “I think I’m going to stumble during this presentation and people are going to think I’m stupid.”  After you notice that thought, you feel anxious or afraid.  As that emotion goes through your body, there are physiological responses.  Typically your heart will beat faster, and you’ll breathe more shallowly.  When you become aware of your heart beating faster and your chest tightening, you have another thought – you think what’s going to happen next will be worse.  “I might faint and hurt myself when I fall.  I’ll be so embarrassed.”  What you felt as mild anxiety has now ramped up to fear and that emotion sweeps through your body.  This time, the physiological response includes adrenaline released into your body, and all the fight-or-flight autonomic nervous system responses (blood diverts from digestive processes to your brain; hormones are released that help with vigilance and muscle strength, etc.).  Your heart beats even faster, and you take very fast short breaths.  “Gosh, I think I’m having a heart attack.  I wonder if I’m going to make it.”  The fear is now terror, and the physiological symptoms are indeed the same as someone having a real heart attack.  This is why so many emergency rooms report that a significant percentage of people coming in convinced they are having a heart attack actually are experiencing panic attacks.  10% to 30% of people will experience at least one panic attack in their lifetime – this normally does not lead to panic disorder.  Do not avoid going to the emergency room if you ever suspect you are having a heart attack – it may be embarrassing to be told you are having a panic attack, but if it is a heart attack and you don’t get prompt treatment, there’s a good chance you won’t survive.

The good news about this cycle of anxiety or panic is that you can interrupt it at the physiological, emotional and mental levels, leaving you three points of leverage to stop this from spiraling out of control:  1) When you notice symptoms at any of the three levels, you can sit down, put your head down, and take long deep breaths or breathe through a paper bag.  This will slow your heart rate, keep you from hyperventilating by delivering less oxygen to your lungs, and make it less likely to pump adrenaline into your system. 2) You can also simply observe without judging the anxiety or fear that is going through you.  Notice in your body where and how you register the fear.  Approaching this with interest and letting it move through you tends to diminish the emotion – resisting the fear or hiding from it makes it stronger.  3) Probably the easiest place to interrupt the cycle is in your thoughts.  Recognizing that the pattern of looking into the future (even if it’s in the next few seconds) and expecting terrible outcomes is associated with increasing panic; when you experience yourself starting to do that, ask yourself if this negative outcome is true.  How do I know if it is true?  It’s likely that all of us have felt some of these kinds of thoughts and emotions, including the strongest fear, and have survived.  If you know that you have survived this once, it is likely that you will survive this time, too.  This can take the power out of expecting the worst, and then your attention can go to breathing, moment by moment, and getting through the fear one breath at a time.

In summary, often you can handle fear and anxiety on your own – they are normal emotions that run through all of us.  If anxiety or fear interferes with your ability to function effectively, at school, home or in your relationships, it will probably be useful to work for a time with a professional therapist.  Talking with friends, ministers or other religious resources, and family members (if they are accessible and willing) can also help.  If you get to the point where you think you are isolated and that no one cares, recognize that this is a dangerous time and keep asking for help until you find someone.